Complications and secondary surgeries after free flap for limb reconstruction at King Chulalongkorn Memorial Hospital: a ten-year retrospective review of patient data
Article Category: Brief communication (Original)
Published Online: Aug 31, 2017
Page range: 235 - 243
DOI: https://doi.org/10.5372/1905-7415.1103.554
Keywords
© 2017 Pobe Luangjarmekorn, Pravit Kitidumrongsuk, Sittisak Honsawek
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Background
Free flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional procedures.
Objectives
To analyze postoperative complications and need for secondary surgery after free flap surgery over a 10-year period at King Chulalongkorn Memorial Hospital.
Methods
We retrospectively reviewed data from a cohort of patients who underwent free flap surgery for limb reconstruction from 2004 to 2014.
Results
We included 35 free flap operations in 29 patients. Mean follow-up time was 6.4 y. Free flap surgical procedures included 7 gracilis transfers, 8 toe transfers, 5 latissimus dorsi flaps, 5 fibular transfers, 4 anterolateral thigh flaps, 2 lateral-arm flaps, 2 radial forearm flaps, and 2 venous free flaps. There were 4 categories of postoperative complications. (1) Patients were those who developed total flap loss after free flap surgery (7/35 flaps, 20%). (2) Patients had major complications requiring additional operations (11/35 flaps, 31%). Major complications included partial flap necrosis, wound swelling with delayed closure, arterial occlusion, postoperative bleeding, infection, and failed implant fixation. (3) Patients had minor complications that required no additional surgical procedures (8/33 flaps, 23%). (4) Patients with no postoperative complications (9/35 flaps, 26%). Secondary surgery after initial free flap was 51% overall (18/35 flaps). The 3 most common secondary procedures included second flap coverage, skin graft, and anastomosis revision. We found free flap surgery performed during the subacute period (14–90 d after injury) to have significantly (
Conclusions
Physicians should be prepared for a range of outcomes of free flap surgery and advise their patients of the risk of additional operations accordingly.