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Free‐flap salvage: muscle only versus skin paddle – an Australian experience
Author(s) -
Dat Anthony D.,
Loh Ian W.,
BruscinoRaiola Frank
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13522
Subject(s) - medicine , surgery , demographics , salvage surgery , free flap , skin flap , salvage therapy , complication , demography , chemotherapy , sociology , radiation therapy
Background Free‐tissue transfer flaps are an effective reconstructive option for complex wounds; however, flap failure is a dreaded complication requiring timely re‐exploration and salvage. The aim of this study was to determine whether salvage rates were higher in skin flaps, as opposed to muscle flaps, due to the durability of the overlying skin paddle allowing for better visual post‐operative monitoring and more timely recognition of the threatened flap. Methods We conducted a retrospective analysis of all patients who underwent a free flap at an Australian tertiary centre between 2004 and 2014. Data were collected on patient demographics, indication, flap type, time of recognition of the threatened flap and re‐exploration outcome. Data were analysed using Stata version 13 ( StataCorp , College Station, TX , USA). Student's t ‐test, analysis of variance and Pearson's chi‐squared test were used to compare groups. Results There were 560 patients who underwent 573 free flaps. The most common indication was trauma. There were 58 re‐explorations with a successful salvage rate of 79.3% (46/58). Overall complete flap loss rate was 2.1% (12/573). In flaps requiring re‐exploration, there was a higher complete flap loss rate for muscle only flaps versus those with a skin paddle ( P ‐value = 0.041). Conclusion While timely recognition and re‐exploration of the compromised free flap in the early postoperative setting is important in determining the flap salvage success, it is demonstrated that salvage rates are poorer for muscle only flaps compared with flaps with a skin paddle.