Free Tissue Transfer Surgery Research Articles

Advances in Modern Microsurgery.

Background/Objectives: Microsurgery employs techniques requiring optical magnification and specialized instruments to operate on small anatomical structures, including small vessels. These methods are integral to plastic surgery, enabling procedures such as free tissue transfer, nerve reconstruction, replantation, and lymphatic surgery. This paper explores the historical development, advancements, and current applications of microsurgery in plastic surgery. Methods: The databases MEDLINE (via PubMed) and Web of Science were selectively searched with the term "(((microsurgery) OR (advances)) OR (robotic)) OR (AI)) AND (((lymphatic surgery) OR (peripheral nerve surgery)) OR (allotransplantation))" and manually checked for relevance. Additionally, a supplementary search among the references of all publications included was performed. Articles were included that were published in English or German up to June 2024. Results: Modern microsurgical techniques have revolutionized plastic surgery, enabling precise tissue transfers, improved nerve reconstruction, and effective lymphedema treatments. The evolution of robotic-assisted surgery, with systems like da Vinci and MUSA, has enhanced precision and reduced operative times. Innovations in imaging, such as magnetic resonance (MR) lymphography and near-infrared fluorescence, have significantly improved surgical planning and outcomes. Conclusions: The continuous advancements in microsurgery, including supermicrosurgical techniques and robotic assistance, have significantly enhanced the capabilities and outcomes of plastic surgery. Future developments in AI and robotics promise further improvements in precision and efficiency, while new imaging modalities and surgical techniques expand the scope and success of microsurgical interventions.

Ultrasound in Microsurgery: Current Applications and New Frontiers.

Ultrasound has revolutionized reconstructive microsurgery, offering real-time imaging and enhanced precision allowing for preoperative flap planning, recipient vessel identification and selection, postoperative flap monitoring, and lymphatic surgery. This narrative review of the literature provides an updated evidence-based overlook on the current applications and emerging frontiers of ultrasound in microsurgery, focusing on free tissue transfer and lymphatic surgery. Color duplex ultrasound (CDU) plays a pivotal role in preoperative flap planning and design, providing real-time imaging that enables detailed perforator mapping, perforator suitability assessment, blood flow velocity measurement, and, ultimately, flap design optimization. Ultrasound also aids in recipient vessel selection by providing assessment of caliber, patency, location, and flow velocity of recipient vessels. Postoperatively, ultrasound enables real-time monitoring of flap perfusion, providing early detection of potential flap compromise and improved flap survival rates. In lymphatic surgery, ultra-high frequency ultrasound (UHFUS) offers precise mapping and evaluation of lymphatic vessels, improving efficacy and efficiency by targeting larger dilated vessels. Integrating ultrasound into reconstructive microsurgery represents a significant advancement in the utilization of imaging in the field. With growing accessibility of devices, improved training, and technological advancements, using ultrasound as a key imaging tool offers substantial potential for the evolution of reconstructive microsurgery.

Diagnostical accuracy of hyperspectral imaging after free flap surgery.

Microsurgical free-tissue transfer has been a safe option for tissue reconstruction. This study aimed to analyze the diagnostic accuracy of hyperspectral imaging (HSI) after free-tissue transfer surgery. From January 2017 to October 2019, 42 consecutive free-flap surgeries were performed, and their outcomes were analyzed via HSI. Clinical examination of free-flap perfusion was initially performed. Clinical examination findings were subsequently compared with those of HSI. Potential venous congestion with subsequent necrosis was defined as a tissue hemoglobin index of ≥53%. Student's t-test was used to compare the results of the analysis. The evaluation of sensitivity and specificity for flap failure detection was time dependent using the Fisher's exact test. A p-value of ≤0.05 was considered statistically significant. Microsurgical tissue transfer success rate was 84%. Seven patients presented with venous congestion that caused total flap necrosis. Overall, 124 assessments were made. HSI accurately identified 12 out of 19 pathological images: four as false positive and seven as false negative. The sensitivity and specificity of HSI were 57 and 94%, respectively, compared to those of clinical examination that were 28 and 100%, respectively, within 24 h following tissue transfer. The sensitivity and specificity of HSI were 63 and 96%, respectively, compared to those of clinical examination that were 63 and 100%, respectively, within the first 72 h. A tissue hemoglobin index of ≥53% could predict venous congestion after free-flap surgery. HSI demonstrated higher sensitivity than clinical examination within the first 24 h; however, it was not superior compared to clinical findings within 72 h.

