Causes Analysis And Countermeasures Of Failed Axial Pattern Flap Surgery

Objective: The causes leading to the failure of flap surgery weresummarized in order to improve the successful rate of such surgery.Methods: Three types of flap including dorsal interosseous forearmflap,sural neurovascular flap and anterolatera thigh flap were included inthis group.889cases which implemented from Sep,1997to Sep,2012inour department were included in this research.The skin necrosis areamore than half flap was considered failure,total45cases were consideredfailure in this group.The retrospective analysis was used to summarize thecauses leading to the failure of the flap.Results:6of349cases of dorsal interosseous forearm flap,19of254cases of sural neurovascular flap and20of286cases of anterolateralthigh flap were diagnosed failure. The direct cause according to bloodsupply can be divided into arterial crisis and venous crisis,in this group,25cases were arterial crisis,20cases were venous crisis. Specific reasonscan be divided into the following categories:(1) improper flap design: atotal of9cases, including2cases dorsal interosseous forearm flap,4cases sural neurovascular flap,3cases free anterolateral thigh flap.(2)vascular variation: a total of7cases, including1cases dorsal interosseousforearm flap,3cases sural neurovascular flap and3cases freeanterolateral thigh flap.(3) infection causes vascular spasm, blocking: atotal of6cases, including1cases dorsal interosseous forearm flap,1cases sural neurovascular flap and4cases free anterolateral thigh flap.(4)the body hypercoagulable state: a total of2cases, both free anterolateralthigh flap.(5) improper handling of vascular pedicle: a total of13cases,including1cases dorsal interosseous forearm flap,9cases sural neurovascular flap and3cases free anterolateral thigh flap.(6) improperpostoperative care: a total of8cases, including1cases dorsalinterosseous forearm flap,2cases sural neurovascular flap and5casesfree anterolateral thigh flap.Conclusions:(1) In the pedicled skin flap surgery, main cause ofoperation failure is arterial crisis, In the free skin flap surgery, main causeof operation failure is venous crisis.(2) when design the flap, we mustCorrect posture and abide by the principle of the points, lines, surfaces ofthe flap to prevent deviation from the axis and excessive cut of flap; whencut the flap,we must pay more attion to prevent the deep fascia and theflap separation.(3) When do flap surgery on the serious pollution orlong-term infection of the wound,we should be thorough debridement, orthe flap operation will be failed because of the vascular embolizationcaused of tissue infection.(4) before do flap surgery on some specialpatients, such as severe trauma or long-term heavy smokers, and on somespecial wounds,such as scar and long-term infection,we must fullyevaluate the vascular conditions of the patient.(5) we must pay moreattion to deal with the pedicle of the flap. To avoid dysfunction of bloodsupply caused by the pressure of the pedicle of the flap. so we should beavoid the excessive torsion of the pedicle of the flap,and we should bestrict hemostasis to avoid the hematoma formation.In addition, in thenursing after operation,we must keep the patient maintaining the correctposition and avoid tight wrap.