Re-exploration in the early postoperative period has a better salvage rate in free flaps

Background The most significant complication of free flap reconstruction is flap failure, which can be a result of numerous factors but ultimately affecting the vascularity of the flap tissues. In cases of doubtful flap viability re-exploration in the early postoperative period has a better salvage rate than the late postoperative period in free flaps. We aim to analize the salvage rate of free flaps undergoing re-exploration in different time periods in the postoperative phase. Methods This is a retrospective analysis of charts of 376 patients who underwent free tissue transfer during 4 consecutive years from August 2013 to July 2017 for the reconstruction of post-oncological resection defects among which 43 patients underwent re-exploration. Indications for re-exploration were vascular compromise indicated by absent or very delayed bleeding, brisk dark bleeding, suspected haematoma, chyle collection, etc. Results Among 43 patients who underwent re-exploration, 3 patients were re-explored on the operative day itself, 23 on the 1st postoperative day, 6 on the 2nd day, 4 on the 3rd day, 5 on the 4th day and 2 on the 5th day with salvage rates of 100%, 48%, 50%, 20%, 20% and 0% respectively. Findings on re-exploration included arterial/venous thrombosis, haematoma, chyle collection, external compression on pedicle/perforator by nerve, etc. Conclusions Analysing the data collected from this series of patients who underwent re-exploration, it has been observed that the re-explorations performed in the early postoperative period have a better chance of salvaging the flap. Although it is intuitive that a high index of suspicion followed by early re-exploration will improve the salvage rate, this paper attends to back this up with evidence. Level of evidence: Level III, risk/prognostic study.