We retrospectively analyzed five cases requiring revision surgery (fibula bone graft: 2, scapular cutaneous flap: 1, gracilis muscle flap: 1, latissimus dorsi musculocutaneous flap: 1) among 96 cases of free flap transfer. Twenty to 324 hours after surgery, vascular problems were recognized by color changes in the monitor flaps in four cases and a sudden decrease in surface temperature of the monitor flap in one case. Temperature-sensitive stickers were used for three cases; however, the stickers were not useful except in one case. The interval between transplantation and revision surgery ranged from 25 to 326 hours. Venous thrombectomy followed by vein grafts was performed in two cases. In one case, the anastomosis site was re-exposed and vascular patency was confirmed. In another case, although thrombectomy followed by re-anastomosis of the flap artery and anastomosis of the flap vein with a new vein in the recipient site was performed, flap necrosis occurred. In yet another case, repeat muscle transplantation was required because of partial necrosis of the transplanted muscle caused by vascular anomaly. These findings suggest that close and detailed observation of flaps, close cooperation between staff, and thorough preoperative investigation of patient risk factors for surgery as well as vascularity of grafts and recipient sites would help in increasing the success rate of surgery.