131. The Impact of Intraoperative Temperature on Venous Thromboembolism and Flap Pedicle Thrombosis in Patients Undergoing Head and Neck Microsurgical Reconstruction

PURPOSE: In vitro studies on platelet function have shown that lower temperatures encourage aggregation and overexpression of the adhesion molecules. Anesthesia guidelines recommend the prevention of hypothermia (T < 36 º). This study aims to explore the impact of intraoperative body temperature on venous thromboembolism (VTE) and flap pedicle thrombosis within 30 days of microsurgical free tissue transfer surgery to the head and neck. METHODS: All patients who underwent head and neck reconstruction with free tissue transfer from January 2012 through March 2022 in a tertiary center were included in this study. Data were collected from a retrospective and prospective held database. Intraoperative temperature readings were extracted electronically in one-minute intervals for each surgery. Non-physiologic readings less than 30 or more than 42 were discarded. A median was calculated for every five consecutive readings to create a five-minute temperature reading. A median value under 36 º was considered an onset of hypothermia. VTE events and thrombosis of the free flap pedicle (arterial or venous) that require revision surgery were the study outcomes, and they were recorded within 30 days of the index surgery. RESULTS: 895 patients were included, and out of those n=300, 34% were females. The mean intraoperative body temperature and Caprini score for the whole cohort were 36.13 ± 1.08 º and 6.54 ± 1.74. The VTE and pedicle thrombosis rates were (n=37, 4.0%) and (n=58, 6%), respectively. The incidence of patients developing at least one onset of hypothermia was (n=720, 80%). The mean number of hypothermia onsets and the mean length of surgery were 52.40 ± 84.80 and 685.12 ± 144.31 minutes, respectively. The mean for Caprini score in those who developed at least one onset of hypothermia did not differ significantly from those who were normothermic (≥ 36 º) for the whole surgery (6.55±1.76 vs. 6.46±1.60, p=0.533). The rate of VTE in those who experienced at least one onset of hypothermia was significantly higher than in those who were normothermic for the whole surgery (n=35/720, 3.9% vs. n=2/175, 0.22%, p=0.026). This association persisted even after controlling for the Caprini score, the number of hypothermic onsets, and the length of surgery in a multivariable regression model (OR, 5.478, 95%CI: 1.222-24.557). In contrast, the rate of free flap pedicle thrombosis was lower in patients who experienced hypothermia than others in the cohort (n=9/175, 1.01% vs. n=49/720, 5.47%). However, the difference failed to reach a statistical significance (p=0.422). CONCLUSIONS: Hypothermia onset is associated with an increased rate of VTE postoperative, even after controlling for the number of hypothermia onsets, Caprini score, and length of surgery. Patients who experienced hypothermia during surgery had a lower incidence of free flap pedicle thrombosis than those who were normothermic throughout the surgery. However, no conclusion can be made about the impact of hypothermia on pedicle thrombosis since the difference failed to reach statistical significance.

Incidence of cerebrovascular accident following head and neck free tissue transfer surgery

The aim of this study was to determine the incidence of postoperative cerebrovascular accident (CVA) following head and neck free tissue transfer and to identify predictive risk factors. A retrospective audit was performed of patients who underwent head and neck reconstructive surgery at Queen Elizabeth University Hospital between 2009 and 2020. The patient records were analysed to identify those who developed CVA within 30 days after surgery. A total of 1109 patients underwent head and neck free tissue transfer surgery, including 1048 neck dissection procedures. Of these, 78.6% had one or more identified risk factors for perioperative stroke. Five patients (0.45%) developed postoperative CVA. The results showed that CVA correlated to patients with hypercholesterolemia (P = 0.007). This study demonstrates the safety of free tissue transfer. Despite underlying co-morbidities and risk factors, the incidence of CVA is low following surgery and manipulation of the major vasculature of the neck.

