Flap Complication Rates Research Articles

Clinical Outcomes and Complications in Complex Closures Under Local Anaesthesia Post-Mohs Surgery.

Mohs micrographic surgery offers high cure rates of cutaneous malignancies, but surgeons are often faced with large and complicated defects after tumour removal. To assess the safety and complication rates of large flaps and grafts (measuring ≥30 cm2) and larger complex linear closures (CLC, ≥12.5 cm, as defined by the American Medical Association Current Procedural Terminology code set), when performed under local anaesthesia. A retrospective analysis was conducted on a cohort of patients who underwent skin cancer treatment by Mohs at an academic institution (UCSD) from January 1, 2010, to December 31, 2022, and whose defects were repaired with CLC, flap, or skin graft. Demographic, surgical, and complication data were collected and analyzed. Of the 436 patients who met inclusion criteria, 39 underwent CLC, 344 underwent flap reconstruction, and 53 underwent grafting. Adverse effects to local anaesthesia were notably absent in all treatment methods. Overall complication rate was noted to be 16.1% (70/436). Complications varied across treatment methods, encompassing infection (6.0%, 26/436), bleeding (3.2%, 14/436), hematoma (5.0%, 22/436), seroma (0.2%, 1/436), and flap/graft necrosis (6.5%, 26/397). Our data suggest that large CLC, flaps, and grafts can be safely performed under local anaesthesia, but have higher complication rates compared to smaller reconstructions.

Intraoperative Surgical Guidance for DIEP Flap Harvest using Augmented Reality

SUMMARY: Augmented reality (AR) systems for surgical navigation provides the capability to project preoperative CT scans and segmented anatomical structures directly into the surgeon’s field of view, along with virtual displays akin to traditional monitors. Utilizing the Meta Quest 3 consumer AR headset, we found that it can achieve clinically acceptable accuracy in surgical navigation for deep inferior epigastric perforator (DIEP) surgeries. Notably, the Quest 3 can operate independently thanks to a novel registration technique employing hand tracking, suitable for use in sterile environments. The DIEP flap is a widely favored option for autologous breast reconstructions. Intraoperatively, the perforator arteries are selected to maximize tissue perfusion and minimize donor site morbidity. Conventionally, preoperative CT angiograms are used to locate perforators and visualize vessel courses, thus reducing DIEP flap harvest time and complication rates. Though, there are currently very limited means to reliably translate information found on preoperative imaging for use in the operating theater. The Meta Quest 3 was trialed in three DIEP flap surgeries by displaying segmented deep inferior epigastric arteries and DIEP arteries during preoperative and intraoperative phases of surgery. The AR projections facilitated the visualization of the DIEP arteries and efficient pedicle dissection by guiding the placement and length of the fascial incision. Furthermore, this work supports the hypothesis that AR will improve flap design, reduce harvest time, and improve safety during DIEP flap harvesting.

Utility and Outcomes of a Keystone Perforator Island Flap for Reconstruction at Various Anatomical Locations: A Prospective Study.

Background In Yemen, traumatic wounds are prevalent, imposing a substantial burden on plastic surgery teams operating within limited-resource settings. Advanced microsurgical reconstruction options are scarce, and expertise in free flap techniques is limited. While local flaps are commonly used for soft tissue reconstruction, there is a need for simpler, effective alternatives with lower complication rates. This study aimed to evaluate the effectiveness and outcomes of the keystone island perforator flap (KIPF) as a viable alternative for soft tissue coverage in resource-challenged facilities. Methods From February 2021 to December 2023, a single surgeon's team in three plastic and reconstructive surgery departments in Sana'a, Yemen, conducted this prospective study, which included 35 patients who underwent KIPF for various soft tissue defects. We assessed patient demographics, intraoperative variables, and postoperative outcomes, including aesthetic outcomes evaluated using the Patient and Observer Scar Assessment Scale (POSAS) at six months postoperatively. We analyzed the factors influencing flap success and complication rates. Results The mean age of patients was 29 ± 11.75 years, with the majority being males, comprising 86% of the sample. Trauma was the leading cause of tissue defects (77.1%), primarily affecting the legs (57.14%) and feet (11.43%). The mean operative time was 73.57 minutes. Complications occurred in 26% of patients, with flap dehiscence being the most common (11.43%). Ninety-seven percent of patients experienced flap survival, and 91.4% experienced complete wound healing within a median of 16 days.Scar assessments at six months postoperatively indicated satisfactory aesthetic outcomes, with scars resembling normal skin. Conclusion The KIPF technique proves to be a reliable and practical option for soft tissue reconstruction in resource-limited settings. Its simplicity, minimal postoperative care needs, and high flap survival rates make it an advantageous alternative to more complex reconstructive techniques. This study supports the adoption of KIPF as a standard approach in similar environments with limited reconstructive surgery capabilities.

