Five-year review outcome of microvascular free flap in siriraj hospital

Abstract

© 2015, Medical Association of Thailand. All rights reserved. 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.