Oral Presentation NZAPS and ANZSOPS Joint Scientific Meeting

Waikato Plastic Surgery Department Free Flap Outcomes: A review from 2011- 2016 (606)

Stephanie Savage 1 , Michael Woodfield 2 , Brandon Adams 2 , Simon Chong 2
  1. Plastic and Reconstructive Surgery Department , Hutt Hospital, Wellington , New Zealand
  2. Plastic and Reconstructive Surgery Department, Waikato Hospital, Hamilton, Waikato, New Zealand

BACKGROUND: A review of Waikato Plastic surgery free flap outcomes from 2011-2016 was performed. The focus was to review failure, take back and salvage rates.


METHOD: Waikato Hospital free flap logbook was reviewed for all free flaps performed 1st January 2011 to 31st December 2016 by the Plastic surgery department. ICD 10 free flap codes were also reviewed to identify any additional free flaps raised. All free flap operation notes, discharges and clinic follow ups were reviewed on the hospital clinical workstation system. Failure, take back and salvage rates along with common indications for free flap surgery were analysed.


RESULTS: 213 free flaps were performed at Waikato Hospital by the Plastic surgery department from 2011 to 2016. 18 free flaps failed during this time frame resulting in a failure rate of 8.4%. 33 free flaps were taken back acutely (15%) with a 63% salvage rate. An overall success rate of 91.5% was identified. The most common indication for free flap surgery was breast cancer (47%). Transverse rectus abdominis myocutaneous flap was the most frequent free flap performed (27%).


DISCUSSION: Four free flaps that failed were not identified to be compromised until they were unsalvageable. The window of opportunity for salvage was therefore lost and has impacted on the failure rate for the department. 8.4% failure rate is higher than desired and could be improved with review into monitoring of free flaps. Take back rates were also higher than recommended but salvage rates were acceptable.


CONCLUSION: Breast surgery was the main indication for free flap surgery at Waikato Hospital. An 8.4% failure, 15% take back and 63% salvage rate were identified for the department with areas requiring investigation highlighted that could improve free flap outcomes for the department.