Free Flap Reconstruction for Longstanding Non-Healing Wounds with Exposed Tendon and bone

초록

Background: Wound healing may be delayed despite conservative care or negative pressure wound therapy (NPWT). For longstanding wounds with exposed tendon and bone, free flap reconstruction can provide a definitive option. This study evaluated outcomes and complications of free flap reconstruction. Methods: A retrospective review from 2012 to 2023 included 15 patients who underwent 16 free flap reconstructions for chronic tendon and bone exposure. Data on demographics, wound causes, flap success, healing time, and complications were analyzed. Results: Of 16 reconstructions, 8 used anterolateral thigh (ALT) free flaps, 5 lateral arm (LAFF), 2 latissimus dorsi musculocutaneous (LDMC), and 1 fibular osteocutaneous flap. The mean flap size was 12 × 7 cm², with an average wound exposure of 9 months. Causes included vehicle accidents (n=5), thermal burns (n=4), falls (n=3), postoperative complications (n=2), chemical burns (n=1), and industrial accidents (n=1). Nine complications occurred: partial flap necrosis (n=3), tendinitis (n=2), osteomyelitis (n=2), and wound dehiscence (n=1). All were managed successfully with local flaps, grafting, NPWT, or conservative treatment. Conclusion: Chronic tendon and bone