Abstract
Background: Understanding factors impacting successful salvage of a compromised free flap. Methods: Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764). Results: Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P <.001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P =.035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P <.0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P <.0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P <.0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P =.04). Conclusions: There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.
Original language | English (US) |
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Pages (from-to) | 3568-3579 |
Number of pages | 12 |
Journal | Head and Neck |
Volume | 42 |
Issue number | 12 |
DOIs | |
State | Published - Dec 2020 |
Keywords
- free flap
- free flap salvage
- head and neck reconstruction
- outcomes
- surgical complications
ASJC Scopus subject areas
- Otorhinolaryngology