title: [A surgical follow-up platform to reduce complications in free flap surgery].
abstract: OBJECTIVE
  In 2007, the WHO adopted surgical safety as the theme for the 2nd global patient safety challenge. Measurement of surgical services was identified as a surgical care area in need of major improvements. Aware of this recommendation, a preliminary study was conducted in our hospital and showed that the incidence of complete necrosis in free flap surgery was 10.0 %, a rate among the highest found in medical literature. In that context, an interactive surgical follow-up platform (PICS) was implemented to monitor outcomes in free flap surgery. The hypothesis was to reduce the short-term failure of microsurgical reconstructions.
  
  
  METHODS
  In Summer 2010, the tool for capturing and analyzing data (PICS) was implemented. All patients who underwent free flap reconstruction were prospectively registered in the platform. The primary endpoints to evaluate the effectiveness of the tool are the rates of surgical re-exploration and complete necrosis of the flap.
  
  
  RESULTS
  From May 2010 to December 2011, 129 cases of free flap reconstruction were recorded. The rate of total flap necrosis was 10.0 % before database introduction and declined to 3.1 % afterwards (P<0.05). Take-backs occurred in 27.0 % of free flap reconstructions at baseline and in 10.1 % after implementation (P<0.01).
  
  
  CONCLUSIONS
  The implementation of PICS is associated with a significant improvement of postoperative short-term outcomes in free flap surgery. This tool is effective to evaluate care services and provides an increased surgical safety for patients. Surgical teams are encouraged to implement a data collection tool in order evaluate operative care on a routine basis.
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: G
authors.initials: G
authors.lastname: Landes
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: E
authors.initials: E
authors.lastname: Boghossian
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: P G
authors.initials: PG
authors.lastname: Harris
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: A
authors.initials: A
authors.lastname: Gagnon
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: J
authors.initials: J
authors.lastname: Bou-Merhi
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: C
authors.initials: C
authors.lastname: Bernier
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: P
authors.initials: P
authors.lastname: Grenier-Vallée
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada.
authors.forename: R
authors.initials: R
authors.lastname: Burke
authors.affiliation: Service de chirurgie plastique & reconstructive, département de chirurgie, centre hospitalier de l'université de Montréal, hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, H2L 4M1 Canada. Electronic address: michel.alain.danino@umontreal.ca.
authors.forename: M A
authors.initials: MA
authors.lastname: Danino
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies
keywords: Base de données; Database; Flap necrosis; Follow-up platform; Free flap; Lambeau libre; Nécrose du lambeau; Plateforme de suivi; Surgical safety; Sécurité chirurgicale