Microsurgical free tissue transfer: a valuable reconstructive procedure--review of 75 cases.

A total of 75 cases of microsurgical composite tissue transfer to reconstruct defects of the head and neck, trunk, upper and lower extremities performed at the American University of Beirut Medical Center between January 1992 and December 1997 were evaluated in a retrospective study. There was a failure rate of 6.6% and a complication rate of 13.3%. Our results show that free tissue transfer can be considered as a safe and viable treatment option in a wide variety of clinical situations including early soft tissue coverage of complex extremity wounds, limb sparing procedures for malignant neoplasms, reconstruction of the head and neck area, treatment of chronic osteomyelitis, and finally reconstruction of the foot in patients with severe diabetic neuropathy and peripheral vascular disease. A brief discussion of the history of microvascular free tissue transfers as well as their value in modern reconstructive surgery is also presented.

Microvascular soft-tissue coverage and distraction osteosynthesis for lower-extremity salvage.

In our attempts to salvage massive lower-extremity injuries, even in the presence of severe peripheral vascular pathology, adequate soft-tissue coverage is no longer a limiting factor due to recent advances in microvascular composite tissue transfer. Restoration of tibial continuity without shortening has emerged as the last obstacle in the formidable task of salvaging lower extremities with grade III B and III C defects. Proposed solutions to this problem include conventional free cancellous bone-grafting applicable to small defects only, vascularized bone grafts, or shortening of the leg with subsequent elongation using the Ilizarov technique. We present our experience with 3 consecutive cases of lower-limb salvage, utilizing a new approach in which microsurgical soft-tissue reconstruction has been combined with bony reconstruction by distraction osteosynthesis. Bone transport by distraction osteosynthesis under a free flap performed while preserving the initial limb length throughout the treatment period proved to be superior to other methods in selected cases and is presented as a new technique for the management of problematic lower-limb injuries.