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Strategy for reoperative free flaps after failure of a first flap.

Publication ,  Journal Article
Baumeister, S; Follmar, KE; Zenn, MR; Erdmann, D; Levin, LS
Published in: Plast Reconstr Surg
September 2008

BACKGROUND: Free vascularized tissue transfer is generally associated with high success rates, but failures do occur. After a flap failure, the decision is often made to perform a second, reoperative free flap. METHODS: A retrospective review of all microsurgical free tissue transfers performed at the authors' institution identified 13 patients who underwent a second, reoperative free flap after a failed primary flap. The records of these patients were reviewed, with particular emphasis on identifying changes in treatment strategy between the initially failed and the reoperative free flap. RESULTS: Thirteen patients were identified as having undergone a reoperative free flap. In nine of 13 primary free flaps, at least one likely cause for the failure was identified (69 percent). In the approach to the second free flap, strategy changes were performed in 10 of 13 cases (77 percent); 11 were successful (85 percent). One of the two patients with a failed reoperative free flap underwent a third attempt at free tissue transfer, which also failed. CONCLUSIONS: The authors' overall approach to the failed free flap includes the following four steps: (1) reconsideration of the need for vascularized free tissue transfer, (2) a sensitive psychosocial approach to the patient and family, (3) analysis of the cause of the first flap failure, and (4) change in microsurgical strategy. Based on the authors' experience, they consider two previously failed free flaps without an obvious cause to be a contraindication to a third attempt.

Duke Scholars

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

September 2008

Volume

122

Issue

3

Start / End Page

962 / 971

Location

United States

Related Subject Headings

  • Treatment Failure
  • Surgical Flaps
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Middle Aged
  • Microsurgery
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Baumeister, S., Follmar, K. E., Zenn, M. R., Erdmann, D., & Levin, L. S. (2008). Strategy for reoperative free flaps after failure of a first flap. Plast Reconstr Surg, 122(3), 962–971. https://doi.org/10.1097/PRS.0b013e3181811ca0
Baumeister, Steffen, Keith E. Follmar, Michael R. Zenn, Detlev Erdmann, and L Scott Levin. “Strategy for reoperative free flaps after failure of a first flap.Plast Reconstr Surg 122, no. 3 (September 2008): 962–71. https://doi.org/10.1097/PRS.0b013e3181811ca0.
Baumeister S, Follmar KE, Zenn MR, Erdmann D, Levin LS. Strategy for reoperative free flaps after failure of a first flap. Plast Reconstr Surg. 2008 Sep;122(3):962–71.
Baumeister, Steffen, et al. “Strategy for reoperative free flaps after failure of a first flap.Plast Reconstr Surg, vol. 122, no. 3, Sept. 2008, pp. 962–71. Pubmed, doi:10.1097/PRS.0b013e3181811ca0.
Baumeister S, Follmar KE, Zenn MR, Erdmann D, Levin LS. Strategy for reoperative free flaps after failure of a first flap. Plast Reconstr Surg. 2008 Sep;122(3):962–971.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

September 2008

Volume

122

Issue

3

Start / End Page

962 / 971

Location

United States

Related Subject Headings

  • Treatment Failure
  • Surgical Flaps
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Middle Aged
  • Microsurgery
  • Male
  • Humans
  • Female