From Inception to Excellence: 500 Free Flaps in Two Years in an Oncological Reconstruction Microsurgery Unit

Correspondence: Subhendu Khan (E-mail: [e-mail])

Abstract

Background Reconstructive microsurgery includes free flaps, which are an essential armamentarium of the microvascular surgeon. The learning curve is steep; however, the reproducible results are phenomenal in this modern era. In this article, we describe our experience of the first 500 free flaps at a tertiary cancer hospital in North India.

Methodology It is a retrospective observation study of the first 500 free flap cases done at the tertiary cancer hospital in North India from August 2023 to date.

Results We have reached the 500 mark in the span of 2 year. In this most commonly done flap was the anterolateral thigh flap (ALT; 50% cases), free fibula and radial artery forearm flap in 40% cases. Rest 10% cases mixed of parascapular osteocutaneous flap, free latissimus dorsi (LD) flap, superficial circumflex iliac artery perforator (SCIP) flap, gracilis flap, medial sural artery perforator (MSAP), thoracodorsal artery perforator flap (TDAP), and deep inferior epigastric perforator (DIEP) flap. Overall success rate was 94%.

Conclusion From the beginning of microsurgical services in our center, we have crossed the 500 free flaps in the initial 2 years. We have shared our experience of initial hurdles at the beginning that we overcame to reach the functional stage.

Keywords: oncological free flap, microsurgery, ALT flap, success rate, institutional experience

Publication History

Article published online:
10 November 2025