A UK based multi-centre prospective study of microvascular free-flap surgery

Background Studies carried out in 1998 by Khouri et al. established a benchmark for free flap survival. Whilst individual factors related to free flap survival have been examined since, there has been little contemporaneous data re-examining overall flap survival rates and factors related to complications to assess progress in the field and specifically European or UK practice. Methods Six plastic surgery units from four regions within the South West UK regional collaboration group prospectively collected data on all free flap surgery performed in a 6-month period between October 2013 and April 2014. Results Data on 264 free flaps were prospectively collected. Total flap failure was 2.7% and partial flap failure was 4.5%. Regression analysis identified obesity and previous recipient site radiotherapy as the most important factors in flap failure. The rate of intra-operative and post-operative flap thrombosis was 3.8% and 6.4%, respectively, and was associated with lower limb recipient site and surgeon grade. Post-operative haematoma occurred in 4.2%, associated with recipient site radiotherapy. Conclusions Our study establishes a UK baseline for standards in free flap surgery. With the recent introduction of a UK Free Flap Surgery Registry, this baseline will support unit audit and improvements in free flap surgery. Level of evidence: Level III, risk/prognostic study.