Experience with Transplantation of Composite Tissues by Means of Microsurgical Vascular Anastomoses: I. Indications, Techniques and Early Results

The clinical experience with 65 transplantations of composite tissues by means of microsurgical vascular anastomoses is reported with emphasis on indications, operative techniques, vascular complications and soft tissue healing. Donor tissues, comprising 28 latissimus dorsi flaps, 20 groin flaps, 2 saphenous flaps, 4 fibular flaps, 9 dorsalis pedis artery flaps and 2 second toes, 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. The reconstruction failed in 3/65 (5%) cases due to vascular thrombosis at the anastomotic sites. Early circulatory impairment (less than 1 week postoperatively) in the transplanted tissues was seen in 16/65 (25%) cases, thirteen of which were successfully managed by evacuation of a haematoma (9) and/or by resection of the anastomotic site and reconstruction of vascular continuity (5). Late circulatory impairment (greater than 1 week postoperatively) secondary to local infection was seen on 2 occasions and resulted in total loss of one flap. In one case persistent posttraumatic ostitis resulted in partial loss of a flap necessitating further reconstructive attempts. Altogether the reconstructive attempt failed in the early postoperative period (less than 3 months) in 5 cases (8%). It is concluded, that difficult reconstructive problems may be solved in a single stage using microsurgical composite tissue transplantation in patients who otherwise would have faced prolonged multistaged reconstructions and/or major limb amputations. Microsurgical composite tissue transplantation has widened the possibilities of reconstructive surgery and seems to be a reliable method, at least as safe as conventional reconstructive flap procedures.