Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction

Larissa Sweeny, Michael Topf, Mark Wax, Eben L. Rosenthal, Benjamin J. Greene, Ryan Heffelfinger, Howard Krein, Adam Luginbuhl, Daniel Petrisor, Scott Troob, Brian Hughley, Steve Hong, Tingting Zhan, Joseph Curry

Research output: Contribution to journalReview article

Abstract

Objective: Analyze the cause and significance of a shift in the timing of free flap failures in head and neck reconstruction. Study Design: Retrospective multi-institutional review of prospectively collected databases at tertiary care centers. Methods: Included consecutive patients undergoing free flap reconstructions of head and neck defects between 2007 and 2017. Selected variables: demographics, defect location, donor site, free flap failure cause, social and radiation therapy history. Results: Overall free flap failure rate was 4.6% (n = 133). Distribution of donor tissue by flap failure: radial forearm (32%, n = 43), osteocutaneous radial forearm (6%, n = 8), anterior lateral thigh (23%, n = 31), fibula (23%, n = 30), rectus abdominis (4%, n = 5), latissimus (11%, n = 14), scapula (1.5%, n = 2). Forty percent of flap failures occurred in the initial 72 hours following reconstruction (n = 53). The mean postoperative day for flap failure attributed to venous congestion was 4.7 days (95% confidence interval [CI], 2.6–6.7) versus 6.8 days (CI 5.3–8.3) for arterial insufficiency and 16.6 days (CI 11.7–21.5) for infection (P <.001). The majority of flap failures were attributed to compromise of the arterial or venous system (84%, n = 112). Factors found to affect the timing of free flap failure included surgical indication (P =.032), defect location (P =.006), cause of the flap failure (P <.001), and use of an osteocutaneous flap (P =.002). Conclusion: This study is the largest to date on late free flap failures with findings suggesting a paradigm shift in the timing of flap failures. Surgical indication, defect site, cause of flap failure, and use of osteocutaneous free flap were found to impact timing of free flap failures. Level of Evidence: 4. Laryngoscope, 2019.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StatePublished - Jan 1 2019

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Free Tissue Flaps
Neck
Head
Confidence Intervals
Forearm
Tissue Donors
Laryngoscopes
Scapula
Rectus Abdominis
Fibula
Hyperemia
Tissue Distribution
Thigh
Tertiary Care Centers
Radiotherapy
Retrospective Studies
History
Demography
Databases
Infection

Keywords

  • free flap
  • free flap failure
  • Head and neck reconstruction
  • outcomes

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction. / Sweeny, Larissa; Topf, Michael; Wax, Mark; Rosenthal, Eben L.; Greene, Benjamin J.; Heffelfinger, Ryan; Krein, Howard; Luginbuhl, Adam; Petrisor, Daniel; Troob, Scott; Hughley, Brian; Hong, Steve; Zhan, Tingting; Curry, Joseph.

In: Laryngoscope, 01.01.2019.

Research output: Contribution to journalReview article

Sweeny, L, Topf, M, Wax, M, Rosenthal, EL, Greene, BJ, Heffelfinger, R, Krein, H, Luginbuhl, A, Petrisor, D, Troob, S, Hughley, B, Hong, S, Zhan, T & Curry, J 2019, 'Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction', Laryngoscope. https://doi.org/10.1002/lary.28177
Sweeny, Larissa ; Topf, Michael ; Wax, Mark ; Rosenthal, Eben L. ; Greene, Benjamin J. ; Heffelfinger, Ryan ; Krein, Howard ; Luginbuhl, Adam ; Petrisor, Daniel ; Troob, Scott ; Hughley, Brian ; Hong, Steve ; Zhan, Tingting ; Curry, Joseph. / Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction. In: Laryngoscope. 2019.
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title = "Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction",
abstract = "Objective: Analyze the cause and significance of a shift in the timing of free flap failures in head and neck reconstruction. Study Design: Retrospective multi-institutional review of prospectively collected databases at tertiary care centers. Methods: Included consecutive patients undergoing free flap reconstructions of head and neck defects between 2007 and 2017. Selected variables: demographics, defect location, donor site, free flap failure cause, social and radiation therapy history. Results: Overall free flap failure rate was 4.6{\%} (n = 133). Distribution of donor tissue by flap failure: radial forearm (32{\%}, n = 43), osteocutaneous radial forearm (6{\%}, n = 8), anterior lateral thigh (23{\%}, n = 31), fibula (23{\%}, n = 30), rectus abdominis (4{\%}, n = 5), latissimus (11{\%}, n = 14), scapula (1.5{\%}, n = 2). Forty percent of flap failures occurred in the initial 72 hours following reconstruction (n = 53). The mean postoperative day for flap failure attributed to venous congestion was 4.7 days (95{\%} confidence interval [CI], 2.6–6.7) versus 6.8 days (CI 5.3–8.3) for arterial insufficiency and 16.6 days (CI 11.7–21.5) for infection (P <.001). The majority of flap failures were attributed to compromise of the arterial or venous system (84{\%}, n = 112). Factors found to affect the timing of free flap failure included surgical indication (P =.032), defect location (P =.006), cause of the flap failure (P <.001), and use of an osteocutaneous flap (P =.002). Conclusion: This study is the largest to date on late free flap failures with findings suggesting a paradigm shift in the timing of flap failures. Surgical indication, defect site, cause of flap failure, and use of osteocutaneous free flap were found to impact timing of free flap failures. Level of Evidence: 4. Laryngoscope, 2019.",
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author = "Larissa Sweeny and Michael Topf and Mark Wax and Rosenthal, {Eben L.} and Greene, {Benjamin J.} and Ryan Heffelfinger and Howard Krein and Adam Luginbuhl and Daniel Petrisor and Scott Troob and Brian Hughley and Steve Hong and Tingting Zhan and Joseph Curry",
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T1 - Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction

