Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

Abstract

Background Monitoring the microcirculation postoperatively has been the subject of numerous original articles and reviews since the early 1980s. Effective monitoring returns compromised flaps to the operating room early, increases the flap success and reduces secondary complications. We would like to present the case based on our experiences that clinical monitoring alone is sufficient for the majority of patients. Methods Using a retrospective case note review, we present the experiences of the senior surgeon (DG) in his first 592 consecutive free tissue transfers in practice. Results The overall success rate was 98.9 % (585/592) with an overall salvage rate of 93 % (13/14).Conclusions Clinical monitoring provides sufficient reassurance in the majority of patients undergoing free tissue transfers. We believe that buried flaps and flaps to the lower limb may warrant adjunctive monitoring techniques on a case-by-case basis. Level of Evidence: Level IV, diagnostic study.