Pedicled Flaps Versus Free Flaps for Back Reconstruction

Sho Komagoe, Toshiyuki Watanabe, Seiji Komatsu, Yoshihiro Kimata

Research output: Contribution to journalArticle

Abstract

Background Back reconstructions using a flap are relatively rare, and clinical reports on such reconstructions are few. We analyzed whether a pedicled flap or free flap was best for treating back defects and established a simplified algorithm for flap selection. Methods We retrospectively analyzed the cases of 22 patients who underwent flap reconstructions for the back between July 2000 and August 2016. We extracted data on the operative time, defect size, patients' height and body weight, and reoperation, and each defect size was calculated as a percentage in relation to the body surface area (BSA). We compared these values between both flap types using univariate analysis. In addition, reconstructions using pedicled flaps were classified as single pedicled flap and combination pedicled flap reconstructions. The reasons for reoperation were also reviewed. Result Seventeen patients underwent reconstructions using pedicled flaps, and 5 patients underwent reconstructions using free flaps. The operative time and the percentage of defect size in relation to the BSA were significantly lower when using pedicled flaps than when using free flaps (P = 0.002, P = 0.046, respectively). There was no significant difference in terms of the rate of reoperation (P = 0.16) between the 2 types of reconstructions. The operative time was also significantly shorter when using combination pedicled flaps than when using free flaps. However, there was no significant difference in terms of the percentage of defect size in relation to the BSA between combination pedicled flaps and free flaps. Reoperation was necessary because of flap necrosis in pedicled flaps and skin graft necrosis in free flaps. Conclusions Our results demonstrated that pedicled flaps should be the first choice for back reconstruction, independent of the defect size, reoperation rate, and reason for reoperation. This is because the operation time required is significantly lower, which benefits patients and surgeons. Free flaps can be used when pedicled flaps cannot be used efficiently.

Original languageEnglish
Pages (from-to)702-707
Number of pages6
JournalAnnals of Plastic Surgery
Volume81
Issue number6
DOIs
Publication statusPublished - Dec 1 2018

Fingerprint

Surgical Flaps
Free Tissue Flaps
Reoperation
Body Surface Area
Operative Time
Necrosis
Body Weight

Keywords

  • Back reconstruction
  • defect size
  • free flap
  • pedicled flap

ASJC Scopus subject areas

  • Surgery

Cite this

Pedicled Flaps Versus Free Flaps for Back Reconstruction. / Komagoe, Sho; Watanabe, Toshiyuki; Komatsu, Seiji; Kimata, Yoshihiro.

In: Annals of Plastic Surgery, Vol. 81, No. 6, 01.12.2018, p. 702-707.

Research output: Contribution to journalArticle

@article{806c1170922d414db78c89ecd0f8e3c0,
title = "Pedicled Flaps Versus Free Flaps for Back Reconstruction",
abstract = "Background Back reconstructions using a flap are relatively rare, and clinical reports on such reconstructions are few. We analyzed whether a pedicled flap or free flap was best for treating back defects and established a simplified algorithm for flap selection. Methods We retrospectively analyzed the cases of 22 patients who underwent flap reconstructions for the back between July 2000 and August 2016. We extracted data on the operative time, defect size, patients' height and body weight, and reoperation, and each defect size was calculated as a percentage in relation to the body surface area (BSA). We compared these values between both flap types using univariate analysis. In addition, reconstructions using pedicled flaps were classified as single pedicled flap and combination pedicled flap reconstructions. The reasons for reoperation were also reviewed. Result Seventeen patients underwent reconstructions using pedicled flaps, and 5 patients underwent reconstructions using free flaps. The operative time and the percentage of defect size in relation to the BSA were significantly lower when using pedicled flaps than when using free flaps (P = 0.002, P = 0.046, respectively). There was no significant difference in terms of the rate of reoperation (P = 0.16) between the 2 types of reconstructions. The operative time was also significantly shorter when using combination pedicled flaps than when using free flaps. However, there was no significant difference in terms of the percentage of defect size in relation to the BSA between combination pedicled flaps and free flaps. Reoperation was necessary because of flap necrosis in pedicled flaps and skin graft necrosis in free flaps. Conclusions Our results demonstrated that pedicled flaps should be the first choice for back reconstruction, independent of the defect size, reoperation rate, and reason for reoperation. This is because the operation time required is significantly lower, which benefits patients and surgeons. Free flaps can be used when pedicled flaps cannot be used efficiently.",
keywords = "Back reconstruction, defect size, free flap, pedicled flap",
author = "Sho Komagoe and Toshiyuki Watanabe and Seiji Komatsu and Yoshihiro Kimata",
year = "2018",
month = "12",
day = "1",
doi = "10.1097/SAP.0000000000001590",
language = "English",
volume = "81",
pages = "702--707",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Pedicled Flaps Versus Free Flaps for Back Reconstruction

