Abstract
Free flap success rates are in excess of 95%. Vascular occlusion (thrombosis) remains the primary reason for flap loss, with venous thrombosis being more common than arterial occlusion. The majority of flap failures occur within the first 48 hours. With early recognition and intervention of flap compromise salvage is possible. Successful salvage rates range from 28% to over 90%. Rapid re-exploration in this clinical setting is crucial to maximise the chances of flap salvage. If salvage is not feasible or unsuccessful then non-surgical methods of salvage may be employed with some possibility of success. The purpose of this article is to review the causes of free flap failure and to highlight the available options for salvage.
Highlights
Free flap failure can lead to functional and cosmetic morbidity, as well as result in additional operative procedures, prolonged hospital stay and increased health care costs
Vascular occlusion remains the primary reason for flap loss, with venous thrombosis being more common than arterial occlusion
In a review of 156 free flaps Chalian et al[2] found a significantly higher failure rate in flaps with venous anastomosis to the external jugular system compared with the internal jugular venous system
Summary
Address: 1Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital, and University of Toronto, Toronto, Canada and 2Department of Otolaryngology-Head and Neck Surgery, Auckland City Hospital, University of Auckland, Auckland, New Zealand. Published: 21 August 2009 Head & Neck Oncology 2009, 1:33 doi:10.1186/1758-3284-1-33.
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