title: Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers.
abstract: BACKGROUND
  Microsurgical free tissue transfer has become a reliable technique. Nevertheless, 5 to 25 percent of transferred flaps require re-exploration due to circulatory compromise. This study was conducted to evaluate the timing of occurrence of flap compromise following free tissue transfer, and its correlation with salvage outcome.
  
  
  METHODS
  Between January of 2002 and June of 2003, 1142 free flap procedures were performed and 113 flaps (9.9 percent) received re-exploration due to compromise. All patients were cared for in the microsurgical intensive care unit for 5 days. Through a retrospective review, timing of presentation of compromise was identified and correlated with salvage outcome.
  
  
  RESULTS
  Seventy-two flaps (63.7 percent) were completely salvaged and 23 (20.4 percent) were partially salvaged. Eighteen flaps (15.9 percent) failed completely. Ninety-three flaps (82.3 percent) presented with circulatory compromise within 24 hours; 108 (95.6 percent) presented with circulatory compromise within 72 hours, and 92 flaps (85.2 percent) were salvaged within this period. One out of the three flaps presenting with compromise 1 week postoperatively was salvaged. Flaps presenting with compromise upon admission to the microsurgical intensive care unit had significantly lower complete salvage rates as compared with those without immediate abnormal signs (40.9 percent versus 69.2 percent, p = 0.01).
  
  
  CONCLUSIONS
  The time of presentation of flap compromise is a significant predictor of flap salvage outcome. Intensive flap monitoring at a special microsurgical intensive care unit by well-trained nurses and surgeons allows for early detection of vascular compromise, which leads to better outcomes.
authors.affiliation: Taoyuan, Taiwan From the Department of Surgery, Saint Paul's Hospital, and the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and University.
authors.forename: Kuang-Te
authors.initials: KT
authors.lastname: Chen
authors.forename: Samir
authors.initials: S
authors.lastname: Mardini
authors.forename: David Chwei-Chin
authors.initials: DC
authors.lastname: Chuang
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
authors.forename: Yu-Te
authors.initials: YT
authors.lastname: Lin
authors.forename: Wei-Chao
authors.initials: WC
authors.lastname: Huang
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011336:Probability; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation; D015427:Reperfusion Injury / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D012867:Skin / Q000098:blood supply; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply*; D013997:Time Factors