Is There an Association between Comorbidities and the Outcome of Microvascular Free Tissue Transfer?

Abstract

The aim of this study was to evaluate the relevant conditions for safe free flap transfers. The authors retrospectively studied the data from 150 patients who received free flaps at a single institution. Many parameters were analyzed to reveal if there was a correlation with respect to surgical or medical complications. Regarding safety of free tissue transfer, we found a worse prognosis in flaps where a revision of the microanastomosis had to be performed. Platelet count and leukocyte count had an impact on the prognosis. Patients older than 60 years did not have an increased rate of surgical complications. Apart from active osteomyelitis, the presence of comorbid conditions did not significantly impair the outcome of flap transfer, although smoking and diabetes correlated with minor surgical complications like wound breakdown or hematoma, respectively. Besides one case of lethal heart failure of an octogenarian patient, no severe medical complications occurred in this series of patients. Microvascular free tissue transfer is not significantly impaired by age and most comorbidities. Osteomyelitis as well as elevated leukocytes and lowered platelets may increase the complication rate and worsen the surgical prognosis. Smoking and diabetes might prolong the hospital course of the patients.

Muscle Flaps and their Role in Limb Salvage

“…Free muscle flaps have proved more resistant to the effects of cigarette smoking than local skin and fasciocutaneous flaps and have been successfully employed in patients with diabetes and peripheral vascular disease. 4 Illig et al evaluated outcomes and prognostic factors in patients who underwent a combined free tissue transfer and distal vascular bypass to manage otherwise nonreconstructible infrainguinal arterial occlusive disease with associated advanced tissue necrosis. 5 Following wound debridement, ischemia was managed by an infrainguinal bypass with the distal anastomosis achieved below the knee in the majority of patients.…”

Changes of Oxygenation and Hemoglobin-Concentration in Lower Extremity Free Flaps during Dangling

“…1 Free tissue transfer itself has been the focus of intense research in the past decades and various factors that potentially influence the outcome have been identified. 2,3 Through technical advantages and improved perioperative care, free tissue transfer has become a safe and reliable procedure. 4 However, the postoperative care of free flaps has not yet been extensively studied.…”

Free Microsurgical and Pedicled Flaps for Oncological Mandibular Reconstruction: Technical Aspects and Evaluation of Patient Comorbidities

“…In regards to the presence of co-morbidities among the candidates for mandibular reconstruction, the association of tobacco use and increased complication rate following microvascular free tissue transfer is well established [12]. Although they are not necessarily associated with complete flap loss, smoking and diabetes have been linked to wound breakdown, hematoma formation, and prolongation of hospital course [12].…”