The time interval
between the onset of ischemia and its clinical recognition is of utmost
importance in terms of free flap salvage in free flap surgery.
Although
microsurgical free-tissue transfer has become a reliable technique, between 5
to 25 percent of transferred flaps require surgical revision because of
circulatory compromise either on the arterial or venous side.
Regardless of the
surgeon’s experience or the reliability of the chosen free flap, immediate
detection of perfusion failure and prompt revision is paramount for
flap salvage as ischemic tolerance of the flap tissue is limited to a
few hours and irreversible disseminated microvascular thrombi may form during
malperfusion.
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