Multi-domain analysis of non-surgical risk factors amenable to pre-operative optimization in microvascular head and neck surgery

PurposeThe goal of this study was to conduct a multi-domain, organ system-based analysis of non-surgical comorbidities amenable to pre-operative optimization in patients undergoing free tissue transfer, in order to better understand factors that influence patient outcomes. Study designRetrospective review. SettingsTertiary academic center. Materials and methodsA retrospective analysis of 546 patients in a prospectively maintained database who underwent free tissue transfer reconstruction between 2007 and 2016 was performed. Analysis of the relationship between binary-coded system-based domains and log-transformed length of stay (LOS), rehabilitation requirement, 30-day readmission, and post-operative complications was conducted with multiple linear regression or logistic regression models. ResultsPoor nutritional status and the presence of anxiety/depression independently increased median hospital LOS. Endocrine and metabolic deficits, poor nutrition status, and psychiatric comorbidities were significant predictors for rehabilitation facility requirement upon discharge. ConclusionInterventions targeted to patient psychiatric and nutritional health may yield substantially improved outcomes in the head and neck cancer population receiving free tissue transfer surgery.

Intraoperative Vasopressor Usage in Free Tissue Transfer: Should We Be Worried?

The role of vasopressors has long been a subject of debate in microsurgery. Conventional wisdom dictates the avoidance of vasopressor use, due to concerns such as peripheral vasoconstriction, inducing vasospasm of the anastomoses, and leading to failure in perfusion. It has since become common practice in some centers to avoid intraoperative vasopressor use during free tissue transfer surgery. Recent studies have suggested that this traditional view may not be supported by clinical evidence. However, none of these studies have separated vasopressor use by method of administration. We conducted a retrospective review of our experience of vasopressor use in free flap surgery at a single high-volume center. The outcome measures were flap failure, flap-related complications and overall postoperative complications (reported using the Clavien-Dindo classification). Groups were compared using Chi-square or Fisher's Exact test where appropriate. A total of 777 cases in 717 patients were identified. 59.1% of these had vasopressors administered intraoperatively. The overall failure rate was 2.2%, with 9.8% experienced flap-related complications. There was no difference in flap loss when vasopressors were administered, but an increased rate of microvascular thrombosis was noted (p = 0.003). Continuous administration of vasopressors was associated with reduced venous congestion, whereas intermittent boluses increased risk of microvascular thrombosis. Our study confirms previous findings that intraoperative vasopressor use in free flap surgery is not associated with increased failure rate. Administering vasopressors continuously may be safer than via repeated boluses.

Comparison Between the Impact of Vasopressors and Goal-Directed Fluid Therapy on the Management of Free Flap Reconstruction of Head and Neck and Monitoring in ICU.

Head and neck reconstructions are often accompanied with complex long surgical procedures. Free flap tissue transfer is a standard reconstruction method that reestablishes severe tissue defects after resection due to trauma or cancer. Imbalanced fluid resuscitation can extremely harm the outcome of the flap either due to hypoperfusion or edema. Flap-related postoperative complications mainly flap failure necessitates the administration of a large amount of intravenous fluids perioperatively especially with lengthy operative time. Therefore, vasopressors may be used to preserve hemodynamic stability without excessive fluids use. Nevertheless, these vasopressors have long been disfavored as they may provoke anastomosis vasoconstriction leading to graft hypoperfusion and finally flap failure. However, according to recent guidelines, they are now well-thought to be safe. Of note, inotropes have been confirmed to increase blood flow in the anastomosis hence they can replace vasoconstrictors. Recently, goal-directed fluid therapy (GDFT) has been proven to be excellent in high-risk head and neck free tissue transfer surgery as it decreases prolonged intensive care unit (ICU) admission hospitalization and complication rate. Today, GDFT is highly suggested as one of the enhanced recoveries after surgery protocols for major head and neck free flap reconstruction surgery.

