Abstract
Background: Free flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional procedures. Objectives: To analyze postoperative complications and need for secondary surgery after free flap surgery over a 10-year period at King Chulalongkorn Memorial Hospital. Methods: We retrospectively reviewed data from a cohort of patients who underwent free flap surgery for limbreconstruction from 2004 to 2014. Results: We included 35 free flap operations in 29 patients. Mean follow-up time was 6.4 y. Free flap surgical procedures included 7 gracilis transfers, 8 toe transfers, 5 latissimus dorsi flaps, 5 fibular transfers, 4 anterolateral thigh flaps, 2 lateral-arm flaps, 2 radial forearm flaps, and 2 venous free flaps. There were 4 categories of postoperative complications. (1) Patients were those who developed total flap loss after free flap surgery (7/35 flaps, 20%). (2) Patients had major complications requiring additional operations (11/35 flaps, 31%). Major complications included partial flap necrosis, wound swelling with delayed closure, arterial occlusion, postoperative bleeding, infection, and failed implant fixation. (3) Patients had minor complications that required no additional surgical procedures (8/33 flaps, 23%). (4) Patients with no postoperative complications (9/35 flaps, 26%). Secondary surgery after initial free flap was 51% overall (18/35 flaps). The 3 most common secondary procedures included second flap coverage, skin graft, and anastomosis revision. We found free flap surgery performed during the subacute period (14–90 d after injury) to have significantly (P = 0.028) more complications (categories 1 and 2) than surgery performed during the acute period ( 90 d). Conclusions: Physicians should be prepared for a range of outcomes of free flap surgery and advise their patientsof the risk of additional operations accordingly. Keywords: Secondary surgery, flap necrosis, free flap surgery, limb reconstruction postoperative complications
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