Early reintervention of compromised free flaps improves success rate

Abstract

Our data shows that the majority of anastomotic failures occur within the first 24 h. Thereafter, the frequency of failures decreases. We also found that the time between initial reconstruction and start of the salvage procedure influences the outcome of the revision negatively.

Noninvasive Flap Monitoring using Sidestream Dark Field Microscan: A Method for Real-Time Observation of Submilimmetric Vessels

“…The reported free flap loss in microsurgery is currently less than 5%, going as low as 2% in some series [12]. Revision surgery has shown salvage rates of potential failures of up to 80% of the reoperations [10,11].…”

Clinical experience with the nasolabial fold as receptor site in microvascular reconstruction

“…Reconstructions in the head and neck region have further developed with the use of free microvascular tissue transfers. [1][2][3] Mandible reconstructions with a free fibula flap and defect coverage with a radial fore arm flap are routinely preformed. An important factor in the success of a free tissue transfer is the selection of the receptor site and vessels.…”

Monitoring of partial and full venous outflow obstruction in a porcine flap model using laser speckle contrast imaging

“…Still, follow ups show that some patients will need reoperation due to compromised flap viability and that a few percent of the flaps are lost due to flap failure [1,3,4].…”

“…The major cause of flap failure is venous thrombosis, which leads to a decrease of the blood drainage from the flap and a stasis and subsequent congestion of blood in the tissue. This mostly occurs within the first two days postoperatively and during this time span it's vital for the surgeon and other health staff to regularly check up on the viability of the flap [1,2].…”