Revisitation of the Utility of Clinical Observation Method in Free Flap Monitoring

Abstract

　In 2012, we reported on the clinical observation method following 544 free flap transfers for head and neck reconstruction. After 10 years, we reviewed the postoperative outcomes using the similar monitoring approach. The success rates of free flap transfer were 97.8% for 495 head and neck defects and 80.8% for 26 lower extremities defects. Compromised flaps were observed in 21 patients. Flap color change was identified as the first clinical sign of flap compromise in 14 out of 21 patients. Of the 14 head and neck cases, emergency salvage surgeries were performed in six cases, and three flaps were salvaged. The other eight flaps were observed conservatively, however, all of them suffered total necrosis. In the five cases of lower extremity reconstruction with flap compromise, one patient underwent salvage surgery; however, the flap could not be salvaged. The other four flaps that did not undergo salvage surgery developed total necrosis. The flap salvage rate using the clinical observation method was comparable to previously reported rates. To further improve the salvage rate, it is essential to inspect the anastomosis site directly and perform salvage surgery promptly upon recognizing subtle and characteristic color changes in the flap.