title: The effect of early detection of anterolateral thigh free flap crisis on the salvage success rate, based on 10 years of experience and 1072 flaps.
abstract: The aim of this study was to assess the effectiveness of early exploration of anterolateral thigh (ALT) free flap compromise in head and neck reconstruction and to correlate this with the salvage success rate. The perioperative data of 1051 patients with 1072 ALT flap reconstructions were reviewed retrospectively for the period January 2002 to December 2012. Outcome measures included ethnicity, defect type, incidence and timing of flap compromise, type of flap compromise, causes of vascular occlusion, and salvage rate. The success rate of free flap reconstruction was 97.3% (1043/1072). Of the 29 failures, 21 were complete and eight were partial failures (10-40% of the flap). Venous occlusions occurred in 39 flaps (83.0%) and arterial occlusions in five flaps (17.0%). Six cases were detected within 8h postoperatively, 13 at 8-16 h postoperatively, seven at 16-24h postoperatively, and 18 at 24-48 h postoperatively, with respective salvage rates of 66.7%, 61.5%, 28.6%, and 22.2%; three cases detected after 48 h failed. The salvage rate at ≤16 h (62.2%) was much higher than that at >16 h (21.4%, P=0.0039). Early detection, re-exploration, and effective handling of the flap crisis increases the rate of flap salvage tremendously.
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Ren
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: D
authors.initials: D
authors.lastname: Chickooree
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: H J
authors.initials: HJ
authors.lastname: Wu
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: H Y
authors.initials: HY
authors.lastname: Tan
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: K
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: He
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: C J
authors.initials: CJ
authors.lastname: Gong
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: V
authors.initials: V
authors.lastname: Ram
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China. Electronic address: ddszhangsh@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D013848:Thigh; D016896:Treatment Outcome
keywords: Anterolateral thigh free flap; Arterial occlusions; Flap failure; Flap monitoring; Head and neck reconstructive surgery; Venous occlusions