Impact of the successful flap but failed reconstruction on the true rate of success in free-tissue transfers

Extraordinarily high success rates for free-tissue transfers are now virtua lly the norm. Unfortunately, expectations to consistently obtain similar ou tcomes, without a Familiarity with the incidence of associated adverse sequ elae, place microsurgeons in a potential quandary. A "true success" rate sh ould consider not just those immediately viable flaps with patent microanas tomoses, but should discount cases in which there is significant partial fl ap loss, or persistence or recurrence of the original indication for the fr ee-flap transfer, including the need For delayed amputation of an extremity . An estimate of the impact of the latter phenomena in redefining success r ates has been derived from the author's experience with 156 free flaps over the past decade. There was overt Failure in 12 flaps, For a stated success rate of 91.7 percent. However. on closer scrutiny, including the above neg ative criteria, successful flaps yet failures occurred in an additional 16 flaps, so that the true rate of success was a more realistic 81.4 percent. An even more difficult assessment that was not quantified is the reality of functional failures, despite successful microsurgery, which could lower th is number even further.