AU - Komagoe, Sho

AU - Watanabe, Toshiyuki

AU - Komatsu, Seiji

AU - Kimata, Yoshihiro

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background Back reconstructions using a flap are relatively rare, and clinical reports on such reconstructions are few. We analyzed whether a pedicled flap or free flap was best for treating back defects and established a simplified algorithm for flap selection. Methods We retrospectively analyzed the cases of 22 patients who underwent flap reconstructions for the back between July 2000 and August 2016. We extracted data on the operative time, defect size, patients' height and body weight, and reoperation, and each defect size was calculated as a percentage in relation to the body surface area (BSA). We compared these values between both flap types using univariate analysis. In addition, reconstructions using pedicled flaps were classified as single pedicled flap and combination pedicled flap reconstructions. The reasons for reoperation were also reviewed. Result Seventeen patients underwent reconstructions using pedicled flaps, and 5 patients underwent reconstructions using free flaps. The operative time and the percentage of defect size in relation to the BSA were significantly lower when using pedicled flaps than when using free flaps (P = 0.002, P = 0.046, respectively). There was no significant difference in terms of the rate of reoperation (P = 0.16) between the 2 types of reconstructions. The operative time was also significantly shorter when using combination pedicled flaps than when using free flaps. However, there was no significant difference in terms of the percentage of defect size in relation to the BSA between combination pedicled flaps and free flaps. Reoperation was necessary because of flap necrosis in pedicled flaps and skin graft necrosis in free flaps. Conclusions Our results demonstrated that pedicled flaps should be the first choice for back reconstruction, independent of the defect size, reoperation rate, and reason for reoperation. This is because the operation time required is significantly lower, which benefits patients and surgeons. Free flaps can be used when pedicled flaps cannot be used efficiently.

AB - Background Back reconstructions using a flap are relatively rare, and clinical reports on such reconstructions are few. We analyzed whether a pedicled flap or free flap was best for treating back defects and established a simplified algorithm for flap selection. Methods We retrospectively analyzed the cases of 22 patients who underwent flap reconstructions for the back between July 2000 and August 2016. We extracted data on the operative time, defect size, patients' height and body weight, and reoperation, and each defect size was calculated as a percentage in relation to the body surface area (BSA). We compared these values between both flap types using univariate analysis. In addition, reconstructions using pedicled flaps were classified as single pedicled flap and combination pedicled flap reconstructions. The reasons for reoperation were also reviewed. Result Seventeen patients underwent reconstructions using pedicled flaps, and 5 patients underwent reconstructions using free flaps. The operative time and the percentage of defect size in relation to the BSA were significantly lower when using pedicled flaps than when using free flaps (P = 0.002, P = 0.046, respectively). There was no significant difference in terms of the rate of reoperation (P = 0.16) between the 2 types of reconstructions. The operative time was also significantly shorter when using combination pedicled flaps than when using free flaps. However, there was no significant difference in terms of the percentage of defect size in relation to the BSA between combination pedicled flaps and free flaps. Reoperation was necessary because of flap necrosis in pedicled flaps and skin graft necrosis in free flaps. Conclusions Our results demonstrated that pedicled flaps should be the first choice for back reconstruction, independent of the defect size, reoperation rate, and reason for reoperation. This is because the operation time required is significantly lower, which benefits patients and surgeons. Free flaps can be used when pedicled flaps cannot be used efficiently.

KW - Back reconstruction

KW - defect size

KW - free flap

KW - pedicled flap

UR - http://www.scopus.com/inward/record.url?scp=85056403936&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056403936&partnerID=8YFLogxK

U2 - 10.1097/SAP.0000000000001590

DO - 10.1097/SAP.0000000000001590

M3 - Article

VL - 81

SP - 702

EP - 707

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 6

ER -