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ANALYSIS OF COMPLICATIONS OF THE FIRST 75 FREE FLAPS – LESSONS FROM A BEGINNER
Author(s) -
Varkey A.
Publication year - 2007
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/j.1445-2197.2007.04127_4.x
Subject(s) - medicine , surgery , presentation (obstetrics) , free flap , fibula , microsurgery , safer , general surgery , tibia , computer security , computer science
Purpose Complications of free tissue transfer often are mentioned only in passing, be it in a forum or published literature. Minor details as discussed in this presentation are often are not emphasized and occasionally neglected. Materials and methods Of the 75 consecutive cases, majority were for head and neck reconstruction. Specific factors that are discussed are 1. Pedicle twist and precautions on perforator flaps 2. Pedicle in a tunnel‐ how wide is safe. 3. One vein versus two veins – when to choose 4. Could the beginner initiate his microsurgery on the second comitant vein? Are there alternatives to a safer teaching model? 5. Precautions in choosing recipient vessels in traumatic limbs with disuse atrophy 6. “Distal run off”– distance of freeing the recipient vessels. Other issues discussed are, prevention of vessel desiccation, precautions with hemoclips; pharmacotherapy versus re exploration, and rare causes of failure such as drug hit phenomenon. Results Among 75 free flaps, the ALT flap was the workhorse. Others included the radial forearm, fibula, Latissimus dorsi and gracilis. Of the 7 re‐explorations 3 had pharmacotherapy as the first intervention. There were 4 complete failures, 2‐partial failures, 1‐complete salvage. Overall success rate was 90%. Conclusions Success comes with good decisions; good decisions come with experience, though experience come with bad decisions. The factors discussed here aim to share the bad experiences that could be diligently avoided to obtain higher success rates.