Vacuum Assisted Closure After Free Flap Failure

Abstract

Background: Free tissue transfer is generally associated with high success rates, but failures do occur. Reported here is a multi-center experience on use of VAC (vacuum assisted closure) therapy after free flap failure. Methods: Twenty-seven patients with total or partial failure of free flaps were treated with VAC therapy in three plastic surgery units until obtaining a granulation tissue that would take a skin graft, contraction of the defect enabling reconstruction with a local/regional flap or preparation of the optimal conditions for another free flap. Results: The mean number of VAC sessions was 6.1. Seventeen of the defects were successfully reconstructed with skin grafts, two with local/regional flaps and one with another free flap. The rate of successful reconstruction with VAC was higher for the defects caused by trauma compared to postoncological and chronic wounds. Conclusion: Failure of a free flap decreases the motivation of both the patient and the surgical team, elongates the hospitalization period and increases the cost of the treatment. VAC therapy, although a long-lasting treatment modality, may eliminate the need for a second free flap. Even if the second free flap is inevitable, VAC is a unique alternative as a safer bridge for the succeeding free tissue transfer.