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A UK based multi-centre prospective study of microvascular free-flap surgery

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Studies carried out in 1998 by Khouri et al. established a benchmark for free flap survival. Whilst individual factors related to free flap survival have been examined since, there has been little contemporaneous data re-examining overall flap survival rates and factors related to complications to assess progress in the field and specifically European or UK practice.

Methods

Six plastic surgery units from four regions within the South West UK regional collaboration group prospectively collected data on all free flap surgery performed in a 6-month period between October 2013 and April 2014.

Results

Data on 264 free flaps were prospectively collected. Total flap failure was 2.7% and partial flap failure was 4.5%. Regression analysis identified obesity and previous recipient site radiotherapy as the most important factors in flap failure. The rate of intra-operative and post-operative flap thrombosis was 3.8% and 6.4%, respectively, and was associated with lower limb recipient site and surgeon grade. Post-operative haematoma occurred in 4.2%, associated with recipient site radiotherapy.

Conclusions

Our study establishes a UK baseline for standards in free flap surgery. With the recent introduction of a UK Free Flap Surgery Registry, this baseline will support unit audit and improvements in free flap surgery.

Level of evidence: Level III, risk/prognostic study.

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References

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Acknowledgements

We thank all surgeons and other members of the plastic surgery units involved for allowing the operative and patient data to be collected to enable this study and for their constructive feedback.

Author information

Authors and Affiliations

  1. Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK

    Hywel Room

  2. The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

    Oliver Sawyer

  3. Salisbury NHS Foundation Trust, Salisbury, UK

    Claire Sethu

  4. North Bristol NHS Trust, Bristol, UK

    Hisham Taha

  5. Morriston Hospital, Swansea, UK

    Jurga Pikturnaite

  6. Plymouth Hospitals NHS Trust, Plymouth, UK

    Sameer Gujral & Juliana Hughes

Authors
  1. Hywel Room
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  2. Oliver Sawyer
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  3. Claire Sethu
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  4. Hisham Taha
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  5. Jurga Pikturnaite
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  6. Sameer Gujral
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  7. Juliana Hughes
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Corresponding author

Correspondence to Hywel Room.

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Conflict of interest

Hywel Room, Oliver Sawyer, Claire Sethu, Hisham Taha, Jurga Pikturnaite, Sameer Gujral and Juliana Hughes declare that they have no conflicts of interest.

Patient consent

Informed consent was obtained from all participants included in the study.

Ethics statement

Audit and research departments at each of the plastic surgery units involved deemed that full ethics committee consideration was not necessary for this study.

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Key Points

• UK-specific prospective study examining free flap plastic surgery outcomes.

• Patient and technical factors associated with total and partial free flap failure, flap thrombosis and post-operative haematoma analysed by logistic regression analysis.

• Obesity and prior recipient site radiotherapy associated with higher rates of total and partial free flap failure.

• Establishes UK-specific baseline for free flap surgical outcomes.

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Room, H., Sawyer, O., Sethu, C. et al. A UK based multi-centre prospective study of microvascular free-flap surgery. Eur J Plast Surg 43, 767–772 (2020). https://doi.org/10.1007/s00238-020-01710-3

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  • DOI: https://doi.org/10.1007/s00238-020-01710-3

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