title: Free-flap salvage: muscle only versus skin paddle - an Australian experience.
abstract: BACKGROUND
  Free-tissue transfer flaps are an effective reconstructive option for complex wounds; however, flap failure is a dreaded complication requiring timely re-exploration and salvage. The aim of this study was to determine whether salvage rates were higher in skin flaps, as opposed to muscle flaps, due to the durability of the overlying skin paddle allowing for better visual post-operative monitoring and more timely recognition of the threatened flap.
  
  
  METHODS
  We conducted a retrospective analysis of all patients who underwent a free flap at an Australian tertiary centre between 2004 and 2014. Data were collected on patient demographics, indication, flap type, time of recognition of the threatened flap and re-exploration outcome. Data were analysed using Stata version 13 (StataCorp, College Station, TX, USA). Student's t-test, analysis of variance and Pearson's chi-squared test were used to compare groups.
  
  
  RESULTS
  There were 560 patients who underwent 573 free flaps. The most common indication was trauma. There were 58 re-explorations with a successful salvage rate of 79.3% (46/58). Overall complete flap loss rate was 2.1% (12/573). In flaps requiring re-exploration, there was a higher complete flap loss rate for muscle only flaps versus those with a skin paddle (P-value = 0.041).
  
  
  CONCLUSIONS
  While timely recognition and re-exploration of the compromised free flap in the early postoperative setting is important in determining the flap salvage success, it is demonstrated that salvage rates are poorer for muscle only flaps compared with flaps with a skin paddle.
authors.affiliation: Plastic, Hand and Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Dat
authors.affiliation: Plastic, Hand and Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Ian W
authors.initials: IW
authors.lastname: Loh
authors.affiliation: Plastic, Hand and Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Frank
authors.initials: F
authors.lastname: Bruscino-Raiola
mesh_terms: D001315:Australia / Q000453:epidemiology; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D009132:Muscles / Q000637:transplantation*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000639:trends; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods / Q000706:statistics & numerical data*; D016038:Skin Transplantation / Q000706:statistics & numerical data*
keywords: free flap; plastic and reconstructive surgery; salvage