title: Prospective evaluation of outcome measures in free-flap surgery.
abstract: Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +/- 29 min) and in those that survived (92 +/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.
authors.affiliation: Department of Plastic Surgery, University College Hospital, Galway, Newcastle, Ireland.
authors.forename: John L
authors.initials: JL
authors.lastname: Kelly
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Eadie
authors.forename: David
authors.initials: D
authors.lastname: Orr
authors.forename: Mogdad
authors.initials: M
authors.lastname: Al-Rawi
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Donnell
authors.forename: Denis
authors.initials: D
authors.lastname: Lawlor
mesh_terms: D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D000925:Anticoagulants / Q000008:administration & dosage; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D006085:Graft Survival; D006801:Humans; D007511:Ischemia; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D013524:Surgical Flaps; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000925:Anticoagulants