AU - Sweeny, Larissa

AU - Topf, Michael

AU - Wax, Mark

AU - Rosenthal, Eben L.

AU - Greene, Benjamin J.

AU - Heffelfinger, Ryan

AU - Krein, Howard

AU - Luginbuhl, Adam

AU - Petrisor, Daniel

AU - Troob, Scott

AU - Hughley, Brian

AU - Hong, Steve

AU - Zhan, Tingting

AU - Curry, Joseph

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Analyze the cause and significance of a shift in the timing of free flap failures in head and neck reconstruction. Study Design: Retrospective multi-institutional review of prospectively collected databases at tertiary care centers. Methods: Included consecutive patients undergoing free flap reconstructions of head and neck defects between 2007 and 2017. Selected variables: demographics, defect location, donor site, free flap failure cause, social and radiation therapy history. Results: Overall free flap failure rate was 4.6% (n = 133). Distribution of donor tissue by flap failure: radial forearm (32%, n = 43), osteocutaneous radial forearm (6%, n = 8), anterior lateral thigh (23%, n = 31), fibula (23%, n = 30), rectus abdominis (4%, n = 5), latissimus (11%, n = 14), scapula (1.5%, n = 2). Forty percent of flap failures occurred in the initial 72 hours following reconstruction (n = 53). The mean postoperative day for flap failure attributed to venous congestion was 4.7 days (95% confidence interval [CI], 2.6–6.7) versus 6.8 days (CI 5.3–8.3) for arterial insufficiency and 16.6 days (CI 11.7–21.5) for infection (P <.001). The majority of flap failures were attributed to compromise of the arterial or venous system (84%, n = 112). Factors found to affect the timing of free flap failure included surgical indication (P =.032), defect location (P =.006), cause of the flap failure (P <.001), and use of an osteocutaneous flap (P =.002). Conclusion: This study is the largest to date on late free flap failures with findings suggesting a paradigm shift in the timing of flap failures. Surgical indication, defect site, cause of flap failure, and use of osteocutaneous free flap were found to impact timing of free flap failures. Level of Evidence: 4. Laryngoscope, 2019.

AB - Objective: Analyze the cause and significance of a shift in the timing of free flap failures in head and neck reconstruction. Study Design: Retrospective multi-institutional review of prospectively collected databases at tertiary care centers. Methods: Included consecutive patients undergoing free flap reconstructions of head and neck defects between 2007 and 2017. Selected variables: demographics, defect location, donor site, free flap failure cause, social and radiation therapy history. Results: Overall free flap failure rate was 4.6% (n = 133). Distribution of donor tissue by flap failure: radial forearm (32%, n = 43), osteocutaneous radial forearm (6%, n = 8), anterior lateral thigh (23%, n = 31), fibula (23%, n = 30), rectus abdominis (4%, n = 5), latissimus (11%, n = 14), scapula (1.5%, n = 2). Forty percent of flap failures occurred in the initial 72 hours following reconstruction (n = 53). The mean postoperative day for flap failure attributed to venous congestion was 4.7 days (95% confidence interval [CI], 2.6–6.7) versus 6.8 days (CI 5.3–8.3) for arterial insufficiency and 16.6 days (CI 11.7–21.5) for infection (P <.001). The majority of flap failures were attributed to compromise of the arterial or venous system (84%, n = 112). Factors found to affect the timing of free flap failure included surgical indication (P =.032), defect location (P =.006), cause of the flap failure (P <.001), and use of an osteocutaneous flap (P =.002). Conclusion: This study is the largest to date on late free flap failures with findings suggesting a paradigm shift in the timing of flap failures. Surgical indication, defect site, cause of flap failure, and use of osteocutaneous free flap were found to impact timing of free flap failures. Level of Evidence: 4. Laryngoscope, 2019.

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KW - Head and neck reconstruction

KW - outcomes

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