Sixty-one free flaps performed in 59 patients from April 1983 to April 1995 were analysed. Various factors that might have affected the outcome of the surgery were studied. These included the patient’s age, history of smoking, pre-existing medical problems such as hypertension and diabetes mellitus, the type of free flap, flap infection, use of postoperative anticoagulation, postoperative anaemia and re-exploration.
The infection rate was 16.4%, and this had a strong correlation with free flap failure in our study population. Postoperative anaemia could adversely affect tissue oxygenation of the free flap and delay re-exploration because of the high anaesthetic risk. Dextran was routinely used for postoperative anticoagulation. There were also rescue attempts using heparin infusion when needed.
The overall failure rate was 13.1%. Besides good anaesthetic support, a well-prepared protocol is necessary for both the preoperative planning of free flap surgery and the salvage of a failed flap.
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The author(s) declare there are no affiliations with or involvement in any organisation or entity with any financial interest in the subject matter or materials discussed in this manuscript.
