Free flap surgery is associated with emotional, physical and financial costs, long operative times, and can be devastating if failure occurs. Compared with microsurgical units overseas, independent New Zealand Plastic surgery departments do not perform large numbers of free flap procedures making statistically significant free flap research difficult reducing the ability to improve patient outcomes. A New Zealand National Free Flap Database is proposed as a solution to this problem.
Current New Zealand National surgical databases (Orthopaedic Joint Registry, Australasian Vascular Audit) were reviewed. An Excel free flap database in conjunction with the Waikato Plastic Surgery department was designed incorporating drop boxes, free text, and partial automation based on ICD 10 codes. The database was modified at Waikato Hospital before being instituted at the Hutt Hospital Plastic Surgery department.
The database is divided into four categories: ‘Patient factors’ recording patient age, gender, comorbidities; ‘Surgeon factors’ documents the surgeons and adjuncts they use; ‘Surgery factors’ collects data about the free flap including microvascular anastomoses and comments about the procedure; ’Post operative factors’ lists complications related to the donor site or free flap.
Surveillance on a national level of free flap surgery would provide individual surgeon and departmental feedback on free flap success, take back, and salvage rates in comparison to the rest of the country. With larger numbers of free flap data, factors related to successful and unsuccessful outcomes, new techniques and areas that require investigation will be readily identifiable.
A New Zealand National Free Flap Database would help unify free flap care across the country promoting a gold standard of care and improved outcomes for free flap patients. It will also establish a reliable way to identify factors related to favourable and unfavourable free flap outcomes within New Zealand.