Long term study into surgical re-exploration of the 'free flap in difficulty'.
BACKGROUND
Free tissue transfers must survive in order to achieve their surgical goals. There is little consensus about managing the 'failing' free flap, and practice is often guided by anecdote.


METHODS
We have prospectively collected data about all free flaps performed within our department between 1985 and 2008 (2569 flaps). We identified 327 flaps which were re-explored a total of 369 times. We analysed these flaps with regard to indication for re-exploration, operative findings and outcome.


RESULTS
Thirteen percent (327) of free flaps were re-explored. Of these, 291 (83%) had a successful outcome. Successful re-explorations took place at a mean 19h post-op and unsuccessful re-explorations at a mean 56h post-op. Clinical diagnosis prior to re-exploration was confirmed operatively in 91% of cases.


CONCLUSIONS
We have considered the factors that allowed us to achieve the salvage rates described over a prolonged period, and identified two key areas. Firstly, we favour a model for free flap monitoring with clinical judgement at its core. Secondly, we feel the facility to recover patients post-operatively in a specialised, warmed environment, and return them to theatre quickly should the need arise, is essential. These two simple, yet institutionally determined factors are vital for maintaining excellent success rates.
Winterton
R I S
RI
Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George Street, Leeds LS1 3EX, UK. wintertonris@hotmail.com
Pinder
R M
RM
Morritt
A N
AN
Knight
S L
SL
Batchelor
A G
AG
Liddington
M I
MI
Kay
S P
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012086:Reoperation; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects* / Q000502:physiology; D055815:Young Adult