title: Outcome of microvascular free flaps in a high-volume training centre.
abstract: OBJECTIVE
  Microvascular free tissue transfer allows major ablative defects following oncologic surgical and traumatic reasons to be reliably reconstructed in the head and neck region. A retrospective analysis of the microvascular flap procedures which were performed within one year in a high volume training centre was performed.
  
  
  METHODS
  The microvascular free flap procedures of the year 2011 were reviewed and followed up until the 31st December 2012. The type and indication of the reconstructive procedure, operation time, operating team, experience and level of training of the surgeons involved, postoperative IMC (intermediate care unit) and/or ICU (intensive care unit) time, inpatient time, flap revisions, further postoperative complications, preoperative and postoperative radiation of the patients, the placement of dental implants were studied.
  
  
  RESULTS
  From 1st of January 2011 to 31st of December, 2011, the data of 101 patients with 103 microvascular free flap procedures were analysed of which 72% (84 flaps) were harvested by residents. The patients ranged in age from 14 to 89 years (mean age 59 years, 71 males and 40 females). The mean operation time was 591 min with the longest operation times for scapular flaps (744 min) and the shortest operation times for ALT flaps (455 min). Mean inpatient time was 34.2 days with a minimal time for the fibular flaps of 27.2 days and a maximum of 45.7 days for the latissimus dorsi flaps. 24 flaps (23.3%) in total had to be revised with bleeding being the main cause of immediate revisions (41.7% of all revisions). 5 flaps (4.85% of all flaps) were lost despite a revision procedure meaning a successful revision rate in 79.2% of all revisions.
  
  
  CONCLUSIONS
  Microvascular reconstruction procedures are safe and should be considered as standard procedures for reconstruction of large defects especially in high volume training centres. Intensive flap monitoring and early revisions maximize the flap outcome.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany. Electronic address: a.al-dam@uke.de.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Dam
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Tomislav Ante
authors.initials: TA
authors.lastname: Zrnc
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Hanken
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Riecke
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Eichhorn
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Dr. Ibrahim Nurwali, DMD), Taibah University, Medinah, Saudi Arabia.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Nourwali
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Smeets
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Blessmann
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Max Heiland, MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gröbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003422:Critical Care; D015921:Dental Implants; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D013502:General Surgery / Q000193:education; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010348:Patient Care Team; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015921:Dental Implants
keywords: Complications; Free flap; Microsurgery; Outcome; Reconstruction; Surgical training