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Page 18 of 26 Chen et al. Plast Aesthet Res 2023;10:24 https://dx.doi.org/10.20517/2347-9264.2022.136

Table 2. Checklist to be reviewed by surgeon after free flap failure. This figure is quoted from Baumeister et al. [160] published in
Plastic & Reconstructive Surgery by the American Society of Plastic Surgeons, copyright 2008.
from Wolters Kluwer Health, Inc
Preoperative preparations
Did I know enough about the recipient vessels (artery and vein)?
Did I need an angiogram?
Did I adequately assess the patient’s coagulation potential?
Did I need to exclude a venous thrombosis?
Did I know about any previous operations, scars, or irradiation?
Were the type, size, and positioning of the flap properly planned?
Recipient vessels/anastomosis
Were there atherosclerotic changes?
Was there poor arterial outflow suggesting a proximal problem?
Did I need to perform the Fogarty maneuver on the artery?
Was it necessary to go more proximal using an interpositional graft to avoid the zone of injury?
Did I injure the vessel during preparation?
Was I satisfied with my technical performance during the anastomosis? Did I see every stitch?
Was it possible to improve the exposure of the vessels during anastomosis?
Was end-to-end or end-to-side anastomosis the best option?
Was there any tension or kinking of the vessels?
Did I irrigate with heparin?
Was there any vasospasm?
Should I have used papaverine or Xylocaine?
Was the room/patient warm enough?
Was the patient’s blood pressure adequate?
Were there any external constricting fascial bands or muscles compressing the vessels?
Coagulation/thrombosis
Was the operation performed in the acute posttraumatic period?
Was I satisfied with the coagulation of bleeding points?
Was there any thrombosis?
Intraoperative positioning
Were the exposure and approach to the vessels optimal?
Was it possible to operate in two teams and thus shorten the operating time?
Was it possible to improve the positioning of the surgeon during anastomosis?
Postoperative care
Was the patient hypovolemic, hypotonic, or hypothermic?
Was patient/flap positioning appropriate?
Was there any pressure on the proximal extremity/vessels?
Would it have been preferable to use an external fixator?
Was there pressure on the flap’s pedicle?
Were the flap’s perfusion and positioning adequately monitored (hourly)?
Would it have been preferable to use a Cook Doppler probe or a similar device?
Was the anticoagulation therapy adequate? Would full heparinization have helped?
Were there problems with patient compliance?
Revision
Was the thrombosis recognized early enough?
Was the revision performed immediately?
Would a different revision strategy have been preferable?
Surgeon
Would referral to another surgeon be appropriate?