Although the success rate of free tissue transfer was recently reported to exceed 95%, this value includes 5 to 25% of cases that required salvage surgery due to postoperative vascular compromise. If the risk factors for vascular compromise after free tissue transfer can be identified, the frequency of salvage surgeries may be reduced. In this study, we investigated the associated risk factors for vascular compromise after free tissue transfer using multivariate analysis focusing on factors deemed as intervenable. A retrospective review was conducted on 115 patients who underwent a total of 123 free tissue transfers for both the upper and lower extremities. We identified 11 (8.9%) cases of vascular compromise, 9 of which were salvaged, equating to an overall success rate of 98.4%. Multivariate analysis revealed the following significant risk factors leading to vascular compromise: female sex［odds ratio=14.5 (95% confidence interval［CI］2.11-91.08, p=0.005) ］, lower extremity cases［odds ratio=8.3 (95% CI 1.45-44.34, p=0.015) ］, and the use of the superficial venous system as a recipient vein［odds ratio=41.9 (95% CI 3.25-487.21, p=0.004) ］. Our study demonstrated that selection of the recipient vein is an important factor when aiming to prevent vascular compromise during surgery.
