TY - JOUR
T1 - Outcome Analysis of Free Flap Salvage in Outpatients Presenting with Microvascular Compromise
AU - Largo, Rene D.
AU - Selber, Jesse C.
AU - Garvey, Patrick B.
AU - Chang, Edward I.
AU - Hanasono, Matthew M.
AU - Yu, Peirong
AU - Butler, Charles E.
AU - Baumann, Donald P.
N1 - Publisher Copyright:
Copyright © 2017 by the American Society of Plastic Surgeons.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. Methods: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. Results: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room. Also, 261 patients (4 percent) suffered from microvascular compromise, of whom 110 (1 percent) experienced total flap loss. The authors identified 17 patients (10 breast cancer patients and seven head and neck cancer patients) who had vascular flap compromise and underwent reoperation after hospital discharge (median, 10 days; range, 4 to 107 days) after free flap reconstruction. Of these 17 patients, nine breast cancer patients and two head and neck cancer patients underwent flap salvage attempts. Salvage procedures included thrombectomy, thrombolytic and heparin injections, and reanastomoses (11 patients); vein grafting (four patients); vein supercharging with cephalic turndown (two patients); and change of recipient vessels (two patients). Sixteen of the 17 patients (94 percent) experienced total flap loss, and one patient (6 percent) had partial flap loss requiring long-lasting wound treatment. Conclusions: Outpatient free flap salvage has a low success rate regardless of flap type, recipient site, or patient population. The authors' study suggests that immediate second-line reconstruction is more effective for late-onset flap vascular crisis than extensive flap salvage procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
AB - Background: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. Methods: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. Results: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room. Also, 261 patients (4 percent) suffered from microvascular compromise, of whom 110 (1 percent) experienced total flap loss. The authors identified 17 patients (10 breast cancer patients and seven head and neck cancer patients) who had vascular flap compromise and underwent reoperation after hospital discharge (median, 10 days; range, 4 to 107 days) after free flap reconstruction. Of these 17 patients, nine breast cancer patients and two head and neck cancer patients underwent flap salvage attempts. Salvage procedures included thrombectomy, thrombolytic and heparin injections, and reanastomoses (11 patients); vein grafting (four patients); vein supercharging with cephalic turndown (two patients); and change of recipient vessels (two patients). Sixteen of the 17 patients (94 percent) experienced total flap loss, and one patient (6 percent) had partial flap loss requiring long-lasting wound treatment. Conclusions: Outpatient free flap salvage has a low success rate regardless of flap type, recipient site, or patient population. The authors' study suggests that immediate second-line reconstruction is more effective for late-onset flap vascular crisis than extensive flap salvage procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
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U2 - 10.1097/PRS.0000000000003917
DO - 10.1097/PRS.0000000000003917
M3 - Article
C2 - 29280859
AN - SCOPUS:85039709410
SN - 0032-1052
VL - 141
SP - 20e-27e
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 1
ER -