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J Reconstr Microsurg 2018; 34(05): 321-326
DOI: 10.1055/s-0037-1621729
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Duration of Perioperative Ischemia on Outcomes of Microsurgical Reconstructions

Denis Ehrl
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
2   Department of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
,
Paul I. Heidekrueger
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
,
Milomir Ninkovic
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
,
P. Niclas Broer
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
› Author Affiliations
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Further Information

Publication History

23 September 2017

19 November 2017

Publication Date:
22 January 2018 (online)

Also available atMedOne
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Abstract

Background Free tissue transfers have become routine for a variety of reconstructive purposes. During the time of transfer, some period of ischemia time is unavoidable, causing structural and metabolic changes. This study aimed to evaluate whether length of intraoperative ischemia affects the outcomes of microsurgical reconstructions.

Methods Within a 7-year period, 638 patients having undergone 690 microvascular free flap reconstructions fulfilled inclusion criteria for this study. The data were retrospectively screened for patients' demographics, intra- and perioperative details, flap survival, surgical complications, and outcomes. The cases were divided into two groups according to the length of intraoperative ischemia time, “< 60” versus “≥ 60 minutes.”

Results Both groups were comparable regarding the patient constellation, comorbidities, smoking status, and perioperative characteristics. Operative times were significantly longer in patients which had ischemia times of ≥ 60 minutes (p < 0.05). Also, during our 3-month follow-up period, a significantly higher rate of major and minor surgical complications, including total and partial flap losses, as well as higher revision rates occurred in the ≥ 60 minutes ischemia time group (p < 0.05).

Conclusion In this study, prolonged ischemia time during free flap reconstructions was associated with higher rates of revision surgeries and complications rates.

Keywords

ischemic time - free flap reconstruction - operative times