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Re-exploration in the early postoperative period has a better salvage rate in free flaps

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European Journal of Plastic Surgery Aims and scope Submit manuscript

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.

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Acknowledgements

The authors would like to thank Dr. Vivek Koushik and Mr. Balasubramaniam Ramakrishnan.

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Authors and Affiliations

  1. Department of Plastic Surgery, Apollo Cancer Speciality Hospitals, C Block, Second Floor, Teynampet, Chennai, 600035, India

    Jijo Joseph, Shivaram Bharathwaj, Antony Arvind, Rajan Ganapathy Bhagavathy & Hari Krishna Muram Reddy

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  1. Jijo Joseph
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  2. Shivaram Bharathwaj
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  3. Antony Arvind
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  4. Rajan Ganapathy Bhagavathy
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  5. Hari Krishna Muram Reddy
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. Jijo Joseph. The first draft of the manuscript was written by Dr. Jijo Joseph and Dr. Shivaram Bharathwaj. All other authors edited, proofread and approved the final manuscript.

Corresponding author

Correspondence to Shivaram Bharathwaj.

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Conflict of interest

Jijo Joseph, Antony Arvind, Shivaram Bharadwaj, G. B. Rajan and Hari Krishna M. declare no conflict of interest.

Ethics approval 

The local research ethics committee has confirmed that no ethical approval is required for retrospective studies.

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

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Patients signed consent regarding publishing their data and photographs.

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Joseph, J., Bharathwaj, S., Arvind, A. et al. Re-exploration in the early postoperative period has a better salvage rate in free flaps. Eur J Plast Surg 44, 219–230 (2021). https://doi.org/10.1007/s00238-020-01744-7

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  • DOI: https://doi.org/10.1007/s00238-020-01744-7

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