Investigate the causes of failure and re-exploration strategies in the free flaps

INVESTIGATE THE CAUSES OF FAILURE AND RE-EXPLORATION STRATEGIES IN THE FREE FLAPSFree tissue transfer in plastic surgery has a significant importance on tissue defect treatments which cannot be recovered by local tissues because of its large surface of defect. At the present time, large series made in advanced microsurgery centers all over the world, have been re-explorated at the rate of 5% - 25% which is quite difficult to recover the tissues by any operation. This is why it is crucial to understand the re-exploration reasons of free flaps, and also examine the salvation strategies of unsuccessful flap operations.A retrospective review of 334 free tissue transfers performed by the Department of Plastic and Reconstructive Surgery at Akdeniz University Faculty of Medicine between the years of 2005 and 2010. Major parts of the study focuses on number of free flaps within years, etiologies, areas of the body implemented, varieties of free flaps, the number of re-explorations and its reasons, unsuccessfull free flaps and its re-exploration reasons.Of the 334 free flap procedures performed, re-explorations due to circulatory compromise were requied in 43 cases. 20 patients presented with signs related to arterial problems, 18 patients presented with signs related to venous problems, 4 of them related to both arterial and venous problems and 1 of them related to the seperated cross-leg. 34 flaps had signs of the first episode of circulatory compromise within the first 24 hours after free tissue transfer. A total of 16 out of 334 free flap operations had failed after re-exploration. The reconstructed defects were mostly in the regions of lower extremities and variety of the flap implemented in most cases was ALT. On the other hand, the flap variety which has the highest re-exploration as well as failure rate was also ALT. The most common etiology of the cases was due to several traumas. As a result, the succes rate of the free tissue transfer was reported in our study as 95 percent.Free tissue transfer is a complicated procedure begining with preparation of the patient, deciding on the technique of the surgery and finally close examination of the patient after operation. To overcome this comlicated process experienced and result-based surgeons would have no reaosons to fail.