Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Sep;122(3):962-971.
doi: 10.1097/PRS.0b013e3181811ca0.

Strategy for reoperative free flaps after failure of a first flap

Steffen Baumeister  1 , Keith E Follmar, Michael R Zenn, Detlev Erdmann, L Scott Levin
Affiliations

Strategy for reoperative free flaps after failure of a first flap

Steffen Baumeister et al. Plast Reconstr Surg. 2008 Sep.

Abstract

Background: Free vascularized tissue transfer is generally associated with high success rates, but failures do occur. After a flap failure, the decision is often made to perform a second, reoperative free flap.

Methods: A retrospective review of all microsurgical free tissue transfers performed at the authors' institution identified 13 patients who underwent a second, reoperative free flap after a failed primary flap. The records of these patients were reviewed, with particular emphasis on identifying changes in treatment strategy between the initially failed and the reoperative free flap.

Results: Thirteen patients were identified as having undergone a reoperative free flap. In nine of 13 primary free flaps, at least one likely cause for the failure was identified (69 percent). In the approach to the second free flap, strategy changes were performed in 10 of 13 cases (77 percent); 11 were successful (85 percent). One of the two patients with a failed reoperative free flap underwent a third attempt at free tissue transfer, which also failed.

Conclusions: The authors' overall approach to the failed free flap includes the following four steps: (1) reconsideration of the need for vascularized free tissue transfer, (2) a sensitive psychosocial approach to the patient and family, (3) analysis of the cause of the first flap failure, and (4) change in microsurgical strategy. Based on the authors' experience, they consider two previously failed free flaps without an obvious cause to be a contraindication to a third attempt.

PubMed Disclaimer

References

    1. Mao, C., Yu, G. Y., Peng, X., et al. A review of 545 consecutive free flap transfers for head and neck reconstruction in a new microsurgery unit (in Chinese). Zhonghua Er Bi Yan Hou Ke Za Zhi 38: 3, 2003.
    1. Nieminen, H., Kuokkanen, H., Tukiainen, E., and Asko-Seljavaara, S. Free flap reconstructions of 100 tibial fractures. J. Trauma 46: 1031, 1999.
    1. Shaw, W. W. Microvascular free flaps: The first decade. Clin. Plast. Surg. 10: 3, 1983.
    1. Disa, J. J., Hu, Q. Y., and Hidalgo, D. A. Retrospective review of 400 consecutive free flap reconstructions for oncologic surgical defects. Ann. Surg. Oncol. 4: 663, 1997.
    1. Kroll, S. S., Schusterman, M. A., Reece, G. P., et al. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast. Reconstr. Surg. 98: 1230, 1996.

LinkOut - more resources