Experience with transplantation of composite tissues by means of microsurgical vascular anastomoses. II. Late results and comments.

Abstract

In a series of 65 composite tissue transplantations the results were evaluated 6-68 (median 28) months postoperatively. The donor tissues, comprising skin flaps (7), neurovascular skin flaps (2), musculocutaneous flaps (26), tendinocutaneous flaps (2), muscle flaps (2), osteocutaneous flaps (18), bone grafts (6), and digits (2), were transplanted to recipient sites in the head and neck area (18), upper extremity (8), torso (2) and lower extremity (37) in sixty-two patients with defects caused by traumata (45), tumor excisions (16) or congenital malformations (1) in which on average 3 therapeutic attempts had been unsuccessful. In 5 cases the reconstruction failed within the first two postoperative weeks while the reconstructed part was included in lower extremity amputations 6-24 months postoperatively in 3 cases. The intended purpose was achieved in 27/34 cases of soft tissue reconstruction, 3/3 cases of combined tendon and skin repair, 18/19 cases of combined skin coverage and bone reconstruction, 4/5 cases of segmental bone reconstruction, 2/2 cases of thumb reconstruction and in 2/2 cases of facial reanimation. In 21 cases of 37 lower extremity reconstructions a major amputation would have been the alternative. Four of these patients were in fact amputated above the knee (1) or below the knee (3). Altogether, the reconstructions were successful in 56/65 (= 86%) cases. It is concluded that difficult reconstructive problems, especially those related to head and neck surgery, orthopaedic surgery and hand surgery may be amenable to successful reconstruction using microsurgical composite tissue transplants with an expected success rate averaging 9 out of 10 cases.