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The purpose of this study was to determine the rate of major and minor flap, donor site, and systemic complications in a consecutive series of 250 free flap operations. The following factors were analyzed to determine their significance on complication rates: age of patient, gender, wound etiology, smoking history, type of flap, operative time, vein graft use, surgeon experience, and the presence of comorbid disease. The major flap, donor-site, and systemic complication rates were 17.2%, 2%, and 6.4%, respectively. The minor flap, donor-site, and systemic complication rates were 7.2%, 12.8%, and 7.2%, respectively. The presence of comorbid medical condition was the only factor which had a statistically significant impact on the rate of major flap complications (P = 0.02). Age and comorbid disease impacted on major systemic complications (P = 0.04).

A three-year-old boy was investigated for inexplicable incessant crying. On examination, his left wrist was mildly swollen (three to four months) and sensitive. Exploration and carpal tunnel decompression of the left wrist with incisional biopsy was performed for the presence of a fusiform swelling intimately associated with the median nerve. Histopathology revealed the presence of enlarged nerve bundles admixed with mature fat cells and diffuse fibroblastic proliferation. Three months later, he underwent urgent contralateral carpal tunnel decompression for a similar presentation. The final diagnosis was bilateral fibrolipomatous hamartoma (FLH) of the median nerves causing acute bilateral compression neuropathy. FLH of the median nerve is an extremely unusual cause of acute bilateral carpal tunnel syndrome in a young child presenting with 'incessant crying'. A comprehensive review of FLH including epidemiology, etiology, clinical presentation, differential diagnosis, imaging, pathology, treatment and prognosis is discussed.

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