Twenty Years of "Occasional" Reconstructive Microsurgery: A Retrospective Review of a Single Surgeon's Experience

Abstract

Background: Microsurgical free flap reconstruction is a highly technical surgery, usually performed in high-volume specialized centers. During the last 20 years, we had to perform occasional microsurgical reconstructions in our plastic surgery department where general and aesthetic plastic surgery is the main activity. The aim of the study was to review the results of our microsurgical activity and compare it with the results published by high-volume microsurgical centers.

Methods: We retrospectively reviewed all our microsurgical free flap reconstructions from 2004 to 2024. We collected from the files all the data concerning demographics, indications, flaps used, technical details, complications, and final outcomes.

Results: Seventy-one patients were included in the study, with a total of 77 flaps. Patients' age ranged from 7 to 82 years. The operative site was the head and neck in 66 cases, the lower limb in 9 cases, and the abdominal wall in 2 cases. The most frequently used flaps were the latissimus dorsi flap (24 flaps), the radial forearm flap (23 flaps), and the fibula flap (16 flaps). Anastomoses were done mainly under loupe magnification. Ten flaps presented signs of vascular compromise. Salvage rate after confirmed vascular thrombosis was 60%. A total of 4 flaps were lost (94.8% success rate).

Conclusions: Provided that some precautions are respected, "occasional microsurgery" can have success rates comparable to high-volume microsurgery centers. It can save lives and improve the patients' quality of life, and it does not prevent the surgeon from pursuing a normal general and aesthetic plastic surgery career.

Fig. 1.

A 42-year-old male patient with squamous cell carcinoma of the left cheek mucosa, who was operated on and reconstructed with a radial forearm flap and irradiated 3 years earlier; later reoperation with an ALT flap was done for severe constriction of the jaws. The patient presented with radionecrosis and a fractured mandible.

Fig. 2.

One year after successful reconstruction with a free fibula flap.

Fig. 3.

A 55-year-old male patient with extensive recurrence of a squamous cell carcinoma, formerly operated on and irradiated. No vital structures were exposed. Many reconstructive options were available.

Fig. 4.

Reconstruction with an ALT flap.

Fig. 5.

A 61-year-old female patient. Defect after excision of the lower lip and the mandibular symphysis for a recurrent squamous cell carcinoma of the lower lip.

Fig. 6.

Reconstruction with an osteocutaneous radial forearm flap.

Fig. 7.

X-ray of the bony reconstruction.

Fig. 8.

A 27-year-old male patient with Romberg disease. Reconstruction with a buried parascapular flap. Note the temporary preauricular skin paddle for flap monitoring.

Fig. 9.

A 12-year-old female patient, operated on for a tibial sarcoma, with postoperative extensive exposure of the osteosynthesis material.

Fig. 10.

One week after coverage with a latissimus dorsi muscle flap. Note the presence of a skin paddle for flap monitoring. The skin paddle was removed at 2 weeks, and the muscle was covered with a split-thickness skin graft.