Increased salvage rates with early reexploration: A retrospective analysis of 547 free flap cases

Kamali, Alexander; Skogh, A.C. Docherty; Nord, Anette; Lundgren, Kalle T.; Jergovic, Davor; Hammarstedt‐Nordenvall, Lalle; Sommar, Pehr; Halle, Martin

doi:10.1016/j.bjps.2021.03.001

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Increased competence as backup during weekends has also been necessary with longer monitoring times because most of the BR re-explorations happen within the 24 hours after surgery, and it is well known that HNRs, to a larger extent, have a risk for complications needing re-exploration during a more extended period after the surgery. 15 , 16 The significantly longer hospitalization also reflects the shift toward a larger proportion of HNR during the COVID-19 year. To not compromise the care of the patients receiving free flap reconstructions, our standard postoperative protocols, including our limited use of antithrombotic agents to prevent postoperative hematoma formation, were used for these surgeries throughout the first pandemic year.…”

Section: Discussionmentioning

confidence: 99%

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

Zindrou

Halle

Jakobsson

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Since its outbreak, the COVID-19-pandemic has had a tremendous impact on healthcare systems worldwide. We conducted a comparative study to analyze the pandemic's consequence on microsurgical reconstructions at a reconstructive plastic surgery center in Sweden. Method: All free flaps performed at a single center between March 2019 and 2021 were analyzed. The patient cohort was divided into two groups, with a period of 1 year in each group: non-COVID-19 year and COVID-19 year. The periods were compared regarding the number and type of surgeries and patient characteristics. Results: In the year prior to the pandemic, 123 free flap surgeries were performed, compared with 103 surgeries during the COVID-19 year. There was a significant shift in the most common site for free flap reconstruction: from the breast [which decreased by 42% (66-38)] to head and neck [which increased by 22% (41-50); OR 0.53 (P = 0.02)]. This was also reflected by a significant increase in hospital stay for free flap patients during the COVID-19 year (P = 0.02). Conclusions: During the COVID-19 pandemic, a shift was seen from breast reconstructions toward head and neck reconstructions as the most common free flap procedure performed. An increasing backlog of elective breast reconstructions demands increased resources and tougher priorities, which challenge the healthcare system in the post-COVID-19 era.

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Section: Discussionmentioning

confidence: 99%

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

Zindrou

Halle

Jakobsson

2022

Plastic and Reconstructive Surgery - Global Open

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“… 3 , 4 Early reintervention of anastomotic problems has been shown to improve survival rates of DIEP flaps. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Tissue perfusion in DIEP flaps using Indocyanine Green Fluorescence Angiography, Hyperspectral imaging, and Thermal imaging

Kleiss,

Michi,

Schuurman

et al. 2024

JPRAS Open

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“…13 Hematomas have also been associated with an increased risk for concomitant vascular complications, especially with the possibility of vessel compression. 14 Rates of postoperative vascular thrombosis vary across institutions but are estimated to be around 5 to 10%. 15 16 It is commonly thought that if a flap survives for the first week after surgery without evident venous congestion, such as duskiness or firmness, or arterial insufficiency, such as pallor and coolness, it will likely not need to be taken back.…”

mentioning

confidence: 99%

An Institutional Analysis of Early Postoperative Free Tissue Transfer Takeback Procedures

Hernandez Alvarez,

Lee,

Kim

et al. 2024

J Reconstr Microsurg

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Background Postoperative free tissue transfer reexploration procedures are relatively infrequent but associated with increased overall failure rates. This study examines the differences between flaps requiring takeback versus no takeback, as well as trends in reexploration techniques that may increase the odds of successful salvage. Methods A retrospective review was conducted on all free tissue transfers performed at our institution from 2011 to 2022. Patients who underwent flap reexploration within 30 days of the original procedure were compared with a randomly selected control group who underwent free flap procedures without reexploration (1:2 cases to controls). Univariate and multivariate logistic regression analyses were performed. Results From 1,213 free tissue transfers performed in the study period, 187 patients were included in the analysis. Of the total flaps performed, 62 (0.05%) required takeback, and 125 were randomly selected as a control group. Free flap indication, flap type, reconstruction location, and number of venous anastomoses differed significantly between the two groups. Among the reexplored flaps, 8 (4.3% of the total) had a subsequent failure while 54 (87.10%) were salvaged, with significant differences in cause of initial flap failure, affected vessel type, and salvage technique. Conclusion Free tissue transfers least prone to reexploration involved breast reconstruction in patients without predisposition to hypercoagulability or reconstruction history. When takeback operations were required, salvage was more likely in those without microvascular compromise or with an isolated venous injury who required a single exploratory operation.

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Increased salvage rates with early reexploration: A retrospective analysis of 547 free flap cases

Cited by 6 publications

References 26 publications

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

Tissue perfusion in DIEP flaps using Indocyanine Green Fluorescence Angiography, Hyperspectral imaging, and Thermal imaging

An Institutional Analysis of Early Postoperative Free Tissue Transfer Takeback Procedures

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