Free flap reconstruction experience and outcomes at a low-volume institution over 20 years

Abstract

Objective: Assess the efficacy of free flap reconstruction performed at a low-volume program and evaluate how volume and outcomes have changed over 20 years.

Study design: Case series with chart review.

Setting: Tertiary academic medical center.

Subjects and methods: A retrospective chart review was performed at a tertiary care academic program on all free tissue flaps from the primary reconstructive surgeon over 20 years (1993-2013). In total, 136 procedures were obtained from operative notes, billing codes, and chart databases. Outcome variables included procedure success and complications. Patients stayed in general intensive care unit and hospital floor units.

Results: Flap success was 92.6% of all cases. In the past 13 years, 70 flaps were performed with 3 failures (96% success rate). Take-back rate was 16% of total cases with a flap recovery rate of 60%. Postoperative failure occurred after 72 hours in 60% of cases. Nearly 60% of patients experienced a complication of any type or severity. Twenty percent had a flap complication while maintaining viability, with half of these being partial dehiscence. Systemic complications affected 20% of all cases. The average hospital stay for noncomplicated patients was 13 days. There was 1 postoperative mortality. Fibula and radial forearm were the most common flaps at 44% and 26%, respectively.

Conclusion: Free flap reconstruction of the head and neck can be performed by appropriately skilled surgeons with acceptable outcomes in low-volume settings. Success rate appears to increase as clinical experience is gained.

Keywords: free flaps; free tissue transfer; head and neck; microsurgery; microvascular surgery; reconstruction.