Evaluation of flap complications following pectoralis major myocutaneous flap reconstruction for oral cancers

Evaluation of flap complications following pectoralis major myocutaneous flap reconstruction for oral cancers

A single-center retrospective comparison of muscle versus cutaneous free flaps for posterior elbow defect reconstruction

Comparative data on free flap outcomes for elbow defect reconstruction are still lacking. This study aimed to compare complication rates of free muscle flaps (MFs) versus cutaneous flaps (CFs) for posterior elbow reconstruction. In a single-center retrospective analysis, patients who underwent posterior elbow reconstruction with free MFs and CFs from 2000 to 2021 were analyzed. Retrospective chart review included patient demographics, operative details, and post-operative complications. Outcomes of interest that were compared included microvascular complications, partial or total flap necroses, wound dehiscence, hematoma or flap infection, and donor-site complications. Sixty-six free flaps (CFs: n=42; MFs: n=24) were included, with a trend over time toward using CFs (64%). MFs were used for larger defects (CF: 175±82 vs. MF: 212±146cm2; p=0.13). Outcome analysis revealed an equal distribution of microvascular complications (10% vs. 13%; p=0.7), partial flap necrosis (7% vs. 8%; p>0.9), wound dehiscence (7% vs. 4%; p>0.9), evacuation of hematoma (10% vs. 4%; p=0.7), and infection (0% vs. 4%; p=0.4). Total flap necrosis requiring additional flap surgery was necessary in one CF (2%) and in no MF (0%) (p>0.9). Surgical outcomes, flap necrosis rates, and microsurgical complications did not differ between CFs and MFs. Both flap types are safe and effective options. The free anterolateral thigh and latissimus dorsi flaps represent indispensable workhorses for the reconstruction of extensive elbow defects.

Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction.

Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is the current gold-standard autologous option. The profunda artery perforator (PAP) and lumbar artery perforator (LAP) flaps have more recently been described as alternatives for patients who are not candidates for a DIEP flap. The aim of this study was to review the survival and complication rates of PAP and LAP flaps, using the DIEP flap as a benchmark. A literature search was conducted using PubMed, MEDLINE, Embase, BIOSIS, Web of Science, and Cochrane databases. Papers were screened by title and abstract, and full texts reviewed by three independent blinded reviewers. Quality was assessed using MINORS criteria. Sixty-three studies were included, for a total of 745 PAP, 62 stacked PAP, 187 LAP, and 23,748 DIEP flap breast reconstructions. The PAP (98.3%) had comparable success rate to DIEP (98.4%), and the stacked PAP (88.7%) and LAP (92.5%) success rate was significantly lower (P < 0.0001). The PAP and LAP groups both had a low incidence of fat necrosis. However, the revision rate for the LAP group was 16.1% whereas the PAP group was 3.3%. Donor site wound dehiscence rate was 2.9 in the LAP group and 9.1% in the PAP group. Profunda artery perforator and DIEP flaps demonstrate very high rates of overall survival. The LAP flap has a lower survival rate. This review highlights the survival and complication rates of these alternative flaps, which may help clinicians in guiding autologous reconstruction technique when a DIEP flap is unavailable.

Impact of goal-directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before-and-after pilot study.

Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with perioperative morbidity is intraoperative hypotension (IOH). The main aim of this pilot study is to determine if the intraoperative use of goal-directed hemodynamic therapy (GDHT) is associated with a reduction in the number of IOH events in this population. A before-and-after study design. The patients who had intraoperative GDHT were compared to patients from a previous period before the implementation of GDHT. The primary outcome was the number of IOH episodes defined as five or more successive minutes with a mean arterial pressure <65 mmHg. The secondary outcomes included major postoperative morbidity and 30-day mortality. A total of 414 patients were included. These were divided into two groups. The control group (n = 346; January 1, 2018, to December 31, 2019), and the monitored group (n = 68; January 1, 2020, to May 1, 2021). The median intraoperative administered fluid volume was similar between the control and monitored groups (2250 interquartile range[IQR][1607-3050] vs. 2210 IQR[1700-2807]mL). The monitored group was found to have an increased use of norepinephrine and dobutamine (respectively, 1.2% vs. 5.9% and 2.4% vs. 30.9%; p < 0.05). When adjusting for confounders (comorbidities, estimated blood loss,and duration of anesthesia) the incidence rate ratio (95% confidence interval) of number of IOH events was 0.94 (0.86-1.03), p = 0.24. The rate of postoperative flap and medical complications did not differ between the two groups. Even though the use of vasopressors/inotropes was higher in the monitored group, the number of IOH episodes and postoperative morbidity and mortality were similar between the two groups. Further change in hemodynamic management will require the use of specific blood pressure targets in the GDHT fluid algorithm.

Patient-Reported Abdominal Morbidity Following Abdomen-Based Breast Reconstruction.

Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes (PROs) in breast reconstruction has been poorly characterized. A retrospective review of obese patients undergoing abdominal-based free autologous breast reconstruction was conducted over 15 years. Patient operative characteristics were recorded and outcomes were analyzed. PROs were assessed using the BREAST-Q abdominal survey. In total, 75 women (108 flaps) with the mean body mass index (BMI) of 33.2 were included. Flaps included deep inferior epigastric artery perforator (24%), muscle-sparing (43%), and free transverse rectus abdominis myocutaneous flaps (f-TRAM; 33%). World Health Organization (WHO) obesity class, BMI, and flap type did not affect flap failure (1%) or complication rates. Hernia developed in 7%; all necessitated repair. Eight percent developed abdominal bulge; one was repaired. Hernia formation was associated with increased patient age (p < 0.05). Bulge formation occurred more often in f-TRAM donor sites (p = 0.005). BMI, WHO class, flap type, and mesh use were not related to hernia or bulge occurrence in either univariate or multivariate analysis. The survey response rate was 63%. Abdominal Physical Well-Being (proxy for abdominal wall function) and Satisfaction with Abdomen (patient-perceived cosmesis) were similar across flap types, age, and WHO classification groups. Patients with postoperative bulge reported higher abdominal physical well-being scores, regardless of flap type (p < 0.01). Bulge was correlated with lower satisfaction (p < 0.05). The incidence of abdominal wall morbidity following abdominal free-tissue transfer for breast reconstruction was acceptably low in our population of obese patients. Hernia was a clinically significant complication, warranting surgical repair. Bulge was primarily a cosmetic concern and did not detract from patient-reported abdominal wall function. Age may represent an independent risk factor for hernia formation in this population.

Buried de-epithelialized flap: An original solution to fill dead space after sarcoma resection in the thigh. Surgical technique and results of 12 cases

