Abstract

VICENTE-RUIZ, Miriam  and  HONTANILLA CALATAYUD, Bernardo. Complete superficial necrosis of a free muscle flap: an unusual complication. Cir. plást. iberolatinoam. [online]. 2021, vol.47, n.3, pp.305-308.  Epub Nov 01, 2021. ISSN 1989-2055.  https://dx.doi.org/10.4321/s0376-78922021000300011.

Although an abundant body of literature exists on complications of free flaps, the description of complete superficial necrosis occurring in free flaps is scarce.

Herein, we present a case of a post-traumatic foot reconstruction with a gracilis muscular free flap which postoperatively developed a thick dry black eschar covering its entire surface that suggested total flap loss. However, percutaneous doppler ultrasound of the flap pedicle maintained a lively tone, so an initial expectant management was decided. A delayed revision surgery was performed at day 21 with debridement of the eschar and superficial necrotic tissue uncovering underlying healthy flap tissue, which was skin-grafted. Subsequently, the flap showed good progress with good graft integration.

Although the exact cause for this complication was not identified in our patient, possible etiologies are discussed with a focus on tobacco as a major risk factor.

Keywords : Complete superficial necrosis; Flap complication; Free flap; Necrotic eschar; Tobacco.

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