Skip to main content

Advertisement

SpringerLink
Log in

The establishment of a microvascular free flap service in a medium-sized hospital (500 beds)—an eight-year experience

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Microsurgery is a specialized procedure that necessitates well-trained and experienced surgeons and a skilled nursing care staff. This study presents our experience with a free flap service in a medium-sized hospital and its feasibility.

Methods

This retrospective study included 91 patients who underwent breast and head and neck free tissue reconstruction between March 2010 and February 2018, by a single microsurgeon. Pre- and post-operative protocols were implemented. Data was retrospectively collected regarding age, gender, medical history, pre-oncological treatments, type of flaps, operation time, success, failure, re-exploration and salvage rates, minor and major complications, and hospitalization length.

Results

Mean operation time was 12.5 h (range 4–26.8 h). Average hospital stay was 14 days (breast 11 days, head and neck 17 days), range 7–56 days. The overall flap success rate was 89% (breast 92.2%, head and neck 85.4%). Total complication rate was 60.6%. Minor complications 41.4% (breast 22.2%, head and neck 19.2%) and major complications 19.2% (breast 8.1%, head and neck 11.1%). Minor complications included seroma (breast 5.9%, head and neck 4.2%), infection/abscess (breast 2%, head and neck 10.4%), wound dehiscence (breast 3.9%, head and neck 8.3%), fistula (breast 0%, head and neck 8.3%), and fat necrosis (breast 21.5%, head and neck 0%). Major complications included flap necrosis (breast 9.8%, head and neck 8.3%) and venous thrombosis (breast 7.8%, head and neck 8.3%).

Conclusions

This study demonstrated the probability of a reconstructive microsurgical service in a medium-sized hospital which achieves respectable results that meet international standards.

Level of evidence: Level IV, therapeutic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kakarala K, Emerick KS, Lin DT, Rocco JW, Deschler DG (2012) Free flap reconstruction in 1999 and 2009: changing case characteristics and outcomes. Laryngoscope 122:2160–2163

    Article  Google Scholar 

  2. Klosterman T, Siul E, Tatum S (2015) Free flap reconstruction experience and outcomes at a low-volume institution over 20 years. Otolaryngol Head Neck Surg 152:832–837

    Article  Google Scholar 

  3. Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara B (2007) Free flap re-exploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 119:2092–2100

    Article  CAS  Google Scholar 

  4. Al-Dam A, Zrnc TA, Hanken H, Riecke B, Eichhorn W, Nourwali I, Smeets R, Blessmann M, Heiland M, Gröbe A (2014) Outcome of microvascular free flaps in a high-volume training centre. J Cranio-Maxillo-Facial Surg 42:1178–1183

    Article  Google Scholar 

  5. Pohlenz P, Blessmann M, Blake F, Li L, Schmelzle R, Heiland M (2007) Outcome and complications of 540 microvascular free flaps: the Hamburg experience. Clin Oral Investig 11:89–92

    Article  Google Scholar 

  6. Haughey BH, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, Spector G (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125:7–10

    Article  Google Scholar 

  7. Kamnerdnakta S, Boochangkool N (2015) Five-year review outcome of microvascular free flap in Siriraj hospital. J Med Assoc Thail 98:985–992

    Google Scholar 

  8. Nakatsuka T, Harii K, Asato H, Takushima A, Ebihara S, Kimata Y (2003) Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection. J Reconstr Microsurg 19:363–368

    Article  Google Scholar 

  9. Eckardt A, Meyer A, Laas U, Hausamen JE (2007) Reconstruction of defects in the head and neck with free flaps: 20 years’ experience. Br J Oral Maxillofac Surg 45:5–11

    Article  Google Scholar 

  10. Acosta R, Smit JM, Audolfsson T, Darcy CM, Enajat M, Kildal M, Liss A (2011) A clinical review of 9 years of free perforator flap breast reconstructions: an analysis of 675 flaps and the influence of new techniques on clinical practice. J Reconstr Microsurg 27:91–98

    Article  Google Scholar 

  11. Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL et al (1996) Choice of flap and incidence of free flap success. Plast Reconstr Surg 98:459–463

    Article  CAS  Google Scholar 

  12. Khouri RK, Cooley BC, Kunselman AR, Landis JR, Yeramian P, Ingram D et al (1998) A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 102:711–721

    Article  CAS  Google Scholar 

  13. Pohlenz P, Klatt J, Scho¨n G, Blessmann M, Li L, Schmelzle R (2012) Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 41:739–743

    Article  CAS  Google Scholar 

  14. Blackwell KE, Brown MT, Gonzalez D (1997) Overcoming the learning curve in microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 123:1332–1335

    Article  CAS  Google Scholar 

  15. Irons GB, Wood MB, Schmitt EH III (1987) Experience with one hundred consecutive free flaps. Ann Plast Surg 18:17–23

    Article  CAS  Google Scholar 

  16. Classen DA, Ward H (2006) Complications in a consecutive series of 250 free flap operations. Ann Plast Surg 56:557–561