Soft tissue sarcomas (STS) are often treated with wide excision in combination with adjuvant or neoadjuvant radiotherapy. This is currently the gold standard procedure for the treatment of STS that arise in the extremities. Wound healing complications frequently occur and negatively affect the prognosis. One of the options is to use a buried de-epithelialized flap as it can increase the lymphatic flow, fill the dead space, and cover neurovascular structures and implants. This aim of this retrospective study were two-fold. 1) Describe the surgical technique for this buried de-epithelialized flap after STS removal in the thigh. 2)Evaluate the efficacy of the buried de-epithelialized flap for decreasing wound complications based on a small case series and compare it with previous publications. We hypothesized that the complication rate of this flap is not higher than the published complication rate for traditional flaps. Twelve patients (7 women and 5 men) with a mean age of 62±12years (38-76), who underwent surgical removal of an STS in the thigh with coverage by a buried de-epithelialized flap were reviewed at a mean follow-up of 15.8months (range 8-24). Two patients presented with a postoperative wound infection (17%): one superficial and one deep at the surgical site. Neither required an additional plastic surgery procedure. Another patient had a dislocation of their total hip arthroplasty that was managed by closed reduction. One patient died from metastatic progression. There was no skin necrosis of the superficial skin edges, no hematoma or seroma in the other 10 patients. The flap was still visible on cross-sectional imaging at 1 month postoperative with no fluid between the tissue planes or signs of necrosis. The rate of wound healing complications that required surgical treatment was 17% in our case series, versus 16 to 56% in previous publications reporting the results of suture closure only. A buried de-epithelialized flap reduces the risk of skin complications by filling dead space, improving lymphatic flow and covering critical structures. It is a reliable and reproducible option after wide local excision of STS in the thigh, with no additional morbidity. IV, retrospective study.

Pediatric Microsurgery and Free-Tissue Transfer.

Advancements in microsurgery, along with increased microsurgical experience in pediatric patients, have made free-tissue transfer a reliable modality for pediatric bone and soft tissue reconstruction today. Free-tissue transfer is most commonly used in children for the coverage of large or complex defects resulting from traumatic, oncologic, or congenital etiologies. While flap success and complication rates between pediatric and adult populations are similar, special considerations must be taken into account within the pediatric population. In this article, we will describe common indications, technical nuances, and clinical considerations for the management of the pediatric free-tissue transfer patient.

Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management.

Axillary hidradenitis suppurativa (HS) can result in significant functional impairment in both personal and professional lives. Stage 3 HS requires radical surgical treatment. Flap reconstruction allows for faster healing and better functional and aesthetic outcomes. We compared the results of thoracodorsal artery perforator (TDAP) and propeller inner arm artery perforator (IAAP) flap reconstructions after radical surgical treatment of axillary HS. We conducted a retrospective study that included 13 consecutive patients who underwent stage 3 axillary HS treatment between August 2015 and January 2023. Seven patients underwent reconstruction by islanded TDAP flaps, whereas six patients underwent reconstruction by propeller IAAP flaps, with one patient undergoing bilateral reconstruction. The data collected from the patient records included age, gender, smoking status, body mass index, comorbidities, operative time, defect size, flap size, hospital stay, and complications. Although not statistically significant (P = 0.1923), a higher rate of flap complications is reported here with propeller IAAP flaps (42.86 %), whereas islanded TDAP flaps had no flap complications (0%). We found a statistically significant difference in operative time (P = 0.0006), defect size (P = 0.0064), and flap size (P = 0.0012) between the two groups. All patients exhibited satisfactory functional and aesthetic outcomes. Fourteen flaps were performed in total; only one case exhibited recurrence (7.14%). After radical surgical management, both islanded TDAP and propeller IAAP flap reconstructions offer excellent outcomes for stage 3 axillary HS. We strongly encourage our peers to consider performing perforator flaps over secondary healing for these patients with a major functional impairment.

Free Flap Failure and Complications in Acute Burns: A Systematic Review and Meta-analysis.

Severe acute burn injuries represent a challenge to the reconstructive surgeon. Free flap reconstruction might be required in cases of significant critical structure exposure and soft tissue deficits, when local options are unavailable. This study aimed to determine the free flap complication rate in acute burn patients. A systematic review and meta-analysis were conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on the International Prospective Register of Systematic Reviews database (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The primary outcome was the free flap failure rate. The study identified 31 articles for inclusion. A total of 427 patients (83.3% men, 16.7% women) accounting for 454 free flaps were included. The mean patient age was 36.21 [95% confidence interval (CI), 31.25-41.16]. Total free flap loss rate was 9.91% [95% CI, 7.48%-13.02%], and partial flap loss was 4.76% [95% CI, 2.66%-8.39%]. The rate of venous thrombosis was 6.41% [95% CI, 3.90%-10.36%] and arterial thrombosis was 5.08% [95% CI, 3.09%-8.26%]. Acute return to the operating room occurred in 20.63% [16.33%-25.71%] of cases. Stratified by body region, free flaps in the lower extremity had a failure rate of 8.33% [95% CI, 4.39%-15.24%], whereas in the upper extremity, the failure rate was 6.74% [95% CI, 3.95%-11.25%]. This study highlights the high risk of free flap complications and failure in acute burn patients.

