<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_1905-7415.1103.554_s_001_w2aab3b7b4b1b6b1aab1c17b1Aa"><h3>Background</h3><p>Free flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional procedures.</p></sec><sec id="j_1905-7415.1103.554_s_002_w2aab3b7b4b1b6b1aab1c17b2Aa"><h3>Objectives</h3><p>To analyze postoperative complications and need for secondary surgery after free flap surgery over a 10-year period at King Chulalongkorn Memorial Hospital.</p></sec><sec id="j_1905-7415.1103.554_s_003_w2aab3b7b4b1b6b1aab1c17b3Aa"><h3>Methods</h3><p>We retrospectively reviewed data from a cohort of patients who underwent free flap surgery for limb reconstruction from 2004 to 2014.</p></sec><sec id="j_1905-7415.1103.554_s_004_w2aab3b7b4b1b6b1aab1c17b4Aa"><h3>Results</h3><p>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 (<italic>P</italic> = 0.028) more complications (categories 1 and 2) than surgery performed during the acute period (&lt;14 d) or late reconstruction (>90 d).</p></sec><sec id="j_1905-7415.1103.554_s_005_w2aab3b7b4b1b6b1aab1c17b5Aa"><h3>Conclusions</h3><p>Physicians should be prepared for a range of outcomes of free flap surgery and advise their patients of the risk of additional operations accordingly.</p></sec></abstract>

BackgroundFree flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional procedures.ObjectivesTo analyze postoperative complications and need for secondary surgery after free flap surgery over a 10-year period at King Chulalongkorn Memorial Hospital.MethodsWe retrospectively reviewed data from a cohort of patients who underwent free flap surgery for limb reconstruction from 2004 to 2014.ResultsWe 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 (P = 0.028) more complications (categories 1 and 2) than surgery performed during the acute period (<14 d) or late reconstruction (>90 d).ConclusionsPhysicians should be prepared for a range of outcomes of free flap surgery and advise their patients of the risk of additional operations accordingly.

Complications and secondary surgeries after free flap for limb reconstruction at King Chulalongkorn Memorial Hospital: a ten-year retrospective review of patient data

Department of Orthopaedics, Vinai Parkpian Orthopaedic Research Center

Faculty of Medicine, Chulalongkorn University

Asian Biomedicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundFree flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional procedures.ObjectivesTo analyze postoperative complications and need for secondary surgery after free flap surgery over a 10-year period at King Chulalongkorn Memorial Hospital.MethodsWe retrospectively reviewed data from a cohort of patients who underwent free flap surgery for limb reconstruction from 2004 to 2014.ResultsWe 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 (P = 0.028) more complications (categories 1 and 2) than surgery performed during the acute period (90 d).ConclusionsPhysicians should be prepared for a range of outcomes of free flap surgery and advise their patients of the risk of additional operations accordingly.

BackgroundFree flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional...

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
Secondary surgery, flap necrosis, free flap surgery, limb reconstruction postoperative complications

© 2017 Pobe Luangjarmekorn, Pravit Kitidumrongsuk, Sittisak Honsawek

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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

KeywordsSecondary surgery, flap necrosis, free flap surgery, limb reconstruction postoperative complications

© 2017 Pobe Luangjarmekorn, Pravit Kitidumrongsuk, Sittisak Honsawek

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
Secondary surgery, flap necrosis, free flap surgery, limb reconstruction postoperative complications