Free Flaps in a Resource Constrained Environment: A Five-Year Experience—Outcomes and Lessons Learned

Abstract

Introduction. Free flap surgery is a routine procedure in many developed countries with good surgical outcomes. In many developing countries, however, these services are not available. In this paper, we audit free flaps done in a resource constrained hospital in Kenya. Objective. This is a five-year audit of free flaps done in a tertiary hospital in Kenya, between 2009 and 2014. Materials and Methods. This was a prospective study of patients operated on with free flaps between 2009 and 2014. Results. A total of one hundred and thirty-two free flaps in one hundred and twenty patients were performed during the five-year duration. The age range was eight to seventy-two years with a mean of 47.2. All the flaps were done under loupe magnification. The overall flap success rate was eighty-nine percent. Conclusion. Despite the many limitations, free flaps in our setup were successful in the majority of patients operated on. Flap salvage was noted to be low due to infrequent flap monitoring as well as unavailability of theatre space. One therefore has to be meticulous during surgery to reduce any possibilities of reexploration.

Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

“…7,8 Nonsurgical salvage and surgical reexploration are often required to rescue these complication-threatened free flaps, and the salvage rate ranges from 12.5 to 76.0%. [6][7][8]37,38 The success rate of flap transfer in the present systematic review was 97.1%, which is quite comparable with previously reported success rates. The complication rate was 5.7%, which is remarkably lower than that of flap transfer without adjuvant application of NPWT.…”

“…In several studies, surgical reexploration was required in 1.8 to 20.0% of these complication-threatened flaps, and only 12.5 to 57.0% of them were successfully salvaged. [6][7][8] Negative-pressure wound therapy (NPWT), also known as vacuum-assisted closure, vacuum sealing drainage, or topical negative pressure, has been extensively reported to accelerate cell proliferation, stimulate angiogenesis, facilitate granulation, promote blood circulation, reduce edema, and inhibit infection. [12][13][14][15] AlthoughNPWThaslong-standinguseinwound treatment, only during the presentdecadehas it achieved some success in assisting flap transfer and salvaging complicationthreatened flaps.…”

Fundamental information about free microvascular flap use in reconstructive

“…Alternativa navadenim metodama su arteriografija flourescentnim kontrastom ili radioaktivnim izotopima. Svrha ovih pretraga je promatranje cirkulacije uporabom RTG uređaja [16].…”

“…Idealna metoda monitoringa treba biti objektivna, kontinuirano bilježiti i najmanje promjene u arterijskoj i venskoj cirkulaciji, biti jednostavna za korištenje kako liječnicima tako i MS/MT [16]. Pribor za klinički monitoring režnja sadržava zadovoljavajuću rasvjetu (samostojeća ili džepna svjetiljka), sterilni štapić s vatom za testiranje tijeka krvi, sterilne igle za izvršavanje ubodnog testa, sterilni pribor za previjanje (pinceta, škare , sterilne rukavice) i listu za praćenje parametara režnja [1].…”

Speech and Swallowing Data in Individual Patients Who Underwent Glossectomy after Prosthetic Rehabilitation

“…Functional surgical reconstruction of the tongue—especially when a free flap is used by a trained surgical team—is not always possible [13], requires a greater surgical time [14], and increases the cost of treatment, which are limiting factors to this type of rehabilitation, especially in developing countries. Surgical reconstruction also does not exclude prosthetic rehabilitation, as many patients lose some of their teeth or the alveolar ridge after glossectomy [15, 16].…”