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Ischemic time and free flap success

A Gürlek¹, S S Kroll, M A Schusterman

¹Department of Plastic Surgery, University of Texas, M. D. Anderson Cancer Center, Houston 77030, USA.

Annals of Plastic Surgery

|May 1, 1997

Summary

Ischemic time, the duration of interrupted blood supply, does not significantly impact free flap survival in breast and head/neck reconstruction. Survival rates remain similar even with prolonged ischemia up to 3 hours.

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Area of Science:

Plastic Surgery
Reconstructive Surgery

Background:

Free flap reconstruction is vital for breast and head/neck cancer patients.
Optimizing flap survival is a key surgical goal.

Purpose of the Study:

To investigate the relationship between ischemic time and free flap survival.
To determine if specific ischemic time thresholds affect reconstructive surgery outcomes.

Main Methods:

Retrospective review of 700 free flaps for breast and head/neck reconstruction.
Analysis of flap survival rates based on varying ischemic time durations.
Statistical comparison of flap survival across different ischemic time intervals.

Main Results:

Mean ischemic time for failed flaps (111.64 min) was not significantly different from surviving flaps (91.25 min).

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Flap survival rates were comparable across groups with ischemic times <100 min and ≥100 min.

No significant difference in flap survival was observed when using 75, 120, or 180 minutes as thresholds.

Conclusions:

Ischemic time appears irrelevant to free flap survival within the studied range.
Prolonged ischemia is acceptable up to 3 hours, avoiding the no-reflow phenomenon.
Current clinical thresholds for ischemic time may not be critical for flap viability.