Techniques in Lower Extremity Reconstruction with Supermicrosurgery

Lee,  Hee Jong; Kim,  Sung Chan; Kim,  Kyu Nam; Yoon,  Chi Seon; Hong,  Joon Pio

doi:2013.22.1.33

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Arch Hand Microsurg > Volume 22(1); 2013 > Article

Original Article

Journal of the Korean Society for Surgery of the Hand 2013;22(1):33-37.
Published online May 31, 2013.
DOI: https://doi.org/10.12790/jkssh.2013.22.1.33

Techniques in Lower Extremity Reconstruction with Supermicrosurgery

Hee Jong Lee*, Sung Chan Kim*, Kyu Nam Kim, Chi Seon Yoon, Joon Pio Hong*

¹Department of Plastic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
²Department of Plastic Surgery, Asan Medical Center, Seoul, Korea. joonphong@amc.seoul.kr

초미세수술을 이용한 하지재건의 기술적 고찰

, , , ,

¹
²

Received: 1 April 2013 • Revised: 1 May 2013 • Accepted: 4 May 2013

Abstract

Purpose: The concept and development of perforator free flaps have led to significant advances in microsurgery. Ongoing developments in perforator free flap surgery are aimed at reducing complications and improving surgical outcomes. The aim of this study was to evaluate the effectiveness and application of supermicrosurgery in free flap surgery.
Materials and Methods: A total of 267 patients with soft tissue defects of the lower extremity due to various etiologies from January, 2007 to January, 2013. The patients received either an anterolateral thigh free flap (n=83), a superficial circumflex iliac artery free flap (n=152), an upper medial thigh free flap (n=19), or a superior gluteal artery perforator free flap (n=13). Microanastomosis was performed using a perforator-to-perforator technique, either end-to-end or end-to-side.
Results: The mean postoperative follow up period was eight months (range: one to 16 months) and flap loss occurred in 11 cases out of 267. All cases of flap loss occurred within two weeks of surgery due to either arterial insufficiency (n=5) or venous congestion (n=6).
Conclusion: Supermicrosurgery enables the selection of the most efficient perforator for microanastomosis at the defect site. It also reduces the time required for dissection of recipient vessels, and reduces the possibility of injury to major vessels. Microsurgery using a vessel of less than 1 mm has been reported to increase the risk of flap failure; however, using the most advanced surgical tools and developing experience in the technique can produce success rates similar to those found in the literature.

Key Words: Supermicrosurgery, Limb salvation, Perforator free flap

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