Trends, Indications, and Postoperative Outcomes of Microsurgical Reconstruction in BIRDEM General Hospital

Abstract

Background & objective: Microsurgery plays a pivotal role in reconstructive surgery, particularly in managing complex posttraumatic, post-infection, and post-oncologic defects, yet there is limited local data on the demographic, clinical characteristics, and outcomes of patients undergoing microsurgical procedures in Bangladesh.  This study aims to evaluate the demographic patterns, clinical indications, and postoperative outcomes of microsurgical procedures at a leading tertiary care center. Methods: A mixed-methodological study combining a prospective observational design with retrospective data evaluation was conducted at BIRDEM General Hospital, Dhaka, from March 2022 to March 2024. A total of 45 patients aged 18 and above who underwent microsurgical reconstruction (free flaps or nerve repairs) were included via purposive sampling. Data on demographics, surgical indications, flap types, and postoperative complications were analyzed using SPSS, v25.0. Results: The majority of patients were male (75.6%), with over 70% falling within the economically productive age group of 31–60 years. Trauma-related defects (15.6%), squamous cell carcinoma of the buccal mucosa (13.3%), and odontogenic cysts (11.1%) were the primary indications for surgery. The anterolateral thigh (ALT) flap was the most frequently used reconstructive tool (46.7%), followed by the radial forearm (24.4%) and latissimus dorsi (15.6%) flaps. The overall success rate was high, with 89% of patients experiencing uneventful recoveries. The total flap failure rate was only 2.2%. The mean postoperative hospital stay was 4.6 ± 2.1 days with the shortest and the longest stays being 2 and 12 days respectively. Conclusion: Microsurgical reconstruction at BIRDEM General Hospital is a highly effective intervention with success rates comparable to international benchmarks. The ALT flap remains the "workhorse" of reconstruction due to its versatility. While clinical outcomes are favorable, there is a need for enhanced institutional infrastructure and standardized training to sustain and expand these life-altering services in Bangladesh.

Ibrahim Card Med J 2025; 15 (2): 33-37