• Alexander Meyer, Raymund E Horch, Elisabeth Schoengart, Justus P Beier, Christian D Taeger, Andreas Arkudas, and Werner Lang.
• Department of Vascular Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany. Electronic address: alexander.meyer@uk-erlangen.de.
• J Plast Reconstr Aesthet Surg. 2016 Apr 1; 69 (4): 545-53.

PurposeFree flap transplantation to vascular reconstructions as arteriovenous (AV) loops has been established in centers as a feasible therapeutic option for defect reconstruction in the absence of proper recipient vessels, caused by oncologic resections, radiation, or trauma. We report our 10-year experience in free flap transplantation after vascular reconstruction with special emphasis on complication rate and postoperative mobility.Patients And MethodsForty-seven patients (mean age: 60 years, range: 19-86) were included. Defect etiology was posttraumatic in 19 patients; 14 defects were due to oncological resections and seven sternal osteomyelitis; three patients presented with radiation ulcers, two with aseptic femoral head necrosis, and one with defects caused by acne inversa and hip joint prosthesis infection. Long-term follow-up was 45 months (range: 0-126). We performed arterial revascularization with 36 AV loops, eight bypass grafts, and three venous interposition grafts. Subsequent tissue transfer comprised 24 latissimus dorsi, two vastus lateralis, one gracilis, one anterior lateral thigh (ALT), 16 rectus abdominis, one radialis forearm, and two osteocutaneous vascularized fibula flaps.ResultsComplications occurred in 25/47 patients (53%). Early complications included five acute occlusions of arterial reconstructions and six major bleedings. There were six flap losses and three major amputations. Two in-hospital deaths were observed (4%). Overall survival accounted for 89.0 and 74.7% after 1 and 5 years, respectively.ConclusionThe 5-year survival rate in long-term follow-up is favorable, despite an initially elevated complication rate. Successful defect coverage can be achieved by this method in a high percentage of patients.Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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