Repair of a finger pulp or fingertip defect using a palmar rotatory flap pedicled with the perforating branch of the proper palmar digital artery: a retrospective study

BackgroundSoft tissue defects in the hand may result from trauma, oncological procedures, or severe infections. This study aimed to introduce an innovative method for repairing soft tissue defects on the palmar side of the distal segment of the affected finger or fingertip. We explored this surgical method and its curative effect on the volar rotation pedicled flap base on a perforator of the palmar digital artery (VRPF-PPDA) for repairing ventral or fingertip soft tissue defects of the distal segment of the affected finger without impairing its main blood vessels.MethodsBetween June 2019 and January 2021, 13 patients with finger pulp or fingertip soft tissue defects were treated with VRPF-PPDA. Flap survival rate, complication rate, two-point discrimination (2PD), and patient satisfaction were used to evaluate the efficacy of this method. The function of the affected finger was evaluated using the upper limb function evaluation method issued by the Trial Standards for Evaluation of Partial Function of the Upper Extremity of the Chinese Society for Surgery of the Hand of the Chinese Medical Association (CMA) and the Disabilities of the Arm, Shoulder, and Head (DASH) score, 6–12 months after the flap-based operation.ResultsThirteen patients (18 fingers) achieved complete flap survival. The finger pulp flap was full, and no complications occurred. 2PD checks of the flaps revealed that all of them were 4–10 mm in length. According to the Trial Standards for Evaluation of Partial Function of the Upper Extremity of the Chinese Society for Surgery of the Hand of the CMA, hand function was excellent in 12 patients (17 fingers) and good in one patient, with a mean DASH score of 26.05 ± 0.45. Eleven patients selected “excellent” on the subjective satisfaction survey, while the other two selected “good.”ConclusionVRPF-PPDA surgery is a simple, effective, minimally invasive, and reliable method for repairing soft tissue defects in the distal finger pulp or fingertips. Optimal esthetic reconstruction and anatomical and functional repair can be achieved in fingers repaired using the VRPF-PPDA surgical approach.

Supermicrosurgery with perforator-to-perforator anastomoses for lower limb reconstructions - A systematic review and meta-analysis.

Supermicrosurgical flaps based on perforator-to-perforator microanastomoses have been described for lower limb reconstruction. This approach offers the benefit of raising short pedicles while sparing axial vessels, which effectively enables complex reconstructive techniques in comorbid patients at high risk of reconstructive failure. The aim of our study is to assess the surgical outcomes of perforator-to-perforator based flaps in comparison to conventional free flaps for reconstructions of the lower limb district, through a systematic review of literature and meta-analysis. A search on PubMed, Embase, Cohrane, and Web of Science was performed between March-July 2022. No restrictions were placed on study date. Only English manuscripts were assessed. Reviews, short communications, letters, correspondence were excluded after reviewing their references for potentially relevant studies. A Bayesian approach was used to conduct the meta-analysis comparing flap-related outcomes. From 483 starting citations, 16 manuscripts were included for full-text analysis in the review, and three were included in the meta-analysis. Out of 1556 patients, 1047 received a perforator-to-perforator flap. Complications were reported in 119 flaps (11.4%), which included total flap failure in 71 cases (6.8%), partial flap failure in 47 cases (4.5%). Overall flap complications had a HR of 1.41 (0.94-2.11; 95% C.I.). Supermicrosurgical and conventional microsurgical reconstructions were not associated with statistically significant differences (p = .89). Our evidence supports the safety of surgical outcomes, with acceptable flap complication rates. Nevertheless, these findings are limited by poor overall quality which must be addressed and used to encourage higher-level evidence in the field.

Autologous Breast Reconstruction Success Rates in Hypercoagulable Patients.

