Free tissue transfers at Hutt Hospital

Authors

  • Jonathan P. S. Heather,

    1. Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital
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  • Gary Avery,

    1. Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital
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  • Christina M. Ackland,

    1. Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital
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  • Swee T. Tan

    Corresponding author
    1. Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital
    2. The Gillies McIndoe Research Institute
    3. The Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
      Professor Swee T. Tan, Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Private Bag 31-907, High St, 5010 Lower Hutt, New Zealand. Email: swee.tan@huttvalleydhb.org.nz
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  • J. P. S. Heather MBChB, FRACS; G. Avery MBBS, FRACS; C. M. Ackland RN; S. T. Tan FRACS, PhD.

  • This paper was presented, in part, at the New Zealand Association of Plastic Surgeons' Annual Scientific Meeting, 26–27 November 2010.

Professor Swee T. Tan, Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Private Bag 31-907, High St, 5010 Lower Hutt, New Zealand. Email: swee.tan@huttvalleydhb.org.nz

Abstract

Background:  The Wellington Regional Plastic, Maxillofacial & Burns Unit based at Hutt Hospital provides comprehensive reconstructive services to central New Zealand with a population of 1.1 million. Free tissue transfer procedures in the Unit were audited to determine the indications and rate of usage in our population, our success and complication rates, and how these compare with published series.

Methods:  Prospectively collected data on all free tissue transfer procedures between January 2006 and September 2010 were analysed.

Results:  Two hundred and seven free flaps including 17 flap types being performed on 186 consecutive patients including 199 primary and 8 salvage flaps. Eighty-three percent were elective and 17% were acute cases. The majority of the flaps were used for head and neck (48%) and breast (31.5%) reconstruction. Ulnar forearm flap was the most commonly used fasciocutaneous flap. 18.8% of patients had major complications requiring return to theatre. Microsurgical revision was performed in nine (4.3%) flaps of which six were successfully salvaged. Overall, 13 flaps (6.3%) failed completely, giving an overall success rate of 93.7%. Haematoma requiring formal drainage occurred in 12 (5.8%) cases.

Discussion:  The wide variety of flaps used reflects the very broad range of defects requiring free flap reconstruction. We show a free flap success rate of 93.7% in our medium-sized regional unit. Our microsurgical revision rate of 4.3% is lower than the revision rate of 10% in reported series with high overall success rates. More consistent early detection of failing flaps is likely to further improve our overall success rate.

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