title: Free tissue transfers at Hutt Hospital.
abstract: BACKGROUND
  The Wellington Regional Plastic, Maxillofacial & Burns Unit based at Hutt Hospital provides comprehensive reconstructive services to central New Zealand with a population of 1.1 million. Free tissue transfer procedures in the Unit were audited to determine the indications and rate of usage in our population, our success and complication rates, and how these compare with published series.
  
  
  METHODS
  Prospectively collected data on all free tissue transfer procedures between January 2006 and September 2010 were analysed.
  
  
  RESULTS
  Two hundred and seven free flaps including 17 flap types being performed on 186 consecutive patients including 199 primary and 8 salvage flaps. Eighty-three percent were elective and 17% were acute cases. The majority of the flaps were used for head and neck (48%) and breast (31.5%) reconstruction. Ulnar forearm flap was the most commonly used fasciocutaneous flap. 18.8% of patients had major complications requiring return to theatre. Microsurgical revision was performed in nine (4.3%) flaps of which six were successfully salvaged. Overall, 13 flaps (6.3%) failed completely, giving an overall success rate of 93.7%. Haematoma requiring formal drainage occurred in 12 (5.8%) cases.
  
  
  CONCLUSIONS
  The wide variety of flaps used reflects the very broad range of defects requiring free flap reconstruction. We show a free flap success rate of 93.7% in our medium-sized regional unit. Our microsurgical revision rate of 4.3% is lower than the revision rate of 10% in reported series with high overall success rates. More consistent early detection of failing flaps is likely to further improve our overall success rate.
authors.affiliation: Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, High Street, Lower Hutt, New Zealand.
authors.forename: Jonathan P S
authors.initials: JP
authors.lastname: Heather
authors.forename: Gary
authors.initials: G
authors.lastname: Avery
authors.forename: Christina M
authors.initials: CM
authors.lastname: Ackland
authors.forename: Swee T
authors.initials: ST
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps / Q000706:statistics & numerical data; D006085:Graft Survival; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D008866:Microsurgery / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D009520:New Zealand; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000706:statistics & numerical data; D012086:Reoperation; D016879:Salvage Therapy; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery; D055815:Young Adult