Sequential free tissue transfers for simultaneous upper and lower limb salvage

Ian L. Valerio, Jennifer Sabino, Adam Bevevino, Scott M. Tintle, Mark Fleming, Anand Kumar

Research output: Contribution to journalArticle

Abstract

Background: The Iraq and Afghanistan Wars have presented military reconstructive surgeons with a high volume of challenging extremity injuries. In recent years, a number of upper and lower extremity injuries requiring multiple tissue transfers for multiple limb salvages in the same casualty have been encountered. Our group will discuss the microsurgical challenges, algorithms, and success and complication rates for this cohort of war injured patients. Methods: All consecutive limb salvage cases requiring free flaps from 2003 to 2012 were reviewed. Cases involving simultaneous free tissue transfers were identified. Data collected included success rates and complications with comparisons made between the single and multiple free-flap limb salvage cohorts. Results: Seventy-four free flap limb salvage cases were performed over the 10-year period. Of these cases, four patients received two free flaps to separate upper and lower extremity injuries for limb salvage within a single operative setting. The complication rate was 63%, which was significantly higher than those cases in which a single microvascular anastomosis was performed (26%, p = 0.046). However, the higher complication rate did not increase the flap or limb salvage failure rates (p = 0.892 and 0.626). Conclusions: The last decade of war trauma has provided a high volume of extremity injuries requiring limb salvage procedures including casualties who underwent single and multiple free flap coverage procedures. Although multiple flap limb salvage procedures have a higher complication rate, they can be performed within the same patient without concern for increased failure rate in carefully selected and appropriately managed patients. © 2013 Wiley Periodicals, Inc. Microsurgery 33:447-453, 2013.

Original languageEnglish (US)
Pages (from-to)447-453
Number of pages7
JournalMicrosurgery
Volume33
Issue number6
DOIs
StatePublished - Sep 2013
Externally publishedYes

Fingerprint

Limb Salvage
Lower Extremity
Free Tissue Flaps
Wounds and Injuries
Extremities
Afghanistan
Iraq
Microsurgery
Multiple Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Valerio, I. L., Sabino, J., Bevevino, A., Tintle, S. M., Fleming, M., & Kumar, A. (2013). Sequential free tissue transfers for simultaneous upper and lower limb salvage. Microsurgery, 33(6), 447-453. https://doi.org/10.1002/micr.22145

Sequential free tissue transfers for simultaneous upper and lower limb salvage. / Valerio, Ian L.; Sabino, Jennifer; Bevevino, Adam; Tintle, Scott M.; Fleming, Mark; Kumar, Anand.

In: Microsurgery, Vol. 33, No. 6, 09.2013, p. 447-453.

Research output: Contribution to journalArticle

Valerio, IL, Sabino, J, Bevevino, A, Tintle, SM, Fleming, M & Kumar, A 2013, 'Sequential free tissue transfers for simultaneous upper and lower limb salvage', Microsurgery, vol. 33, no. 6, pp. 447-453. https://doi.org/10.1002/micr.22145
Valerio IL, Sabino J, Bevevino A, Tintle SM, Fleming M, Kumar A. Sequential free tissue transfers for simultaneous upper and lower limb salvage. Microsurgery. 2013 Sep;33(6):447-453. https://doi.org/10.1002/micr.22145
Valerio, Ian L. ; Sabino, Jennifer ; Bevevino, Adam ; Tintle, Scott M. ; Fleming, Mark ; Kumar, Anand. / Sequential free tissue transfers for simultaneous upper and lower limb salvage. In: Microsurgery. 2013 ; Vol. 33, No. 6. pp. 447-453.
@article{ceb0db26a43c4286bf309bedabd4360b,
title = "Sequential free tissue transfers for simultaneous upper and lower limb salvage",
abstract = "Background: The Iraq and Afghanistan Wars have presented military reconstructive surgeons with a high volume of challenging extremity injuries. In recent years, a number of upper and lower extremity injuries requiring multiple tissue transfers for multiple limb salvages in the same casualty have been encountered. Our group will discuss the microsurgical challenges, algorithms, and success and complication rates for this cohort of war injured patients. Methods: All consecutive limb salvage cases requiring free flaps from 2003 to 2012 were reviewed. Cases involving simultaneous free tissue transfers were identified. Data collected included success rates and complications with comparisons made between the single and multiple free-flap limb salvage cohorts. Results: Seventy-four free flap limb salvage cases were performed over the 10-year period. Of these cases, four patients received two free flaps to separate upper and lower extremity injuries for limb salvage within a single operative setting. The complication rate was 63{\%}, which was significantly higher than those cases in which a single microvascular anastomosis was performed (26{\%}, p = 0.046). However, the higher complication rate did not increase the flap or limb salvage failure rates (p = 0.892 and 0.626). Conclusions: The last decade of war trauma has provided a high volume of extremity injuries requiring limb salvage procedures including casualties who underwent single and multiple free flap coverage procedures. Although multiple flap limb salvage procedures have a higher complication rate, they can be performed within the same patient without concern for increased failure rate in carefully selected and appropriately managed patients. {\circledC} 2013 Wiley Periodicals, Inc. Microsurgery 33:447-453, 2013.",
author = "Valerio, {Ian L.} and Jennifer Sabino and Adam Bevevino and Tintle, {Scott M.} and Mark Fleming and Anand Kumar",
year = "2013",
month = "9",
doi = "10.1002/micr.22145",
language = "English (US)",
volume = "33",
pages = "447--453",
journal = "Microsurgery",
issn = "0738-1085",
publisher = "Wiley-Liss Inc.",
number = "6",