Hypercoagulable disorders may adversely affect microsurgical outcomes, including increased flap failure and complication rates. Outcomes specific to autologous breast reconstruction are not well described. A retrospective review was performed of autologous breast reconstructions between 2009 and 2020. Patients with either a thrombophilic disorder (TD) diagnosis or a previous thrombotic event (TE) were identified. The analysis compared perioperative complications and flap success rates. In this series, 23 patients with a TD underwent 39 flaps, and 78 patients who had experienced a TE underwent 126 flaps, compared with 815 control patients, who underwent 1300 flaps. In logistic regression models, a TD diagnosis was an independent predictor of early total flap loss [OR, 8.42 (95% CI, 1.59 to 44.47); P = 0.01], late partial flap loss [OR, 3.9 (95% CI, 1.0 to 15.22); P = 0.05], and delayed healing [OR, 2.26 (95% CI, 1.02 to 5.04); P = 0.04]. TE history trended toward an association only with late partial flap loss ( P = 0.057). Flap salvage rates (25%) and flap success rates (92.3%) were statistically lower in patients with a TD but normal in patients who had experienced a TE. Microsurgical breast reconstruction is a reasonable option for patients with hypercoagulation disorders. No increased risk of flap complications was associated with a previous TE; however, TDs carried increased risk. Risk, II.

Surgical Outcomes of Autologous Breast Reconstruction in Low BMI Patients; Beyond the Gold Standard DIEP Flap.

Autologous breast reconstruction provides higher satisfaction than implant-based reconstruction in women with low Body Mass Index (BMI). However, the gold standard of microvascular breast reconstruction, the Deep Inferior Epigastric Perforator (DIEP) flap, can be challenging to achieve due to the paucity of adnominal bulk in these patients. This study compares operative outcomes in women with BMIs less than 23.5 following reconstruction after one of three free flap methods: The DIEP flap, alternative flaps (I.e., lumbar artery perforator flap (LAP) or profounda artery perforator flap (PAP)), and stacked flaps. A retrospective study was conducted on thin patients (BMI < 23.5) who underwent autologous breast reconstruction between 2010 and 2021 by two senior authors (NTH, SST) at a single institution. One hundred and fifteen patients were divided into three reconstructive groups. Flap weights, complication rates, secondary revisions, and fat grafting in each group were then compared. The success rate in all three groups was 100%, with only one partial flap loss in the stacked group. There was a significant difference in overall minor complications and donor complications between the three groups, with alternative flaps experiencing the most. All three groups had similar incidences of recipient breast complications, medical complications, need for secondary revisions, and amount of fat grafted. Autologous breast reconstruction in low BMI patients yields successful and durable results. This study shows that predictable results in the thin patient population can be obtained via alternate autologous methods beyond the gold standard DIEP flap.

Comparison of fasciocutaneous and fascial anterolateral thigh free flaps in foot reconstruction

Purpose: This study compared the surgical outcomes and quality of life of patients who underwent fasciocutaneous and fascial anterolateral thigh (ALT) free flaps for the reconstruction of traumatic soft tissue defects in the foot.Methods: A single-institution retrospective review of medical data from 2008 to 2021 was conducted on 20 patients who underwent a fasciocutaneous ALT free flap or fascial ALT free flap in the foot. Information was collected on patients’ baseline information, preoperative characteristics, and postoperative courses. Quality of life was measured through the Foot and Ankle Disability Index (FADI) score. A questionnaire survey was administered to evaluate aesthetic satisfaction and subjective improvement of dryness and sensory function at the surgical site.Results: The mean flap dimensions were 13.96×4.58 cm and 10.75×3.50 cm in the fasciocutaneous and fascial groups, respectively. The overall flap failure and complication rates were higher in the fasciocutaneous group (total necrosis in one case, partial flap loss in two cases, and vascular complications in three cases). While aesthetic satisfaction and functional outcomes (FADI Sports) showed better outcomes in the fascial group, subjective improvement of dryness and sensory recovery showed better results in the fasciocutaneous group.Conclusion: In comparison to fasciocutaneous flaps, fascial free flaps demonstrated lower rates of wound complications, higher aesthetic satisfaction, and better functional outcomes, but less improvement in dryness and sensory recovery at the flap site. Therefore, the choice of a flap for foot reconstruction should depend on the plastic surgeon’s discretion and a thorough discussion with the patient.

