Free flap reconstruction experience in Medellin, Colombia; analysis of 567 cases

Abstract

Background and objective. Free flap reconstruction has evolved thanks to advances in magnification devices, microsurgical techniques, and a better understanding of tissue vascularization. In high-complexity reconstructive centers, success rates exceed 90%; however, numerous factors can influence free flap failure, increasing patient morbidity and imposing additional costs to the health care system. The aim of the present study was to describe the sociodemographic, clinical, and surgical characteristics of patients who underwent reconstructive surgery with free flaps at 3 health care institutions in the city of Medellín, Colombia, in a 5-year period (2017 y 2021). Methods. An analytical cross-sectional, multicenter study was conducted, reviewing 1103 medical records, with 567 patients included in the analysis. Information was obtained from institutional medical records, feeding a database designed specifically for the study. An exploratory analysis was performed between flap loss and potential independent clinical variables. Odds ratios and 95% confidence intervals were estimated for each independent variable and flap loss. Results. In this patient population, the lower limb was the most frequent recipient site. The total percentage of major complications was 22%, being the most common the surgical site infection. The failure rate in free flap reconstruction was 20.2% and the most consistent intraoperative finding in failed flaps was arterial thrombosis. Cigarette smoking, surgical time, intraoperative transfusion, and the need for preoperative vascular evaluation with angio-scan were significantly associated with free flap loss. The number of venous anastomoses was not related free flap loss. The use of postoperative antiplatelet agent, immediate oncological reconstruction and reconstructions performed in hospital 1 were identified as protective factors. A mortality of 2.8% was reported. Conclusions. The loss of free flap sis a frequent complication in our city; therefore, it is necessary to implement strategies and care protocols that reduce complications and morbidity in patients. © 2024 Sociedad Espanola de Cirugia Plastica Reparadora y Estetica (SECPRE). All rights reserved.