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European Journal of Plastic Surgery

Published in:

01-04-2021 | Venous Thrombosis | Original Paper

Re-exploration in the early postoperative period has a better salvage rate in free flaps

Authors: Jijo Joseph, Shivaram Bharathwaj, Antony Arvind, Rajan Ganapathy Bhagavathy, Hari Krishna Muram Reddy

Published in: European Journal of Plastic Surgery | Issue 2/2021

Abstract

Background

The most significant complication of free flap reconstruction is flap failure, which can be a result of numerous factors but ultimately affecting the vascularity of the flap tissues. In cases of doubtful flap viability re-exploration in the early postoperative period has a better salvage rate than the late postoperative period in free flaps. We aim to analize the salvage rate of free flaps undergoing re-exploration in different time periods in the postoperative phase.

Methods

This is a retrospective analysis of charts of 376 patients who underwent free tissue transfer during 4 consecutive years from August 2013 to July 2017 for the reconstruction of post-oncological resection defects among which 43 patients underwent re-exploration. Indications for re-exploration were vascular compromise indicated by absent or very delayed bleeding, brisk dark bleeding, suspected haematoma, chyle collection, etc.

Results

Among 43 patients who underwent re-exploration, 3 patients were re-explored on the operative day itself, 23 on the 1st postoperative day, 6 on the 2nd day, 4 on the 3rd day, 5 on the 4th day and 2 on the 5th day with salvage rates of 100%, 48%, 50%, 20%, 20% and 0% respectively. Findings on re-exploration included arterial/venous thrombosis, haematoma, chyle collection, external compression on pedicle/perforator by nerve, etc.

Conclusions

Analysing the data collected from this series of patients who underwent re-exploration, it has been observed that the re-explorations performed in the early postoperative period have a better chance of salvaging the flap. Although it is intuitive that a high index of suspicion followed by early re-exploration will improve the salvage rate, this paper attends to back this up with evidence.

Level of evidence: Level III, risk/prognostic study.

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Title: Re-exploration in the early postoperative period has a better salvage rate in free flaps
Authors: Jijo Joseph
Shivaram Bharathwaj
Antony Arvind
Rajan Ganapathy Bhagavathy
Hari Krishna Muram Reddy
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keywords: Venous Thrombosis
Thrombosis
Venous Thrombosis
Published in: European Journal of Plastic Surgery / Issue 2/2021
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-020-01744-7

At a glance: The STEP trials

Springer Medicine

Re-exploration in the early postoperative period has a better salvage rate in free flaps

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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