Identification of independent risk factors for flap failure: A retrospective analysis of 1530 free flaps for breast, head and neck and extremity reconstruction

Improving quality outcomes in head and neck free flap surgery with the use of a physician inpatient coordinator

“…Ryan and Hochman estimate the LOS after free tissue transfer reconstruction to be 2 to 4 weeks . Increased LOS may be attributed to prolonged recovery, fear of complications, and complex discharge criteria . Employing a dedicated inpatient coordinator may compress and streamline discharge processes and evolve into improved quality metrics.…”

“…Major complication (24% in group 1 and 22% in group 1) and 30dROR rates were not improved with the presence of an inpatient coordinator. This rate is similar to others showing rates of 20% to 30% . It is known that complication rates are influenced heavily by nonmodifiable factors such as concurrent medical comorbidities, diabetes, and advanced cancer stages .…”

Diabetes is not associated with increased rates of free flap failure: Analysis of outcomes in 6030 patients from the ACS‐NSQIP database

“…Importantly, our analysis demonstrated that DM was not an independent risk factor for partial or total flap failure. In contrast, the existing literature is inconsistent regarding the relationship of diabetes and flap failure (Las et al, ; Nahabedian, Singh, Deune, Silverman, & Tufaro, ; Sanati‐Mehrizy et al, ; Wong et al, ), and varies widely depending on anatomical site and flap type (Las et al, ). In head and neck surgery, overall flap failure has been reported five times higher in diabetic patients (Bozikov & Arnez, ; Rosado et al, ; Valentini et al, ), but a wider report by Las et al found no association between DM and free flap failure; however, foot and ankle flap failure rates were over nine times higher in diabetic patients (Las et al, ).…”

“…In contrast, the existing literature is inconsistent regarding the relationship of diabetes and flap failure (Las et al, ; Nahabedian, Singh, Deune, Silverman, & Tufaro, ; Sanati‐Mehrizy et al, ; Wong et al, ), and varies widely depending on anatomical site and flap type (Las et al, ). In head and neck surgery, overall flap failure has been reported five times higher in diabetic patients (Bozikov & Arnez, ; Rosado et al, ; Valentini et al, ), but a wider report by Las et al found no association between DM and free flap failure; however, foot and ankle flap failure rates were over nine times higher in diabetic patients (Las et al, ). Clinical and preclinical evidence suggests that DM alone does not compromise free flap survival (Cooley, Hanel, Anderson, Foster, & Gould, ; Cooley, Hanel, Lan, Li, & Gould, ; Khouri et al, ; Wong et al, ); this is supported by a large‐scale retrospective review in which flap survival rates were comparable between diabetic and nondiabetic patients (Sanati‐Mehrizy et al, ).…”

“…As such, DM has been linked to higher rates of infection in oral cancer reconstruction, but this patient cohort was not limited to microsurgical repair (Liu et al, ). In addition to the associated morbidity, mortality, and cost burden (Joynt, & Jha, ), postoperative infections have been shown to predispose patients to flap loss (Las et al, ). Interestingly, increased rates of superficial incisional SSI were not observed among patients with DM in our cohort.…”