My First 100 Consecutive Microvascular Free Flaps: Pearls and Lessons Learned in First Year of Practice
Identifieur interne : 001A25 ( Main/Merge ); précédent : 001A24; suivant : 001A26My First 100 Consecutive Microvascular Free Flaps: Pearls and Lessons Learned in First Year of Practice
Auteurs : Edward I. ChangSource :
- Plastic and Reconstructive Surgery Global Open [ 2169-7574 ] ; 2013.
Abstract
Microvascular reconstruction for oncologic defects is a challenging and rewarding endeavor, and successful outcomes are dependent on a multitude of factors. This study represents lessons learned from a personal prospective experience with 100 consecutive free flaps.
All patients’ medical records were reviewed for demographics, operative notes, and complications.
Overall 100 flaps were performed in 84 consecutive patients for reconstruction of breast, head and neck, trunk, and extremity defects. Nineteen patients underwent free flap breast reconstruction with 10 patients undergoing bilateral reconstruction and 2 patients receiving a bipedicle flap for reconstruction of a unilateral breast defect. Sixty-five free flaps were performed in 61 patients with 3 patients receiving 2 free flaps for reconstruction of extensive head and neck defects and 1 patient who required a second flap for partial flap loss. Trunk and extremity reconstruction was less common with 2 free flaps performed in each group. Overall, 19 patients (22.6%) developed complications and 14 required a return to the operating room. There were no flap losses in this cohort. Thorough preoperative evaluation and workup, meticulous surgical technique and intraoperative planning, and diligent postoperative monitoring and prompt intervention are critical for flap success.
As a young plastic surgeon embarking in reconstructive plastic surgery at an academic institution, the challenges and dilemmas presented in the first year of practice have been daunting but also represent opportunities for learning and improvement. Skills and knowledge acquired from time, experience, and mentors are invaluable in optimizing outcomes in microvascular free flap reconstruction.
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DOI: 10.1097/GOX.0b013e31829e1007
PubMed: 25289221
PubMed Central: 4173838
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">My First 100 Consecutive Microvascular Free Flaps: Pearls and Lessons Learned in First Year of Practice</title><author><name sortKey="Chang, Edward I" sort="Chang, Edward I" uniqKey="Chang E" first="Edward I." last="Chang">Edward I. Chang</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25289221</idno><idno type="pmc">4173838</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173838</idno><idno type="RBID">PMC:4173838</idno><idno type="doi">10.1097/GOX.0b013e31829e1007</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002449</idno><idno type="wicri:Area/Pmc/Curation">002449</idno><idno type="wicri:Area/Pmc/Checkpoint">001135</idno><idno type="wicri:Area/Ncbi/Merge">003348</idno><idno type="wicri:Area/Ncbi/Curation">003348</idno><idno type="wicri:Area/Ncbi/Checkpoint">003348</idno><idno type="wicri:Area/Main/Merge">001A25</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">My First 100 Consecutive Microvascular Free Flaps: Pearls and Lessons Learned in First Year of Practice</title><author><name sortKey="Chang, Edward I" sort="Chang, Edward I" uniqKey="Chang E" first="Edward I." last="Chang">Edward I. Chang</name></author></analytic><series><title level="j">Plastic and Reconstructive Surgery Global Open</title><idno type="eISSN">2169-7574</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Microvascular reconstruction for oncologic defects is a challenging and rewarding endeavor, and successful outcomes are dependent on a multitude of factors. This study represents lessons learned from a personal prospective experience with 100 consecutive free flaps.</p></sec><sec><title>Methods:</title><p>All patients’ medical records were reviewed for demographics, operative notes, and complications.</p></sec><sec><title>Results:</title><p>Overall 100 flaps were performed in 84 consecutive patients for reconstruction of breast, head and neck, trunk, and extremity defects. Nineteen patients underwent free flap breast reconstruction with 10 patients undergoing bilateral reconstruction and 2 patients receiving a bipedicle flap for reconstruction of a unilateral breast defect. Sixty-five free flaps were performed in 61 patients with 3 patients receiving 2 free flaps for reconstruction of extensive head and neck defects and 1 patient who required a second flap for partial flap loss. Trunk and extremity reconstruction was less common with 2 free flaps performed in each group. Overall, 19 patients (22.6%) developed complications and 14 required a return to the operating room. There were no flap losses in this cohort. Thorough preoperative evaluation and workup, meticulous surgical technique and intraoperative planning, and diligent postoperative monitoring and prompt intervention are critical for flap success.</p></sec><sec><title>Conclusions:</title><p>As a young plastic surgeon embarking in reconstructive plastic surgery at an academic institution, the challenges and dilemmas presented in the first year of practice have been daunting but also represent opportunities for learning and improvement. Skills and knowledge acquired from time, experience, and mentors are invaluable in optimizing outcomes in microvascular free flap reconstruction.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Whitaker, Is" uniqKey="Whitaker I">IS Whitaker</name></author><author><name sortKey="Karoo, Ro" uniqKey="Karoo R">RO Karoo</name></author><author><name sortKey="Spyrou, G" uniqKey="Spyrou G">G Spyrou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mccarthy, Jg" uniqKey="Mccarthy J">JG McCarthy</name></author><author><name sortKey="Schreiber, J" uniqKey="Schreiber J">J Schreiber</name></author><author><name sortKey="Karp, N" uniqKey="Karp N">N Karp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Karp, Ns" uniqKey="Karp N">NS Karp</name></author><author><name sortKey="Thorne, Ch" uniqKey="Thorne C">CH Thorne</name></author><author><name sortKey="Mccarthy, Jg" 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