gms | German Medical Science

Objectives/Interrogation: The hypothesis of this study was that upper extremity free tissue transfers can be performed with a low complication rate.

Methods: This study used the National Surgical Quality Improvement Program (NSQIP) database to identify all patients who underwent upper extremity free flap transfer procedures performed between 2008 and 2016. A total of 111 patients with CPT codes corresponding to free flap transfers with concomitant procedures on the upper extremity were selected. The patients had a mean age of 37 years (range, 18 to 82 years), and were 76.6% men and 23.4% women, and 78.4% were white, 6.3% were black and 15.3% were others. The types of flaps included muscle or myocutaneous free flaps (45.9%), free fasciocutaneous flap (8.1%), fascial flap (2.7%), free vascularized bone graft with microanastomosis (1.8%), free metatarsal flap (10.8%), other free vascularized bone graft with microanastomosis (27.9%), and free osteocutaneous flap (2.7%). Complications, reoperations, and readmissions were queried from the database. Chi-square was used to evaluate differences in sex, race and insurance type. The frequency of complications was reported, and the total reoperation rate and procedures performed, along with readmissions for suspected flap failure and total readmission percentage and corresponding diagnoses were identified.

Results and Conclusions: The 30-day complications included superficial surgical site infection (2.7%), pneumonia (0.9%), deep venous thrombosis (0.9%), intraoperative transfusions (14.3%), and postoperative transfusions (0.9%). The re-operation rate was 4.5%, and most commonly occurred for incision and drainage (1.8%), secondary closure of surgical wound (0.9%), debridement (0.9%), or other procedure of the integumentary system (0.9%). The readmission rate was 3.6% and was for suspected flap failure (0.9%), pleural effusion (0.9%), fever (0.9%), and infected postoperative serosa (0.9%); of note, the mean time from discharge to readmission was 12.5 days. In conclusion, free flap transfers to the upper extremity can be performed with a low rate of complications. The 30-day re-operation rate was 4.5%, and most commonly for incision and drainage, and the readmission rate within 30-days was 3.6%.