RETROSPECTIVE REVIEW OF 400 CONSECUTIVE FREE-FLAP RECONSTRUCTIONS FORONCOLOGIC SURGICAL DEFECTS

Background: Free tissue transfer has become an important method for re constructing complex oncologic surgical defects, allowing single stage reconstruction in most instances. The purpose of this study is to rev iew a single center's experience with free flap reconstruction and des cribe trends that have evolved with respect to technique and donor sit e selection. Methods: A retrospective review of 400 consecutive free f lap reconstructions performed in 396 patients over 10 years was done. Regional applications include the head and neck (63%), trunk: and brea st (16%), lower extremity (16%), and upper extremity (5%). Donor sites include the fibula (109), rectus abdominis (93), forearm (72), latiss imus dorsi (51), scapula (26), gluteus (25), jejunum (16), and five ot hers (8). Microvascular anastomoses were performed to large-caliber ve ssels using a continuous suture technique; end-to-end anastomoses were preferred. Flaps were designed to avoid the need for vein grafts, Pos toperative flap monitoring included clinical observation, conventional Doppler ultrasonography, surface temperature probes, and pinprick tes ting. Results: The overall free flap success rate was 97%. Twenty-eigh t flaps (7%) were reexplored, of which seventeen were salvaged (61%). Surviving flaps resulted in a healed wound that did not delay postoper ative radiation or chemotherapy. The complication rate was 14%. The me an duration of hospitalization was 21 days, with an average cost of $4 0,000. Conclusions: The use of fewer, reliable donor sites to reconstr uct the vast majority of oncologic defects and the simplification of t he microsurgical process have contributed to the success of free tissu e transfer in this series.