title: Free tissue transfer: comparison of outcomes between university hospitals and community hospitals.
abstract: BACKGROUND
  In university hospitals, free tissue transfer has become a standard method of reconstruction for a broad spectrum of defects. Because of its complexity, free tissue transfer has not been routinely performed in a community hospital setting. This study reports the outcomes of two equal groups of free tissue transfer performed by the same surgeons, comparing the university versus the community hospital setting.
  
  
  METHODS
  A total of 735 free tissue transfers were performed at one university hospital and six community hospitals in our region over a 10-year study period. Outcome parameters used in this study included wound complications such as infection, dehiscence, delayed healing, hematoma, and fat necrosis.
  
  
  RESULTS
  A total of 674 operations were performed using 735 free tissue transfers: 386 free tissue transfers were performed at the university hospital (53 percent) and 349 (47 percent) were performed at the community hospital. Categories of free tissue transfer reconstruction included breast, lower extremity, head and neck, and upper extremity reconstructions. Most of the breast reconstructions were performed in the community hospital, whereas most of the lower extremity and head and neck reconstructions were performed at the university hospital. Fifty-one major postoperative complications occurred in the university hospital (14 percent), while 31 (10 percent) occurred in the community hospital. Complication rates did not differ significantly between settings; however, there was a trend toward more wound infections in the university hospital and more cases of fat necrosis in the community hospital, most likely reflected in the differing case mix between hospital settings.
  
  
  CONCLUSIONS
  Free tissue transfer is an effective and practical method of reconstruction that has been safely performed in both university and community hospital settings.
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pa. 19104, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Vega
authors.forename: Shao
authors.initials: S
authors.lastname: Jiang
authors.forename: Amir B
authors.initials: AB
authors.lastname: Behnam
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
authors.forename: H Raul
authors.initials: HR
authors.lastname: Herrera
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000714:Anastomosis, Surgical; D001132:Arm / Q000601:surgery; D005218:Fat Necrosis / Q000453:epidemiology; D005260:Female; D006257:Head / Q000601:surgery; D006406:Hematoma / Q000453:epidemiology; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007866:Leg / Q000601:surgery; D008297:Male; D016462:Mammaplasty / Q000706:statistics & numerical data; D008866:Microsurgery; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000706:statistics & numerical data*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D016378:Tissue Transplantation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014945:Wound Healing