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Semin Plast Surg 2023; 37(01): 019-025
DOI: 10.1055/s-0042-1759563
Review Article

Management of the Failing Flap

Allison A. Slijepcevic
1   Department of Otolaryngology - HNS, Oregon Health Sciences University, Portland, Oregon
,
Sara Yang
1   Department of Otolaryngology - HNS, Oregon Health Sciences University, Portland, Oregon
,
Daniel Petrisor
2   Department of Oral Maxillofacial Surgery, Oregon Health Sciences University, Portland, Oregon
,
Srinivasa R. Chandra
2   Department of Oral Maxillofacial Surgery, Oregon Health Sciences University, Portland, Oregon
,
Mark K. Wax
1   Department of Otolaryngology - HNS, Oregon Health Sciences University, Portland, Oregon
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Abstract

Free tissue transfer has become the reconstructive modality of choice for replacing composite tissue defects. While the success rate in high-volume centers is reported to be greater than 95%, up to 10% of patients will require revision of their vascular anastomosis secondary to thrombosis or compromise to flow. In the intraoperative setting, immediate revision is successful in the majority of cases. Rarely, the flap cannot be revascularized and a secondary option must be used. In the perioperative setting revision is successful if the patient can be brought back to the operating room in a timely fashion. Revision rates up to 70% are reported. A small number of these patients may then suffer a second episode of compromise where revision is less successful at 30%. In these cases, consideration should be given to secondary reconstruction rather than attempting salvage. Finally, there are a small number of patients whose flaps will fail following discharge from the hospital. These patients can rarely be salvaged and secondary reconstructive options should be explored.

Keywords

free flap failure - salvage - free flap compromise


Publication History

Article published online:
03 December 2022

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