Recipient vessels for free flaps in advanced facial oncologic defects

To prospectively compare the results of microvascular flap reconstruction of midface and scalp advanced oncologic defects using superficial temporal versus cervical as recipient vessels. This is a parallel group clinical trial with 1:1 allocation ratio of patients who underwent midface and scalp oncologic reconstruction with free tissue flap from April 2018 to April 2022 in a tertiary oncologic center. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels (Group A) and those in whom cervical vessels were used as the recipient vessels (Group B). Patient gender and age, cause and localization of the defect, flap choice for reconstruction, recipient vessels, intraoperative outcome, postoperative course, and complications were recorded and analyzed. A Fisher's exact test was used to compare outcomes between the 2 groups. On the basis of the different recipient vessels, 32 patients were randomized into 2 groups, and of these 27 patients completed the study: Group A with superficial temporal recipient vessels (n = 12) and Group B with cervical recipient vessels (n = 15). There were 18 male and 09 female patients with an average age of 53.92 ± 17.49 years. The overall flap survival rate was 88.89%. The overall complication rate for vascular anastomosis was 14.81%. The total flap loss rate in patients with superficial temporal recipient vessels was higher than the complication rate in those with cervical recipient vessels but with no statistical significance (16.67% vs. 6.66%, p = 0.569). Minor complications occurred in 05 patients without statistical significance between the groups (p = 0.342). In the group with superficial temporal recipient vessels, the postoperative rate of free flap complications was similar than the cervical recipient vessel group. Therefore the use of superficial temporal recipient vessels for midface and scalp oncologic reconstruction could be a reliable option.

Outcomes Associated with Multiple Free Tissue Transfers Performed in a Single Day.

Background: Although microvascular free tissue transfer (MFTT) remains technically challenging, surgeons may need to perform >1 MFTT operations in a given day. Objective: To compare MFTT outcomes in cases where surgeons completed one versus two flaps per day by measuring flap viability and complication rates. Methods: A retrospective review was conducted of MFTT cases from January 2011 to February 2022 with >30-day follow-up. Outcomes, including flap survival and operating room takeback, were compared using multivariate logistic regression analysis. Results: Of 1096 patients meeting inclusion criteria (1105 flaps), there was a male predominance (n = 721, 66%). Mean age was 63.0 ± 14.4 years. Complications requiring takeback were identified in 108 flaps (9.8%) and were greatest for double flaps in the same patient (SP) (27.8%, p = 0.06). Flap failure occurred in 23 (2.1%) cases and was also greatest for double flaps in the SP (16.7%, p = 0.001). Takeback (p = 0.06) and failure (p = 0.70) rates were not different between days with one versus two unique patient flaps. Conclusions: Among patients undergoing MFTT, those treated on days in which surgeons perform two unique cases compared with single cases will demonstrate no difference in outcomes, as measured by flap survival and takeback, whereas patients with defects requiring multiple flaps will experience greater takeback and failure rates.

Comparison of outcomes between early and delayed weight bearing following lower limb free flaps: an 18-month single-center study

Aim: Post-operative protocols following lower limb free flap surgery are not well defined, with a lack of consensus in the literature around limb dependency and weight bearing. The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling (day 3 vs. day 4) and weight bearing (day 5 vs. day 14) post lower limb free flap surgery. Methods: All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap database. Patient data were collected from the comprehensive lower limb free flap database, medical notes, and electronic records. Patients prescribed an extended non-weight-bearing period due to the method of bone fixation were excluded. Results: A total of 37 patients, 15 pre- and 22 post-enhanced protocol, were identified for comparison. The mean age was 43 (17-72) with a M:F of 3:1. There was no difference in the type of flap reconstruction between groups, with the anterolateral thigh flap being the most common in both groups. No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol, with the mean length of stay reduced from 12.1 to 10.6 days (P = 0.34). Conclusion: The new enhanced protocol remains the standard of care in our unit, as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.