Five-Year Review Outcome of Microvascular Free Flap
in Siriraj Hospital
Sirichai Kamnerdnakta MD*,
Nuttorn Boochangkool MD*
Affiliation :
* Division of Plastic Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Microvascular free flap operation has become the preferred reconstructive technique at many medical centers
to cover complex defects from tumor ablative surgery or trauma and for reconstructive procedure such as functioning muscle
transfer. There are many clinical reports about free tissue transfer since the beginning of microvascular technique in the
early 1960s. The overall success rate is about 90 to 98% but there may be postoperative complications.
Objective : Retrospectively analyze outcome and complications of consecutive series of microvascular free flap procedures,
and compare with series published by other center.
Material and Method: The chart review was conducted of all patients that underwent microvascular free tissue transfer in
our hospital between January 2007 and December 2011. The age, gender, underlying disease, other risk factors (smoking,
obesity, pre-operative radiation on recipient site), American Society of Anesthesiologists (ASA) classification, indication
for surgery, location of defect, type of flap, operative time, inflow and outflow vessel, type of anastomosis, vein graft usage,
ischemic time, length of hospital stay, length of intensive unit stay, flap success rate, re-exploration surgery, salvage rate,
and perioperative complications of all patient were noted. These data were collected in database and were available for
statistical analysis.
Results : Between January 2007 and December 2011, 153 microvascular tissue transfers were performed to coverage and
reconstruct various kind of defects and diseases. There were 102 men and 51 women, age ranged from 11 to 84 years
(mean 48 years). There were 50 patients over 60 years old (33%). Among the 153 procedures, there were 124 defects from
tumor ablation, 14 procedures for wound coverage including defect from acute trauma in five patients, and other procedure
such as functioning muscle transfer and sex reassignment surgery. The microvascular free flap reconstruction of various
kinds of indication all over the body showed success rate of 92.8%. Re-explorative surgery and ASA class more than 1 were
significant factors influence with flap failure rate. Only significant factor associated with wound complication was age
more than 60 years. ASA class more than 1 and age more than 60 years were significant factors that increasing general
medical complication.
Conclusion : Microvascular free flap was the versatile reconstructive option. The failure rate of them should not be more
than 5%. Factors associated with flap failure were re-exploration, ASA classification and factors that affect complications
were preoperative morbidity level (ASA) and elderly patient.
Keywords : Microvascular free flap, Factors that influence with flap failure, Outcome of free flap reconstruction
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