Guidelines for Complications of Cancer Treatment Vol VIII Part B

- Graft loss is commonly due to shearing forces andhaematoma.- Tendon exposure at the forearm or peroneal tendons inthe leg. This may require tendon debridement anddelayed skin grafting.- Wound dehiscence and delayed healing.- Seroma at the donor site especially in latissimus dorsibed, or anterolateral thigh flap bed.- Radius bone fracture in case of radial Osteomyocutaneousflap.- Distal Limb Ischemia - It is a very rare but dreadedcomplication.- It can happen with Radial artery Forearm Flap harvesteven after checking preoperatively negative Allen’s test.Limb perfusion should be checked after flap raising andif found to be inadequate, vein graft may be used torestore vessel continuity or flap vessel may be reanastomosed back.- In the leg there is less than one percent chance of theperoneal vessel being the dominant supply of leg knownas “Peronea magna”. If fibula from such a leg isharvested, it may critically compromise foot vascularity.- To avoid this problem, it is mandatory that posterior tibialand dorsalis pedis vessel is clinically palpable beforesurgery. In case any one vessel is not clinically palpable,color Doppler examination of leg vessels is warranted.- There is no need for invasive angiography to assess legvessel as color Doppler examination is reasonablyadequate.- Rectus abdominis and iliac crest free flaps may lead toabdominal or inguinal hernia.188