Persistence of Pedicle Blood Flow up to 10 Years after Free Musculocutaneous Tissue Transfer

The hypothesis of whether or not flap perfusion remains persistent through its vascular pedicle up to 10 years after free tissue transfer was tested. Since 1982, more than 1,000 free tissue transfers have been performed at this institution. Of these, 40 patients were selected with comparable posttraumatic soft-tissue defects of the lower leg and surgical repair by a latissimus dorsi myocutaneous free flap. All patients had a postoperative course free of complications. Measurements of flap perfusion were started in groups 1 through 4 (each 10 patients) 3 to 5 weeks, 5 to 7 months, 4 to 6 years, and 8 to 10 years after free tissue transfer, respectively. Quantitative measurements of local flap perfusion were performed by means of the hydrogen clearance technique (Ameda, Switzerland) at definite sites intracutaneously and subcutaneously within the flap's skin paddle as well as in the adjacent intracutaneous and subcutaneous skin of the surrounding soft tissue. Simultaneously, the vascular pedicle of the flap was visualized by a duplex scanner (Toshiba, Japan). In each group nine measurements were performed before (phase A), during (phase B), and after closing the pedicle (phase C) by manual compression. Each measurement took about 10 minutes. Statistical evaluation of the obtained values was achieved by the Mann-Whitney U test and the Wilcoxon signed rank test. Local flap perfusion showed no statistical differences for phase A and C in all four groups of patients. In phase B, however, a statistically highly significant (p < 0.01) absence of local flap perfusion was registered in all four groups at the site of the flap's skin paddle. No statistically significant alterations of intracutaneous and subcutaneous blood flow was found in the surrounding soft tissue. In our clinical-experimental setting, flap perfusion persisted by means of its vascular pedicle even 10 years after free tissue transfer. Our findings support the importance of an intact vascular pedicle for permanent flap survival after free tissue transfer.