Microvascular Free-Flap Outcomes at a Low-Volume Canadian Center: A Retrospective Analysis.

INTRODUCTION: This descriptive outcomes study evaluated microvascular free-flap outcomes at a low-volume Canadian center where procedures were performed by surgeons with high-volume fellowship training. METHODS: A retrospective chart review included 65 consecutive patients who underwent a microvascular free-flap surgical procedure from 2016 to 2021 in St. John's, Newfoundland and Labrador. Six annual institutional failure rates were compared with six published high-volume-center failure rates using Welch's independent-samples t-test. The primary outcome was total or partial free-flap failure within 14 postoperative days. Secondary outcomes included postoperative complications, operative takeback, and flap salvage. RESULTS: The mean age of the study sample was 63.29 years; 41 were male, and 24 were female. The radial forearm was the most common harvest site (n = 32, 49%). Post-operative complications occurred in 24/65 patients (37%). Eight patients underwent flap-related operative takeback (8/65, 12%); seven required surgical salvage, corresponding to a partial-failure rate of 7/65 (11%), while one underwent exploration without intervention. All seven flaps requiring intervention were successfully salvaged, yielding a salvage rate of 7/7 (100%) and an overall flap success rate of 65/65 (100%). The mean annual institutional failure rate was significantly lower than the mean rate reported across the six high-volume comparator studies (0% versus 3.33%, p = 0.003). CONCLUSION: Favourable free-flap outcomes and complete salvage of threatened flaps were achieved at this low-volume regional center. These findings suggest that successful microvascular reconstruction can be maintained within an experienced and appropriately supported low-volume program staffed by surgeons with high-volume fellowship training.