Re-exploration in the early postoperative period has a better salvage rate in free flaps
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ORIGINAL PAPER
Re-exploration in the early postoperative period has a better salvage rate in free flaps Jijo Joseph 1 & Shivaram Bharathwaj 1 Hari Krishna Muram Reddy 1
&
Antony Arvind 1 & Rajan Ganapathy Bhagavathy 1 &
Received: 16 June 2020 / Accepted: 9 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The most significant complication of free flap reconstruction is flap failure, which can be a result of numerous factors but ultimately affecting the vascularity of the flap tissues. In cases of doubtful flap viability re-exploration in the early postoperative period has a better salvage rate than the late postoperative period in free flaps. We aim to analize the salvage rate of free flaps undergoing re-exploration in different time periods in the postoperative phase. Methods This is a retrospective analysis of charts of 376 patients who underwent free tissue transfer during 4 consecutive years from August 2013 to July 2017 for the reconstruction of post-oncological resection defects among which 43 patients underwent re-exploration. Indications for re-exploration were vascular compromise indicated by absent or very delayed bleeding, brisk dark bleeding, suspected haematoma, chyle collection, etc. Results Among 43 patients who underwent re-exploration, 3 patients were re-explored on the operative day itself, 23 on the 1st postoperative day, 6 on the 2nd day, 4 on the 3rd day, 5 on the 4th day and 2 on the 5th day with salvage rates of 100%, 48%, 50%, 20%, 20% and 0% respectively. Findings on re-exploration included arterial/venous thrombosis, haematoma, chyle collection, external compression on pedicle/perforator by nerve, etc. Conclusions Analysing the data collected from this series of patients who underwent re-exploration, it has been observed that the re-explorations performed in the early postoperative period have a better chance of salvaging the flap. Although it is intuitive that a high index of suspicion followed by early re-exploration will improve the salvage rate, this paper attends to back this up with evidence. Level of evidence: Level III, risk/prognostic study. Keywords Free tissue flaps . Re-exploration . Salvage . Microcirculation . Thrombosis
Introduction
* Shivaram Bharathwaj [email protected] Jijo Joseph [email protected] 1
Department of Plastic Surgery, Apollo Cancer Speciality Hospitals, C Block, Second Floor, Teynampet, Chennai 600035, India
The choice of free tissue transfer as a definitive method for covering the defects created by tumour resection, trauma and for congenital defects has been on a rise ever since the birth of the monocular microscope by Nylen in 1921 and the binocular microscope by Holmgren in 1923 [1]. Studies have shown that free flaps are superior to pedicled flaps in the reconstruction of head and neck defects in terms of cosmesis and functionality [2–4]. The most significant complication of free flap reconstruction is flap failure, which can be a result of numerous factors but ultimately affecting the vascul
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