Twenty Years of "Occasional" Reconstructive Microsurgery: A Retrospective Review of a Single Surgeon's Experience.

Background: Microsurgical free flap reconstruction is a highly technical surgery, usually performed in high-volume specialized centers. During the last 20 years, we had to perform occasional microsurgical reconstructions in our plastic surgery department where general and aesthetic plastic surgery is the main activity. The aim of the study was to review the results of our microsurgical activity and compare it with the results published by high-volume microsurgical centers. Methods: We retrospectively reviewed all our microsurgical free flap reconstructions from 2004 to 2024. We collected from the files all the data concerning demographics, indications, flaps used, technical details, complications, and final outcomes. Results: Seventy-one patients were included in the study, with a total of 77 flaps. Patients' age ranged from 7 to 82 years. The operative site was the head and neck in 66 cases, the lower limb in 9 cases, and the abdominal wall in 2 cases. The most frequently used flaps were the latissimus dorsi flap (24 flaps), the radial forearm flap (23 flaps), and the fibula flap (16 flaps). Anastomoses were done mainly under loupe magnification. Ten flaps presented signs of vascular compromise. Salvage rate after confirmed vascular thrombosis was 60%. A total of 4 flaps were lost (94.8% success rate). Conclusions: Provided that some precautions are respected, "occasional microsurgery" can have success rates comparable to high-volume microsurgery centers. It can save lives and improve the patients' quality of life, and it does not prevent the surgeon from pursuing a normal general and aesthetic plastic surgery career.