Factors that influence the outcome of salvage in free tissue transfer
Section snippets
INTRODUCTION
Microvascular free tissue transfer is now a reliable technique.1., 2., 3., 4., 5. Accurate monitoring of the flap permits the surgical team to have another chance of a successful transfer if the tissue becomes compromised in the early postoperative period. Successful salvage rates have been reported between 28 and 87.5%.6., 7., 8. Previous reports have confirmed the success of flap salvage techniques but there are few detailed data on the circumstances surrounding the decision to return to the
PATIENTS AND METHODS
A computerised database has been in regular use for patients with head and neck cancer who are operated on at the Regional Maxillofacial Unit in Liverpool, and data are available for analysis from January 1992. We analysed the database from January 1992 until October 1998, and identified 408 patients who had 427 free flap reconstructions. A detailed complication form indicated the early return to theatre (within 7 days), and flap compromise. Sixty-five patients were identified who required an
RESULTS
Sixty-five of 408 patients (16%) returned to the operating room within 7 days for further surgery as part of an early complication. Forty (10%) patients had flaps compromised by vascular thrombosis and 25 (6%) were not compromised but had a bleeding site or haematoma.
Table 1 shows the reasons for returning to the operating room as given on the flap chart. Of the 65 patients, 41 patients had a change in the flap chart although 5 of these also had a haematoma or bleeding as an additional reason
DISCUSSION
The rates of return to theatre have been reported between 139 and 20%,5 which are comparable with the 16% rate in this study. Operations specifically for compromised flaps has been reported in between 3.83 and 8%,5., 10. which is less than the overall result in this study of 10% (40/408). The flap salvage rate in this study of 73% (29/40) is comparable with other reports.5., 11.
The results show that for venous thrombosis an early return to theatre is essential if there is going to be a
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