Role, Management, and Outcome of Free Flap Reconstruction for Acute Full-Thickness Burns in Hands

Severe thermal trauma to the hand can result in major impairment and reduced function due to defective healing or even extremity loss. Full-thickness injuries frequently incur exposure of tendons or bone and require an early and stable coverage with soft tissue transplants to allow for rapid induction of exercise and to preserve structures and hand function. Free tissue transfer to the hand after thermal trauma is a rare indication, and safety, management, and outcome of free flap surgery for severe acute burn injuries to the hand remains underreported. Patients with primary reconstructions of full-thickness burn injuries to the hand undergoing microsurgical free tissue transfer surgery were retrospectively assessed in a period from 2013 to 2016. Salvage strategy of the extremity, postoperative complications, length of hospital stay, and primary reconstructive result were quantified and analyzed. Functional outcome measures (range of motion and grip strength) were assessed during clinical follow-up examinations. During the investigated period, 13 patients were identified undergoing reconstruction of 14 hands via free flap transplantation after severe burn injury in the acute phase. Nine anteriolateral thigh flaps (64%), 3 latissimus dorsi flaps (18%), 1 serratus anterior flap, and 1 tensor fasciae lata flap (7%) were performed. In all cases, salvage of the affected extremity was achieved, although 1 flap (7%) was lost during the early postoperative period requiring secondary reconstruction via pedicled groin flap. Further complications were venous thrombosis (n = 2; 14%) and hematoma (n = 2; 14%). Mean length of hospital stay was 51 days. Functional outcome during follow-up examination after an average of 9.3 months was inhomogeneous depending on the pattern of injury and ranged from complete recovery to nearly entire loss of hand function. Free flap transfer can be a mandatory and valuable tool to cover full-thickness burn injuries of the hand early in the clinical course of thermal trauma and may provide extremity salvage by favorable means of reconstruction to achieve acceptable functional outcomes, in the most severe cases. Although microsurgical failure rates in burn patients are slightly higher than in free flap transfer to the upper extremity in general, it can be performed with reasonable risk-to-benefit ratio.

Head and Neck Tumor Resection and Free Flap Reconstruction in Low-Volume Center.

To determine the surgical outcomes of free tissue transfer surgery following head and neck tumor extirpation in a low-volume medical center. Retrospective chart review of patients who underwent free tissue transfer surgery for head and neck cancer at Moanalua Medical Center from 2015 to 2018. Free flap failure rate and free flap-related complications. From 2015 to 2018, there were 27 free tissue transfer surgery (mean 6.75 flap surgery/year). There were 2 events of partial flap necrosis, and no cases of total flap loss. One patient required leech therapy for venous congestion. One patient required additional free flap surgery. Two patients developed orocutaneous fistula that resolved with local wound care. One patient developed malocclusion following mandible reconstruction using fibular free flap. Overall free flap success rate was 96%. This study supports the ability of small-volume centers to produce positive outcomes with few complications in head and neck cancer free flap reconstructive surgery. While the data are limited to a single surgical team in one care center, it provides additional support for the idea that there are factors beyond the surgical volume that determine outcome.

Free tissue transfer for burns reconstruction: A single-site experience

This study reviews free tissue transfer (FTT) surgery for both acute wound and reconstructive scar management of burn injuries at a UK burns unit over a 10-year period. Thirty eight patients underwent 46 FTTs, or free flaps, as part of their burn injury pathway. For the cohort of patients, there was one flap failure, which occurred for a secondary scar reconstruction. It is noted that FTT was successful for all seven acute or primary interventions. Anterolateral thigh flap was the most frequently performed (57%); followed by parascapular flaps (22%) of which 43% were pre-expanded. A method of pre-expansion for neck contractures and a novel technique of anchoring this flap to the pre-tracheal fascia are described here. This can provide the patient with good neck contouring by using the capsule to hitch the flap into a good position. It is clear that further work is required to study the prevention of hypertrophic scarring that can occur at the interface between flap and adjacent skin, where occurrence rate in this cohort was 17%. It is proposed that FTT now provides a viable solution both to the coverage of complex burn wounds and to the revision of scar contractures. Consensus over an FTT protocol for the primary management of open burn wounds is seen as the logical next step for this surgical intervention.

