Poster Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Factors contributing to free flap failure (858)

Robert Phan 1 , Warren Rozen 1 2 , Muhammed CHOWDHR 2 , Edmund O’CONNOR 2 , David HUNTER-SMITH 1 , Venkat RAMAKRISHNAN 2
  1. Peninsula Clinical School, Frankston
  2. St Andrew’s Centre for Plastic Surgery and Burns, United Kingdom

Background: Free tissue transfer breast microvascular reconstructive surgery is currently the gold standard following mastectomy. However, it is not without risk. Haematomas following breast reconstruction can compromise flap viability and lead to haemodynamic instability. This study evaluates an institutional experience with haematomas following free flap breast reconstruction.


Methods: A retrospective study was undertaken of patients undergoing autologous free flap breast reconstruction at the St Andrews Centre over a 4-year period from 2010 to 2014. A surgeon’s logbook was analysed for age of patient, flap selection, arterial and venous anastomosis time and complications. The hospital database was interrogated to provide accurate timings of patients who developed haematomas and flap compromise.


Findings: 1212 flaps where undertaken in 1070 patients during the period of review. 69 flaps where taken back to theatre for haematomas. There was no statistically significant difference between immediate vs delayed reconstruction for time to haematoma (TTH). However, there was a positive relationship between arterial and venous anastomosis time. There was no correlation between age of patient or length of pedicle to TTH time. There was a bimodal distribution for the detection of TTH, occurring at a peak of within the first 4 hours and 12-14 hours after operation. 2 flaps were lost following a haematoma. Blood products was used in 15% of patients following haematoma. 


Conclusion: Haematomas are a complication which must be managed with prompt return to theatre to ensure flap salvage and patient stabilisation. They are most common within the first 20 hours after surgery. Further analysis is required to ascertain factors leading to this bimodal distribution of increased detection, so as to apply it throughout the day to increase earlier detection of flap compromise and hence increase the chance of flap salvage.