Publication:

Intraoperative risk factors associated with the need for reintervention in free flaps: a retrospective study in a third-level referral center in Mexico (2022-2025)

Background Free flap surgery is the gold standard for complex reconstruction, yet vascular compromise requiring reintervention remains a significant challenge. This study aims to identify intraoperative risk factors associated with take-back procedures at the Hospital General de México "Dr. Eduardo Liceaga."

Methods A retrospective comparative study of 121 patients undergoing free flap reconstruction (2022–2025) was conducted. Demographic data, flap types, and intraoperative variables were analyzed. Patients were divided into two groups: Reintervened (n=41) and non-reintervened (n=80). Statistical significance was set at p<0.05.

Results The reintervention rate was 33.8%. The DIEP flap was the most common (26.45%). Younger age was significantly associated with reintervention (32 vs 46 years; p=0.004). The use of intraoperative vein grafts was a major risk factor, present in 29.27% of reintervened cases versus 10% in the successful group (p=0.01). Ischemia time and type of anastomosis did not show statistical significance.

Conclusions In our population, younger age and the primary need for vein grafts are critical predictors of reintervention. These findings emphasize the need for specialized monitoring protocols for these high-risk subgroups in high-volume Mexican institutions.