Abstract
Free flaps are used in reconstructive surgery for head and neck cancer, trauma, and burns. Because the flaps require monitoring, the patient needs to be transferred to the ICU postoperatively. The main postoperative complications of free flaps are thrombosis, hematoma, fistula, and flap failure. To recognize the occurrence of postoperative complications, it is necessary to evaluate the condition of the flap every few hours. Although one report recommends monitoring of flaps for the first 72 hours postoperatively, in Japan, it may be impractical to keep the patient in the ICU solely for monitoring of flaps. Because thrombosis may occur with mechanical pressure, free flaps must be maintained without stress. However, agitation and delirium can cause stress. Previous reports on postoperative free flaps were based on retrospective observational studies; thus, randomized controlled trials are required. In this article, we provide basic knowledge of free flap management in the ICU, and discuss management problems.
