[Evaluation of 106 free flaps. Analysis of the failures and the indications]

Between April 1982 and April 1987, 106 free flaps were performed: 27 in the head and neck, 9 in the upper limbs and 60 in the lower limbs. 4 types of free flaps were essentially used: 42 latissimus dorsi flaps, 30 Chinese flaps, 18 temporalis flaps and 12 gracilis flaps. 14 free flaps were performed as a real emergency to cover defects of the upper limb in 4 cases and of the lower limb in 10 cases. The overall success rate was 87%, but this varied according to the recipient site, as the success rate was only 80% in the lower limb, and according to the type of flap, the latissimus dorsi flap ensured a success rate of 90%. Apart from one case of drepanocytosis, the failures observed could have been prevented. Rigorous intensive care as well as a strategy based on a precise preoperative assessment and appropriate selection of flaps should allow a considerable improvement in the results. Due to its reliability and its possibilities, we consider the latissimus dorsi flap to be the most useful flap. The Chinese flap retains a place in ENT surgery and in the case of emergency by-pass flaps. The gracilis and temporalis flaps may be proposed in certain cases because of their surface area and their minimal scars.