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Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction
Author(s) -
Chang Edward I.,
Zhang Hong,
Liu Jun,
Yu Peirong,
Skoracki Roman J.,
Hanasono Matthew M.
Publication year - 2016
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24097
Subject(s) - medicine , surgery , anastomosis , salvage therapy , head and neck , free flap , thrombosis , salvage surgery , vein , venous thrombosis , radiation therapy , chemotherapy
Background Risk factors and techniques for free flap salvage in head and neck reconstruction are poorly described. Methods We conducted a retrospective review of all head and neck free flaps performed from 2000 to 2010. Results Overall, 151 of 2296 flaps (6.6%) underwent salvage for microvascular complications. Age, comorbidities, surgeon experience ( p = .88), vein grafts, and supercharging ( p = .45) did not affect flap salvage. Muscle‐only flaps ( p = .002) were associated with significantly worse outcomes. Coupled venous anastomoses were superior to handsewn anastomoses ( p = .03). Arteriovenous thrombosis had worse outcomes than a venous or arterial thrombosis alone ( p < .0001). Anticoagulation, thrombolytics, and thrombectomy did not improve survival. Multiple takebacks ( p = .003) and late takebacks (>3 days) had significantly worse outcomes ( p = .003). Flap salvage was 60.3% successful with 60 total flap losses (2.6%). Conclusion Although flap salvage should be attempted, multiple attempts are not recommended, especially for muscle‐only flaps. Combined arteriovenous and late thrombosis has a dismal prognosis regardless of different salvage techniques. © 2015 Wiley Periodicals, Inc. Head Neck 38 : E771–E775, 2016