gms | German Medical Science

Objectives/Interrogation: The advances of reconstructive microsurgery in orthopaedic surgery provided better functional and aesthetic results and prevented many indications of amputations. The indications of free flaps for the treatment of traumatized extremity is increasing, including, open wounds, long bone defects, muscle impairment after brachial plexus injuries, reconstruction of pinch with toe to hand transfer, among others. The combination of treatment are described as orthoplastic and early transference for centres for combined treatment is recommended in literature. We describe an orthopaedic microsurgery group with residency performing free flaps for orthopaedic injuries with indications and evaluating predictors factors influencing free flaps outcomes in musculoskeletal system.

Methods: From July 2014 to July 2018, patients undergoing microsurgical free flaps were consecutively included in this cross-sectional study. Data regarding personal medical history, intraoperative microsurgical procedure and laboratory tests were collected. Complications and free flap results were observed during follow-up.

Results and Conclusions: A total of 128 flaps in 126 patients were evaluated. The mean age was 34.8 years with 103 male patients. The most frequent cause of the musculoskeletal defect was traumatic in 79 patients (61,7%), followed by brachial plexus injury in 34 patients. Complications of type III Clavien-Dindo Classification were observed in 42 microsurgical flaps. Seven cases (5.5%) had partial loss of the flap. Twelve cases progressed to total loss of the flap (9.4%). The overall success rate of the microsurgical flaps was 90.6%. In the multivariate analysis, the risk factors for complications were: ischemia time greater than or equal to 2 hours (p = 0,037), end-to-side arterial anastomosis (p = 0,021) and obesity (p=0,012). The indication of take-back flap to operative room was associated with a higher incidence of total loss (p <0,001). In the multivariate analysis, the independant risk factor for partial flap loss was the presence of thrombocytosis (p=0,004).The main indication of microsurgical flaps in orthopaedic surgery was trauma with complex wounds, followed by free functional muscle flap for brachial plexus injury and limb reconstruction after tumor resection We observed a statistically significant increase in complications in patients with ischemia time greater than 2 hours, obesity and end-to-side arterial anastomosis.