Use of Skin Substitute to Facilitate Tension-Free Closure Over the Vascular Pedicle and Free Flap in Lower Extremity Reconstruction

Introduction

Free tissue transfer to the lower extremity are often challenging cases, as the lack of local tissue laxity and convex surface of the lower extremity can lead to pedicle compression after inset. Methods exist to lessen this risk of compression, including additional free tissue transfer, local tissue rearrangement, and skin grafting. We hypothesize that one cause of venous thrombosis and flap failure is excessive pressure over the flap and vascular pedicle. Veins could collapse from postoperative swelling after primary closure, causing impaired blood flow dynamics and elevating the risk of flap loss if not recognized. This study describes the use of skin substitutes to facilitate a tension-free closure over the vascular pedicle and around the flap.

Methods