Free flap reconstruction in 1999 and 2009: Changing case characteristics and outcomes

Abstract

Patients undergoing free flap reconstruction are increasingly older and have more medical comorbidities. Despite these challenges, increased efficiency and teamwork stemming from accumulated institutional experience have led to decreased operative times, length of stay, and complication rates and increased overall success rates.

Revisiting the argument for 1‐ versus 2‐vein outflow in head and neck free tissue transfers: A review of 317 microvascular reconstructions

“…Although overall success rates for head and neck free flap reconstruction are high, complications remain relatively frequent. [1][2][3][4][5][6] Many factors contribute to the overall success of these complex reconstructions. Venous congestion is a common perioperative complication and cause of partial or total flap loss.…”

“…With increasing surgeon experience, refinement of surgical techniques, and improvements in technology, the overall success rates of microvascular reconstruction reported in large series from high-volume institutions are favorable, with most greater than 95%. [1][2][3][4] However, perioperative complications, which can be medical or surgical, remain a frequent occurrence ranging from 20% to 30%. 1,[3][4][5][6] A variety of free flaps have been described and utilized to reconstruct skin, bone, muscle, and other soft tissues.…”

“…[1][2][3][4] However, perioperative complications, which can be medical or surgical, remain a frequent occurrence ranging from 20% to 30%. 1,[3][4][5][6] A variety of free flaps have been described and utilized to reconstruct skin, bone, muscle, and other soft tissues. Despite advances in surgical techniques, microscope technology, and surgeon experience, complication rates still remain predictable with flap failure occurring in less than 10% of free tissue transfers to the head or neck.…”

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

“…Early flap failure rates approached 40 to 50 percent, 2 but advances over time have resulted in success rates of 90 to 99 percent. [3][4][5][6][7][8][9] Although rare, total flap failure and even partial flap loss can have devastating consequences.…”

Near‐infrared imaging for the assessment of anastomotic patency, thrombosis, and reperfusion in microsurgery: A pilot study in a porcine model

“…As microsurgical techniques continue to evolve, increasingly complex free tissue transfers are being performed for a broader range of indications on patients with more comorbidities. 2,[31][32][33] Early recognition of flap vascular compromise is known to improve rates of flap salvage. 34 The ideal method for earlier recognition and revision of compromised flaps, however, has yet to be established.…”