J Reconstr Microsurg 2001; 17(5): 341-346
DOI: 10.1055/s-2001-16026
IDEAS AND INNOVATIONS

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Clinical Classification of Free-Flap Perfusion Complications

Riccardo Giunta, A. Geisweid, A.-M. Feller
  • Department of Plastic Surgery, Behandlungszentrum Vogtareuth, Vogtareuth, Germany
Further Information

Publication History

Publication Date:
31 December 2001 (online)

ABSTRACT

Free-tissue transfer is a standard procedure in hand and other plastic and reconstructive surgery. The aim of the present article was to present a new clinical classification of disturbances of the circulation, and to assess the results of treating the specific complication at each of the stages described.

Within a period of 29 months, 194 free microvascular flaps were prepared and evaluated in a prospective study. Postoperative monitoring was carried out from a purely clinical point of view. A distinction was made between arterial and venous circulatory disturbances and, in both cases, four stages were characterized, according to the time required for recapillarization, the color of the transfer, and bleeding on puncture. Complications occurred in 69 cases (36 percent), including intraoperative revisions during a first operation. The ratio of arterial to venous insufficiency was 33:35. In the presence of arterial disturbances of the circulation, the proportion of losses increased in progressive stages to 41 percent. With venous disturbances, losses which occurred in stages 1 and 2 were predominantly partial. In 164 cases (85 percent), the flaps remained undamaged. In 15 cases (8 percent), there was partial loss of the transfer and, in a further 13 cases (6 percent), there was complete loss.

The authors' results confirmed that the presented clinical classification is, indeed, a measurement of the severity of circulatory impairment. Despite the relatively high complication rate, the use of various methods of treatment finally led, in the overwhelming majority of cases, to a positive result.

REFERENCES

  • 1 Tsai T-M, Bennett D L, Pederson W C, Matiko J. Complications and vascular salvage of free-tissue transfers to the extremities.  Plast Reconstr Surg . 1988;  82 1022-1026
  • 2 Harashina T. Analysis of 200 free flaps.  Br J Plast Surg . 1988;  41 33-36
  • 3 Simpson K H, Murphy P G, Hopkins P M, Batchelor A G. Prediction of outcomes in 150 patients having microvascular free tissue transfers to the head and neck.  Br J Plast Surg . 1996;  49 267-273
  • 4 Strauss J M, Neukam F W, Krohn S. Postoperative Überwachung mikrovaskulärer Lappenplastiken mit der Pulsoxymetrie-Erste Erfahrungen.  Handchir Mikrochir Plast Chir . 1993;  26 80-83
  • 5 Svenson H, Holmberg J, Svedman P. Interpreting laser Doppler recordings from free flaps.  Scand J Plast Reconstr Hand Surg . 1993;  27 81-87
  • 6 Hirigoyen M B, Blackwell K E, Zhang W X. Continous tissue oxygen tension measurement as a monitor of free-flap viability.  Plast Reconstr Surg . 1997;  99 763-773
  • 7 Khouri R K, Shaw W W. Monitoring of free flaps with surface recordings: is it reliable?.  Plast Reconstr Surg . 1992;  89 495-502
  • 8 Thorniley M S, Sinclair J S, Barnett N J. The use of near-infrared spectroscopy for assessing flap viability during reconstructive surgery.  Br J Plast Surg . 1998;  51 218-226
  • 9 Buncke H J. Microsurgery: Transplantation-Replantation.  Philadelphia/London: Lea & Febiger 1991
  • 10 Giunta R, Geisweid A, Lukas B, Feller A-M. Behandlung und Ergebnisse von Komplikationen nach freien Lappenplastiken.  Handchir Mikrochir Plast Chir . 2000;  32 176-180
  • 11 Kroll S S, Schusterman M A, Reece G P. Timing of pedicle thrombosis and flap loss after free-tissue transfer.  Plast Reconstr Surg . 1996;  98 1230-1233
  • 12 Hidalgo D A, Jones C S. The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases.  Plast Reconstr Surg . 1990;  86 492-498