In most university hospitals, free tissue transfer (FTT) has become a standard method of reconstruction for a broad spectrum of defects. Because of its complexity, FTT has not been routinely performed in a community hospital setting. This study reports on the outcomes of two equal groups of FTT comparing the university (UH) versus the community hospital (CH) setting.

725 FTTs were performed on 645 patients (mean age=51.1 yrs) at 2 UH and 6 CH: 444 females (69%) and 201 males (31%). Outcomes included wound infection, dehiscence, delayed healing, hematoma, fat necrosis, postoperative vascular compromises as well as partial and total flap loss. 379 FTTs were performed at UH (52%) and 346 (48%) were performed at CH. Categories of FTT reconstruction included 388 breast (32% UH, 68% CH), 169 lower extremity (75% UH, 25% CH), 140 head and neck (80% UH, 20% CH), 13 upper extremity (100% UH), 1 gender reassignement (UH), and 1 perineal reconstruction (CH). Type of free flaps used included: 383 TRAM (30% UH, 70% CH), 130 radial forearm (79% UH, 21% CH), 123 rectus abdominus (80% UH, 20% CH), 35 latissimus dorsi (80% UH, 20% CH), 33 fibulas (76% UH, 24% CH), 10 gluteal myocutaneous (50% UH, 50% CH), 9 SGAP (33% UH, 67% CH), 6 omental (83% UH, 17% CH), 4 DIEP (75% UH, 25% CH), 3 lateral arm (UH), 3 VRAM (67% UH, 33% CH), 1 serratus (UH), 3 scapular (UH), 3 jejunum (67% UH, 33% CH), and 5 other free flaps (4 UH, 1 CH).

60 major postoperative complications occurred in the UH setting (16%) while 42 occurred in the CH setting (12%). These included wound infection (n=24 UH vs. n=11 CH, p=0.02), delayed healing (n=12 UH vs. n=5 CH, p>0.05), dehiscence (n=6 UH vs. n=3 CH, p>0.05), fat necrosis (n=3 UH vs. n=8 CH, p>0.05), hematoma (n=6 UH vs. n=4 CH, p>0.05), and others. Partial flap loss was present in 6 UH vs. 3 CH flaps, p>0.05. Total flap loss occurred in 6 (1.6%) UH and 5 (1.4%) CH flaps, p>0.05.

In conclusion, the frequency of postoperative complications did not differ between the UH and CH with the exception of wound infection. This sole difference is probably reflected in the difference of the case mix between the two settings. FTT is an effective and practical method of reconstruction that can be safely performed by experienced microsurgeons in both a university and community hospital.