Review of 100 consecutive microvascular free flaps.

Aim: To analyse the outcome of microvascular free flap reconstructions in Middlemore Hospital (South Auckland, New Zealand).

Method: 100 consecutive free flap reconstructions from January 2004 to April 2010 were identified from the Middlemore Hospital Theatre Coding List. Basic patient demographics and indication for surgery along with free flap types were recorded and outcomes were analysed.

Results: The free flap success rate was 96%. There were 21 short term complications without any perioperative mortality. The most common complication was flap infection (7/21) followed by vascular thrombosis (6/21 venous and 1/21 arterial). Other complications included partial ischaemic flap (3/21), haematoma (2/21), venous congestion (1/21) and partial wound dehiscence (1/21). Fourteen flaps needed salvage procedures in the operating theatre including eight cases for re-anastomosis of vessels. The overall successful salvage rate was 71% resulting in four failures. The successful salvage rate following re-anastomosis of vessels was 63%.

Conclusion: Overall success and salvage rates for free flap reconstructions at our plastics and reconstruction centre are comparable to that of international literature. Diligent postoperative monitoring and early return to theatre for re-exploration is the key to ensuring maximal free flap success.