Late avulsion of a free flap in a patient with severe psychiatric illness: Establishing a successful salvage strategy.

Details

Serval ID
serval:BIB_B8653D4C19E1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Late avulsion of a free flap in a patient with severe psychiatric illness: Establishing a successful salvage strategy.
Journal
Archives of plastic surgery
Author(s)
Schaffer C., Hart A., Watfa W., Raffoul W., Summa PGD
ISSN
2234-6163 (Print)
ISSN-L
2234-6163
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Post-traumatic defects of the distal third of the leg often require skipping a few steps of the well-established reconstructive ladder, due to the limited local reliable reconstructive options. In rare cases, the reconstructive plan and flap choice may encounter challenges when the patient has psychiatric illness affecting compliance with postoperative care. We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures may be preferred over a long and complex surgical reconstruction requiring good compliance with postoperative care. The medical team should be aware of the risk of postoperative collapse, focus on the prevention of pain, and be wary of drug interactions. Whenever necessary, free tissue transfer should be performed despite potential compliance issues.
Keywords
Free tissue flap, Lower extremity, Mental disorder, Reconstruction
Pubmed
Open Access
Yes
Create date
03/05/2019 16:48
Last modification date
21/08/2019 5:37
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