CHOICE OF FLAP AND INCIDENCE OF FREE-FLAP SUCCESS

A review of 854 consecutive free flaps was performed to determine whet her the choice of nap used for the reconstruction influenced the proba bility of a successful outcome. Flaps were grouped into nine categorie s: rectus abdominis, free transverse rectus abdominis myocutaneous, ra dial forearm, jejunum, latissimus dorsi, fibula, scapula, iliac crest, and other. There were significant differences among the success rates of different flaps (p < 0.0001). Rectus abdominis-based flaps used fo r breast or head and neck reconstruction had lower failure rates (0.9 percent) than did non-rectus abdominis flaps (6.6 percent; p < 0.0001) . Flaps requiring vein grafts had a higher rate of flap loss (18.4 per cent) than did naps that did not require vein grafts (2.9 percent; P < 0.0001). There was a strong trend favoring survival of flaps without a bone component (compared with osteocutaneous flaps), and a weaker tr end favoring survival of flaps in nonobese patients (compared with fla ps in obese patients). Smoking, age, and previous irradiation had no s ignificant effect on flap failure rates. Surgeons should consider the flap success rate as one (but not necessarily the most important) fact or in choosing the best reconstruction for any individual patient.