Surgical findings and timing in re-exploration of free flaps in extremity reconstruction

Objective: This study aims to evaluate the salvage rates of re-explored free flaps in extremity reconstruction, focusing on the timing of re-exploration, types of vascular compromise, and related factors that affect outcomes. Methods: A retrospective review of 527 free flap surgeries conducted between January 2010 and July 2024 was performed. Cases requiring re-exploration within seven days postoperatively (n=78) 14.8% were analysed. Data collected included demographics, flap types, timing of vascular compromises and re-explorations, and surgical outcomes. Statistical analyses were performed to identify relationships between variables. Results: Among the re-explored cases, a salvage rate of 71.7% (n=56) was achieved. Venous thrombosis emerged as the leading cause of re-exploration (44.9%) (n=35). Significant findings included a median time to re-exploration of 12.2 hours from the initial surgery and 2.5 hours from the first sign of compromise. The first signs of flap compromise were observed in 91.1% (n=71) of cases within the first 24 hours postoperatively and no instances of flap compromise were recorded after 72 hours. Conclusion: Timely intervention was found to be strongly associated with improved flap salvage rates. These findings underscore thecritical importance of early monitoring and prompt surgical management in free flap reconstructions, particularly for extremity cases. The study supports re-exploration within 2.5 hours of detecting vascular compromise as essential for maximizing salvage success. High re-exploration and survival rates demonstrate that effective and timely management protocols are vital for optimizing outcomes in microsurgical procedures. Cite this article as: Erol K, Güntürk ÖB. Surgical findings and timing in re-exploration of free flaps in extremity reconstruction. Acta Orthop Traumatol Turc., Published online October 27, 2025. doi:10.5152/j.aott.2025.25353.