Oromandibular reconstruction with free fibula osteocutaneous flap after oncologic resection: retrospective analysis of surgical experience and operative outcome of 56 cases

Background: Reconstruction of post oncologic resection oromandibular defect is challenging and it provides the base for subsequent radiotherapy and oromaxillary rehabilitation for functional and aesthetic outcome. Multiple reconstructive options including different free flaps exist in the present time of greater awareness, facility and expertise in the field of free tissue transfer surgery. But free fibula osteocutaneous flap (FFOCF) has been the state of art in this area. FFOCF is technically difficult but believed to be reliable even to start with and has a progressively comprehensive surgical technique and learning curve. We are presenting here our experience of FFOCF reconstruction of 56 cases over the last 3 years.Methods: 56 patients operated between 2015 to 2018 were assessed retrospectively for operative and surgical outcome.Results: Flap was successful in 54 (96.43%) cases. Re-exploration was done in 4 cases and was successful in 2 cases. Jaw shape and contour was satisfactory in 70.37% and solid food tolerance was noted in 80.35% cases. Recurrence was seen in 5 cases.Conclusions: FFOCF is a reliable reconstructive option for complex oromandibular defect with a predictable outcome. Flap harvest is reliable and contouring is comprehensive. It gives good functional and aesthetic results with high success rate. Thus this flap is truly the preferred reconstructive option for all type of oncologic oromandibular defect with micro vascular surgery facilities.

Pervasive wearable device for free tissue transfer monitoring based on advanced data analysis: clinical study report

.Free tissue transfer (FTT) surgery for breast reconstruction following mastectomy has become a routine operation with high success rates. Although failure is low, it can have a devastating impact on patient recovery, prognosis, and psychological well-being. Continuous and objective monitoring of tissue oxygen saturation () has been shown to reduce failure rates through rapid detection time of postoperative vascular complications. We have developed a pervasive wearable wireless device that employs near-infrared spectroscopy (NIRS) to continuously monitor FTT via measurement. Previously tested on different models, the results of a clinical study are introduced. Our goal for the study is to demonstrate that the developed device can reliably detect variations in a clinical setting: 14 patients were recruited. Advanced data analysis was performed on the variations, the relative gradient change, and the classification of the within different clusters of blood occlusion level (from 0% to 100% at 25% step) based on previous studies made on a vascular phantom and animals. The outcomes of the clinical study concur with previous experimental results and the expected biological responses. This suggests that the device is able to correctly detect perfusion changes and provide real-time assessment on the viability of the FTT in a clinical setting.

Taking Free Flap Surgery Abroad: A Collaborative Approach to a Complex Surgical Problem.

Accessibility to health care, especially complex surgical care, represents one of the major health care disparities in developing countries. While surgical teams may be willing to travel to these areas to help address these needs, there are many logistical and ethical dilemmas inherent in this pursuit. We reviewed our approach to the establishment of the team-based surgical outreach program, wherein we perform head and neck free tissue transfer surgery in Haiti. We describe the challenges encountered in the delivery of surgical care as well as ethical dilemmas relevant to surgical outreach trips, highlighting an approach reliant on strong local cooperation. Despite the obstacles in place, our experience shows that free flap surgery can be successfully and ethically performed in these areas of great need.

Intraoperative hypotension and flap loss in free tissue transfer surgery of the head and neck.

In free flap head and neck reconstructions, hemodynamic management is complicated by the deleterious effects of excessive crystalloid administration. Patients may undergo periods of hypotension or excess fluid administration. The purpose of this study was to present our examination of the hypotheses that intraoperative hypotension and blood pressure lability are associated with increased fluid administration and flap failure. We reviewed the records of 445 patients undergoing head and neck surgery involving free tissue transfer. We used multivariate logistic regression to examine the relationship between hemodynamic variables and flap loss (primary outcome) and other complications. On multivariate analysis, intraoperative hypotension and large-volume fluid administration were associated with flap loss. Neither blood pressure lability nor vasopressor administration was significantly associated to our primary outcome. Intraoperative hypotension is associated to flap failure in head and neck free tissue transfer surgeries, as is large-volume fluid administration.

Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries.

We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS. Using Taiwan's national data (2001-2012), we conducted a retrospective cohort study of all adults 18-64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day. Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals (P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11-1.55) and high-volume surgeons (OR = 1.16; CI,1.03-1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small. There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan.

