Background
In 2007 the Dunedin Plastic Surgical Unit was established. One of the major achievements of the unit during its fifteen years of operation is the development of the free flap service for patients requiring major reconstruction. Microvascular reconstruction is well known to be a challenging endeavour, and successful outcomes are dependent on a multitude of factors. However, many of these fine nuance’s imperative to success in free flap surgery are not referenced in textbooks.
Methods
We present an in-depth audit of all free flap surgeries carried out at the Dunedin Public Hospital Plastic and Reconstructive Surgical Department from 2007 -2022. Data collected included the patient demographics: type of flap, indication for flap, complications, and the post-operative period. These findings have informed the development of a practical framework for surgeons establishing a new free flap service.
Results
A total of fifty-one free flaps in fifty patients were completed in 15 years. Of these, two developed complications and a subsequent two experienced flap failure. There was one patient death. 27 were performed for cancer and 24 for trauma. Of these 32 were for head and neck reconstruction; 18 for limb reconstruction and 1 for trunk reconstruction. Lessons learnt included those learnt from the surgery itself but also the important aspects of the team, the decision making, the communication, and the post-operative period.
Conclusion
The learnings from auditing the Dunedin Public Hospital free flap service has allowed us to deduce a pragmatic framework which details the absolute necessities when establishing a Plastic surgical unit that can successfully undertake free flap surgery.