8.0: Thursday, March 17, 2005

Occult Vascular Injury After Orthopedic Procedures in Lower Extremity Free Flaps

Jennifer Newman Keagle, MD, Shelly Marder, MD, Geoff Hastings, MD, Theodore Miclau, MD, and David Young, MD.

PURPOSE: Occult iatrogenic vascular injury from orthopedic procedures in patients with lower extremity trauma influences microvascular free tissue transfers.

METHODS AND MATERIALS: All patients undergoing free tissue transfer procedures for lower extremity trauma (1999-2003) had arteriograms reviewed by two interventional radiologists.

RESULTS: Preoperative arteriograms and free tissue transfers were performed on 35 patients. Abnormal arteriograms were found in 24 cases but records could only be obtained on 15. Iatrogenic injury from the orthopedic procedure was found in 3 cases (20%) and the remaining abnormal findings were due to fracture (53%), congenital (13%) and indeterminate (13%). Fifteen free flaps were performed on 14 patients with loss of one flap (success rate =94%). Overall complication rate was 20%. The operative plan was altered based on the angiographic findings in all patients including those with iatrogenic injury. In the 3 cases of iatrogenic injury, 2 had successful free flaps and one was aborted due to insufficient recipient vessels.

CONCLUSIONS: It is important to recognize that iatrogenic injury to vessels occurs in the course of orthopedic repair of traumatic lower extremity fractures. Arteriograms are important in preoperative planning and careful attention needs to be paid to the results.