J reconstr Microsurg
DOI: 10.1055/s-0037-1607309
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Preoperative Medical Status on Microsurgical Free Flap Reconstructions: A Matched Cohort Analysis of 969 Cases

Denis Ehrl1, 2, Paul I. Heidekrueger1, Milomir Ninkovic1, P. Niclas Broer1
  • 1Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
  • 2Department of Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
Further Information

Publication History

27 June 2017

24 August 2017

Publication Date:
27 October 2017 (eFirst)


Background Free tissue transfers have become standard for a wide variety of reconstructive purposes. In an era of increasing economic pressure, it is important to precisely define appropriate candidates and indications for a complex surgery to optimize efficiency and patient outcomes. This study evaluates the feasibility to perform microsurgical procedures in a medically compromised patient cohort at a major academic microsurgical center.

Methods Within 7 years, 897 patients underwent 969 microvascular free flap reconstructions. The data were retrospectively screened for patients' demographics, perioperative details, flap survival, surgical complications, and outcomes. The cases were divided into two groups in “low-risk” (American Society of Anesthesiologists [ASA] I and II) or “high-risk” (ASA III and IV) as per the preoperative medical status classified according to the ASA score of physical status.

Results Despite the significantly higher prevalence of hypertension, peripheral artery disease, diabetes, obesity, and smoking status in the “high-risk” group (p < 0.05), there was no significant difference in the rate of surgical or medical complications, in operative times regarding overall as well as different flap entities, flap failures, need for revision surgery, or hospital length of stay between the two patient groups during our 3-months follow-up period (p > 0.05).

Conclusion In this study, free flap reconstruction in medically compromised patients was not associated with higher rates of revision surgeries, overall complication rates, or surgery-related costs. Complex microsurgical free flap reconstruction can therefore also be advocated in patients with high preoperative risk constellation.