Timing of Presentation of the First Signs of Vascular Compromise Dictates the Salvage Outcome of Free Flap Transfers

Chen, Kuang-Te; Mardini, Samir; Chuang, David Chwei‐Chin; Lin, Chih‐Hung; Cheng, Ming‐Huei; Lin, Yu‐Te; Huang, Wei-Chao; Tsao, Chung‐Kan; Wei, Fu‐Chan

doi:10.1097/01.prs.0000264077.07779.50

Cited by 379 publications

(322 citation statements)

References 24 publications

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“…A culture of success is reflected in their failure rates which are historically low [8][9][10][11][12]17,28,31]. It's important to mention that when a variety of flaps or new flaps are used the success rate goes down with a thrombotic rate of 17.4%, even at centers of excellence [28].…”

Section: Discussionmentioning

confidence: 99%

“…Overall a success rate of 96% seems to be the watermark for a program to accept [8][9][10][11][12]21,30]. Factors like OR availability, the start time of the reconstruction, and involvement of the resident versus fellow probably also contribute [23,26,32,33].…”

Section: Discussionmentioning

confidence: 99%

“…We would characterize the 1990's as the age of anastomosis. In this time of Centers of Excellence, MD Anderson, Sloan Kettering, and the Bunke Clinic established benchmarks of success in the anastomosis patency [8][9][10][11][12]. However, similar to theories about Nature vs. Nurture in raising children; is success at their centers a result of their technique versus their environment?…”

Section: Introductionmentioning

confidence: 99%

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Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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“…A retrospective study of 1,142 free flaps had a re-exploration rate of 9.9%, with 82% of these flaps presenting circulatory problems within 24 hours 45 . The most frequent causes are inadequate surgical anastomosis, arterial thrombosis and spasm, and insufficient venous drainage.…”

Section: Postoperative Periodmentioning

confidence: 99%

Anestesia e retalhos microvascularizados

Pereira¹,

Figueiredo²,

Carvalho³

et al. 2012

Rev. Bras. Anestesiol.

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Background and objectives: Head and neck reconstructive surgery represents a major challenge facing the need to achieve a good cosmetic and functional outcome. Anesthesia may be an important and determining factor in the technique success due to its role in hemodynamic stability and regional blood flow. On the other hand, regional anesthesia, changes in blood volume, and vasoactive drugs may influence blood flow in the flap. Thus, due to the lack of recommendations based on evidence, the anesthetic technique of these procedures is most often inspired in pathophysiological considerations. The aim of this paper is to review relevant aspects regarding anesthetic practice in these cases.

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“…[1][2][3][4][5] The most common causes of leg and foot defects are electrical burns, non-healing skin wounds, chronic venous ulcers, traffic accidents, and explosive injuries. [6,7] High voltage (>1000 volts) electrical injuries can result in mortality, and limb amputation is reported at a rate of up to 40%.…”

Section: Introductionmentioning

confidence: 99%

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally Based Cross-Leg Sural Flap

Eser

Kesiktaş

Gencel

et al. 2015

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: High voltage electrical injuries can cause devastating results especially in distal extremities. Although free flaps are the golden standards for the reconstruction of these defects, sometimes local flap alternatives are more useful. One of the most favorable local flap is distally based sural flap (DBSF), which can be used in cross-leg fashion when ipsilateral extremity is affected by a high voltage electrical injury. The purpose of this study was to evaluate long term results of eleven patients who underwent a reconstruction to the lower extremity with cross-leg DBSF due to high voltage electrical burn injury between the years of 2003-2013.

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Timing of Presentation of the First Signs of Vascular Compromise Dictates the Salvage Outcome of Free Flap Transfers

Abstract: The time of presentation of flap compromise is a significant predictor of flap salvage outcome. Intensive flap monitoring at a special microsurgical intensive care unit by well-trained nurses and surgeons allows for early detection of vascular compromise, which leads to better outcomes.

Cited by 379 publications

References 24 publications

Anatomy of Free Flap Failures: Dissection of a Series

Anatomy of Free Flap Failures: Dissection of a Series

Anestesia e retalhos microvascularizados

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally Based Cross-Leg Sural Flap

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