    Article  CAS  Google Scholar 

  17. Chen KT, Mardini S, Chuang DC, Lin CH, Cheng MH, Lin YT et al (2007) Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg 120:187–195

    Article  CAS  Google Scholar 

  18. Herold C, Gohritz A, Meyer-Marcotty M, Steiert A, Jokuszies A, Vaske B, Vogt P (2011) Is there an association between comorbidities and the outcome of microvascular free tissue transfer? J Reconstr Microsurg 27:127–132

    Article  Google Scholar 

  19. Schusterman MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H (1994) A single center’s experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 93:472–478

    Article  CAS  Google Scholar 

  20. Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 130:962–966

    Article  Google Scholar 

  21. Bianchi B, Copelli C, Ferrari S, Ferri A, Sesenna E (2009) Free flaps: outcomes and complications in head and neck reconstructions. J Craniomaxillofac Surg 37:438–442

    Article  Google Scholar 

  22. Evans GRD, Schusterman MA, Kroll SS, Miller MJ, Reece GP, Robb GL, Ainslie N (1994) The radial forearm free flap for head and neck reconstruction: a review. Am J Surg 168:446–450

    Article  CAS  Google Scholar 

  23. Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL (2006) Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg 118:1100–1109

    Article  CAS  Google Scholar 

  24. Bourget A, Chang JT, Wu DB, Chang CJ, Wei FC (2011) Free flap reconstruction in the head and neck region following radiotherapy: a cohort study identifying negative outcome predictors. Plast Reconstr Surg 127:1901–1908

    Article  CAS  Google Scholar 

  25. Haddock NT, Gobble RM, Levine JP (2010) More consistent postoperative care and monitoring can reduce costs following microvascular free flap reconstruction. J Reconstr Microsurg 26:435–439

    Article  Google Scholar 

  26. Lin TR, Yang CI, Wu CY, Liao YM (2013) Project to improve the free flap survival rate in oral cancer micro reconstruction free flap surgery. Hu Li Za Zhi 60:68–75

    PubMed  Google Scholar 

  27. Hashibe M, Brennan P, Chuang S, Boccia S, Castellsague X, Chen C, Curado MP, Dal Maso L, Daudt AW, Fabianova E, Fernandez L, Wunsch-Filho V, Franceschi S, Hayes RB, Herrero R, Kelsey K, Koifman S, la Vecchia C, Lazarus P, Levi F, Lence JJ, Mates D, Matos E, Menezes A, McClean MD, Muscat J, Eluf-Neto J, Olshan AF, Purdue M, Rudnai P, Schwartz SM, Smith E, Sturgis EM, Szeszenia-Dabrowska N, Talamini R, Wei Q, Winn DM, Shangina O, Pilarska A, Zhang ZF, Ferro G, Berthiller J, Boffetta P (2009) Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomark Prev 18:541–550

    Article  CAS  Google Scholar 

  28. Kruse AL, Luebbers HT, Gratz KW, Obwegeser JA (2010) Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review. Microsurgery 30:242–248

    PubMed  Google Scholar 

  29. Pattani KM, Byrne P, Boahene K, Richmon J (2010) What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope 120:717–723

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Metanes Issa: equal contribution as the first author

Authors and Affiliations

  1. The Department of Plastic Surgery, Carmel Medical Center, 3436212, Haifa, Israel

    Aviv Kramer, Issa Metanes, Aharon Amir, Eyal Franco, Leonid Bryzgalin, Nir Eyal, Miriam Segal-Trabelsi & Yaron Har-Shai

  2. The Bruce and Ruth Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel

    Aviv Kramer, Issa Metanes, Aharon Amir, Eyal Franco, Ilana Doweck, Leonid Bryzgalin, Nir Eyal, Miriam Segal-Trabelsi, Idit Lavi, Arie Bitterman & Yaron Har-Shai

  3. The Department of E.N.T, Carmel Medical Center, 3436212, Haifa, Israel

    Ilana Doweck

  4. The Department of Community Medicine and Epidemiology, Carmel Medical Center, 3436212, Haifa, Israel

    Idit Lavi

  5. The Department of Surgery A, Carmel Medical Center, 3436212, Haifa, Israel

    Arie Bitterman

Authors
  1. Aviv Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Issa Metanes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aharon Amir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eyal Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ilana Doweck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leonid Bryzgalin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nir Eyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Miriam Segal-Trabelsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Idit Lavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Arie Bitterman
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yaron Har-Shai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yaron Har-Shai.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Financial interest

None of the authors have a financial interest.

Ethical approval

This study was approved by the institutional ethical committee.

Informed consent

All patients have signed an informed consent prior to surgery.

Funding

This study was not funded.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kramer, A., Metanes, I., Amir, A. et al. The establishment of a microvascular free flap service in a medium-sized hospital (500 beds)—an eight-year experience. Eur J Plast Surg 43, 37–42 (2020). https://doi.org/10.1007/s00238-019-01548-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-019-01548-4

Keywords

Search

Navigation