}

TY - JOUR

T1 - Sequential free tissue transfers for simultaneous upper and lower limb salvage

AU - Valerio, Ian L.

AU - Sabino, Jennifer

AU - Bevevino, Adam

AU - Tintle, Scott M.

AU - Fleming, Mark

AU - Kumar, Anand

PY - 2013/9

Y1 - 2013/9

N2 - Background: The Iraq and Afghanistan Wars have presented military reconstructive surgeons with a high volume of challenging extremity injuries. In recent years, a number of upper and lower extremity injuries requiring multiple tissue transfers for multiple limb salvages in the same casualty have been encountered. Our group will discuss the microsurgical challenges, algorithms, and success and complication rates for this cohort of war injured patients. Methods: All consecutive limb salvage cases requiring free flaps from 2003 to 2012 were reviewed. Cases involving simultaneous free tissue transfers were identified. Data collected included success rates and complications with comparisons made between the single and multiple free-flap limb salvage cohorts. Results: Seventy-four free flap limb salvage cases were performed over the 10-year period. Of these cases, four patients received two free flaps to separate upper and lower extremity injuries for limb salvage within a single operative setting. The complication rate was 63%, which was significantly higher than those cases in which a single microvascular anastomosis was performed (26%, p = 0.046). However, the higher complication rate did not increase the flap or limb salvage failure rates (p = 0.892 and 0.626). Conclusions: The last decade of war trauma has provided a high volume of extremity injuries requiring limb salvage procedures including casualties who underwent single and multiple free flap coverage procedures. Although multiple flap limb salvage procedures have a higher complication rate, they can be performed within the same patient without concern for increased failure rate in carefully selected and appropriately managed patients. © 2013 Wiley Periodicals, Inc. Microsurgery 33:447-453, 2013.

AB - Background: The Iraq and Afghanistan Wars have presented military reconstructive surgeons with a high volume of challenging extremity injuries. In recent years, a number of upper and lower extremity injuries requiring multiple tissue transfers for multiple limb salvages in the same casualty have been encountered. Our group will discuss the microsurgical challenges, algorithms, and success and complication rates for this cohort of war injured patients. Methods: All consecutive limb salvage cases requiring free flaps from 2003 to 2012 were reviewed. Cases involving simultaneous free tissue transfers were identified. Data collected included success rates and complications with comparisons made between the single and multiple free-flap limb salvage cohorts. Results: Seventy-four free flap limb salvage cases were performed over the 10-year period. Of these cases, four patients received two free flaps to separate upper and lower extremity injuries for limb salvage within a single operative setting. The complication rate was 63%, which was significantly higher than those cases in which a single microvascular anastomosis was performed (26%, p = 0.046). However, the higher complication rate did not increase the flap or limb salvage failure rates (p = 0.892 and 0.626). Conclusions: The last decade of war trauma has provided a high volume of extremity injuries requiring limb salvage procedures including casualties who underwent single and multiple free flap coverage procedures. Although multiple flap limb salvage procedures have a higher complication rate, they can be performed within the same patient without concern for increased failure rate in carefully selected and appropriately managed patients. © 2013 Wiley Periodicals, Inc. Microsurgery 33:447-453, 2013.

UR - http://www.scopus.com/inward/record.url?scp=84883600515&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883600515&partnerID=8YFLogxK

U2 - 10.1002/micr.22145

DO - 10.1002/micr.22145

M3 - Article

C2 - 24006342

AN - SCOPUS:84883600515

VL - 33

SP - 447

EP - 453

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 6

ER -