Reusing of the Failing Free Flap “Nutrient Flap” as Salvage Procedure

• Published in: Plastic and reconstructive surgery. Global open Vol. 2; no. 1; p. e93
• Main Authors: Takahashi, Koji, Hsieh, Ching-Hua, Jeng, Seng-Feng
• Format: Journal Article
• Language: English
• Published: United States American Society of Plastic Surgeons 01.01.2014; Wolters Kluwer Health; Wolters Kluwer
• Subjects: Ideas and Innovations
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000000026

A 26-year-old woman sustained a traffic accident injury to her left medial malleolus. A soft-tissue defect 15 × 7 cm with exposure of bone was found and underwent free anterolateral thigh flap to cover it. On the second postoperative day, venous congestion occurred and re-exploration was performed. Re-anastomosis of the vein was done after the thrombectomy; unfortunately, the flap did not recover. We found there was a good granulation bed under the failing flap and thinned the failing flap and used it as a full-thickness skin graft. The graft survived completely; 9 months later, the graft site was softer and of good texture. The patient can wear the same size shoes without a debulking procedure. The free flap provided nutrients to the raw surface and nurtured a good granulation bed while it survived for 50 hours; as a result, it was used as “the nutrient flap.” Reuse of the failing free flap as “the nutrient flap” is useful as an alternative backup procedure.