The Associations of Hospital Volume, Surgeon Volume, and Surgeon Experience with Complications and 30-Day Rehospitalization after Free Tissue Transfer: A National Population Study

Greater provider volume is associated with better outcomes. There is, however, a paucity of evidence on volume-outcome associations for surgical complications and 30-day all-cause rehospitalization after free tissue transfer or free flap surgery. Surgical complications and frequent rehospitalization are important quality indicators that substantially hinder appropriate health care spending. The authors hypothesized that increased provider volume and surgeon experience are associated with lower complication and hospital readmission rates. The authors conducted a retrospective cohort study of adults aged 18 to 64 years who underwent free tissue transfer. They examined 100 percent of all free tissue transfers between 2001 and 2012 using Taiwan's national data, and used regression modeling to examine associations between volume and outcome. All models were adjusted for patient, surgeon, and hospital characteristics. Seventeen percent of free tissue transfer operations (4201 of 25,327) had complications. Infection was the most prevalent after free tissue transfer (70 percent), and the 30-day rehospitalization rate was approximately 20 percent. Hospital volume was associated with a small decrease in complications (OR, 0.99; 95 percent CI, 0.99 to 0.99; p < 0.01). For surgeons, years of experience and not annual case volume decreased surgical complications (OR, 0.98; 95 percent CI, 0.97 to 0.99; p = 0.01). The authors did not find any association between hospital or surgeon volume, or surgeon's years of experience and 30-day rehospitalization. Higher-volume hospitals and more experienced surgeons were shown to have a lower likelihood of postsurgery complications. Hospital process and structure affect outcomes and reduce surgical complications. Reducing 30-day rehospitalization may require payment reform, as it demands coordinated care before and after hospital discharge. Therapeutic, III.

Risk factors for free flap failure: a retrospective analysis of 881 free flaps for head and neck defect reconstruction

The aim of this study was to identify the risk factors for free flap failure after head and neck reconstructive surgery. The data of 881 consecutive patients who underwent free flap surgery at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, between January 2013 and November 2016, were reviewed retrospectively. All surgeries were performed by a single head and neck surgical team. Patient demographic and surgical data that may have an influence on free flap outcomes were recorded. The χ2 test and multivariate logistic regression analysis were used to identify relevant risk factors. In total, 881 free tissue transfer surgeries were included in this study. Free flap failure occurred in 26 of 881 flaps (2.9%). A history of irradiation (odds ratio 0.205, 95% confidence interval 0.07–0.56; P=0.002) was a statistically significant risk factor for free flap failure. Age, diabetes mellitus, history of previous neck surgery to the anastomosis side, donor site, choice of recipient vein, use of a coupler device, and postoperative anticoagulation were not associated with free flap outcomes. Thus, it is concluded that when performing head and neck reconstructive surgery, special attention should be paid to patients who have previously undergone irradiation.

Short-stay hospital admission after free tissue transfer for head and neck reconstruction.

To show that, for patients with few medical comorbidities and at low risk for airway compromise or fistula formation, early discharge after free tissue transfer for head and neck reconstruction is a safe and viable option. Retrospective chart review. A cohort of patients who underwent free tissue transfer for head and neck reconstruction between February 2010 and December 2014 and who were discharged from the hospital by postoperative day 3 were reviewed. Fifty patients undergoing 51 free-tissue transfer surgeries were discharged by postoperative day 3. The surgeries performed included anterolateral thigh free flaps (ALT) (n = 46), radial forearm free flaps (n = 2), latissimus myogenous and myocutaneous free flaps (n = 1), supraclavicular free flap (n = 1), and serratus free flap (n = 1). All ALT flaps were harvested exclusively as perforator free flaps; and the vast majority used superficial temporal, angular, or facial vessels. All free flaps were viable without evidence of vascular compromise at discharge and the initial follow-up appointment. One patient required take-back for successful flap salvage. One patient experienced late flap failure (between 2-3 weeks postoperatively), requiring another surgery. This resulted in an overall success rate of 98% in this cohort. No other postoperative complications related to early discharge were identified. In a carefully selected subset of patients undergoing free tissue transfer, early discharge has been shown to be possible without compromising patient safety or surgery success rates. 4. Laryngoscope, 126:2679-2683, 2016.

Vasopressor use in free tissue transfer surgery

Vasopressor use in free tissue transfer surgery