Free‐flap salvage: muscle only versus skin paddle – an Australian experience

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Since its introduction in the 1970s, the evolution of free flaps has seen it become a reliable reconstructive option for complex defects. Advantages include improved aesthetic and functional outcomes and stable wound coverage. Success rates of free flaps in high volume centres are in excess of 95%.1 Despite these advances, there is still a risk of flap compromise requiring urgent re‐exploration. Thus, early post‐operative clinical recognition of the threatened flap is critical in ensuring successful flap salvage.
Post‐operative flap monitoring includes flap colour, capillary refill time, temperature, doppler signal and pinprick test.2 Free flaps can be divided into skin flaps (e.g. fasciocutaneous/myocutaneous) with an overlying skin paddle and muscles flaps with or without an overlying skin graft (e.g. gracilis flap). Currently, there is a paucity of studies comparing the salvage rates of threatened muscle flaps versus flaps with an overlying skin paddle. The aim of this study was to determine whether salvage rates were higher in skin flaps, as opposed to muscle flaps, due to the overlying skin paddle allowing for better visual post‐operative flap monitoring and more timely recognition of the threatened flap.
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