Free-tissue transfer experience at a county hospital.

As reimbursement for free-tissue transfer decreases, the authors find an increase in the number of free flaps performed at their county facility. Over 60 percent of the free flaps performed during the past 10 years were completed within the last 4 years. This influx of patients prompted a review of their experience with free-tissue transfer. This retrospective study of the free-flap experience at a county hospital reviewed 49 patients with 53 free flaps between 1991 and 1999. Forty-five free flaps (85 percent) were successful, with an overall failure rate of 15 percent. Most free flaps were performed on traumatic wounds. Risk factors, such as smoking, diabetes, and peripheral vascular disease, did not reliably predict free-flap failure. Irradiated, chronic wounds were associated with the highest failure rates. Seventy-five percent of the free-flap failures were due to delayed return to the operating room, once the flap appeared compromised. Delay in reexploration resulted in a zero salvage rate. Prompt recognition of failed flaps and emergent exploration will improve the success rate.