ABSTRACT
Free-tissue transfer is a standard procedure in hand and other plastic and reconstructive
surgery. The aim of the present article was to present a new clinical classification
of disturbances of the circulation, and to assess the results of treating the specific
complication at each of the stages described.
Within a period of 29 months, 194 free microvascular flaps were prepared and evaluated
in a prospective study. Postoperative monitoring was carried out from a purely clinical
point of view. A distinction was made between arterial and venous circulatory disturbances
and, in both cases, four stages were characterized, according to the time required
for recapillarization, the color of the transfer, and bleeding on puncture. Complications
occurred in 69 cases (36 percent), including intraoperative revisions during a first
operation. The ratio of arterial to venous insufficiency was 33:35. In the presence
of arterial disturbances of the circulation, the proportion of losses increased in
progressive stages to 41 percent. With venous disturbances, losses which occurred
in stages 1 and 2 were predominantly partial. In 164 cases (85 percent), the flaps
remained undamaged. In 15 cases (8 percent), there was partial loss of the transfer
and, in a further 13 cases (6 percent), there was complete loss.
The authors' results confirmed that the presented clinical classification is, indeed,
a measurement of the severity of circulatory impairment. Despite the relatively high
complication rate, the use of various methods of treatment finally led, in the overwhelming
majority of cases, to a positive result.
KEYWORD
Complications in free-flap perfusion - disturbances in arterial and venous circulation
- clinical classification
