Florid hyperaemia arising in ALT free flaps harvested from old skin graft donor sites
- PDF / 148,894 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 25 Downloads / 178 Views
LETTER TO THE EDITOR
Florid hyperaemia arising in ALT free flaps harvested from old skin graft donor sites Kieran T. Power & Banan Osman & Kelvin Ramsey
Received: 20 January 2013 / Accepted: 16 March 2013 # Springer-Verlag Berlin Heidelberg 2013
Sir, We would like to highlight two cases of localized hyperaemia arising in antero-lateral thigh (ALT) free flaps harvested from previously healed split thickness skin graft donor sites. The vascular changes led to concerns about possible flap perfusion compromise, with the increasing popularity of the ALT free flap, we thought it's important to document this phenomenon and suggest possible aetiology. A 52-year-old gentleman presented for management of recurrent Merkel cell carcinoma arising from his left calf. After an extensive resection, a free ALT flap was used to reconstruct the defect. The flap was based on two septocutaneous perforators, and the skin paddle was harvested from a part of a thigh which incorporated a 6-month-old healed skin graft donor site. There was no obvious discoloration of the donor site prior to raising the flap. On the first post-operative day, the flap developed an area of florid hyperaemia with epidermolysis corresponding exactly to the site of the previous split skin graft harvest (Fig. 1). Despite normal capillary refill and patent Doppler signals, these clinical signs gave a reason for concern that there may be an intraflap perfusion issue. An ultrasound showed a possible small collection beneath the flap and we were then faced with the dilemma whether to explore a flap, which was clearly well perfused, albeit segmentally discoloured. After some consideration, we chose to explore the flap to rule out possible compression by haematoma or kinking of the distal perforator. At exploration, in theatre, the anastomoses were found to be patent and both perforators had good venous and arterial flow. Also, there was slow pink bleeding from all areas of K. T. Power : B. Osman (*) : K. Ramsey Royal Marsden NHS trust, London, UK e-mail: [email protected]
the flap. Only a small haematoma was found, not correlating with the observed hyperaemia. The hyperaemia intensified in the subsequent days particularly when the patient started to mobilise. It then regressed and healed over a period of 3 weeks prior to commencement of radiotherapy (Fig. 2). A 59-year-old gentleman presented for management of a recurrent myxoinflammatory fibroblastic sarcoma of the right medial ankle. After definitive resection, a free ALT flap based on a single musculocutaneous perforator was used for reconstruction. The skin paddle incorporated a small area of 3-month-old split thickness skin graft donor site. Again, there was no obvious discolouration of the skin graft donor site prior to raising the free flap. We observed similar changes in this area of the flap postoperatively (Fig. 3). We were reassured by our previous experience and the flap healed in a similar manner. To our knowledge, there are no previous reports of this phenomenon in the literature. In the past de
Data Loading...
