Trends in Microvascular Free Flap Reconstruction at a Single Tertiary Centre: A 12-Year Retrospective Review

Microvascular free flap surgery is a cornerstone of modern reconstructive surgery, providing robust coverage for complex defects. While studies have examined outcomes in specific anatomical sites, few have evaluated long-term institutional trends across all indications. This study aimed to assess temporal changes in microvascular free flap reconstructive surgery at a tertiary plastic surgery unit over 12 years.

A retrospective review was conducted of free and locoregional flap reconstructions performed between 2012 and 2023 at a single tertiary centre. Data collected included patient demographics, flap type, anatomical region, surgical indication and complication rates.

A total of 912 free flaps and 628 locoregional flaps were performed during the study period. The volume of free flaps increased by 2.6-fold, from 4.7 procedures per month in 2012 to 12.2 in 2023 (p < 0.0001), whereas locoregional flap rates remained stable. Head and neck reconstruction accounted for the majority of cases (58%), followed by lower limb (29%) and breast (6.3%), with breast and lower limb demonstrating the greatest proportional growth. Malignancy was the most frequent indication, although trauma and infection-related reconstructions increased in later years. Takeback rates declined from 25.6% in 2012 to 17.1% in 2023, with flap loss rates consistently below 5%.

This 12-year review demonstrates a significant rise in free tissue reconstructions without a corresponding decline in locoregional procedures, indicating a genuine growth in microsurgical activity. These findings highlight increasing demand, improved outcomes, and the ongoing need for investment in microsurgical services, training, and infrastructure.