Risk factors for free flap failure: a retrospective analysis of 881 free flaps for head and neck defect reconstruction

Zhou, W.; Zhang, W.-B.; Yu, Yanxin; Wang, Y.; Mao, Chi; Guo, Chuan Bin; Yu, Guang‐Yan; Peng, Xin

doi:10.1016/j.ijom.2017.03.023

Cited by 88 publications

(93 citation statements)

References 30 publications

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“…It is regrettable that the only flap with a venous crisis was salvaged successfully, whereas two cases with venous crises and all four cases with arterial crises failed. The successful salvage rate of 14.3% was lower than that for adults in our department . This was most likely because the early stages of arterial crises are difficult to detect; therefore, the cases were detected later on, when there was less chance of successful rescue .…”

Section: Discussionmentioning

confidence: 54%

“…In our study, postoperative vascular crises occurred in seven flaps, with arterial crises in four cases and venous crises in three cases. Arterial crises accounted for 57.1% of the vascular crises, which differs from findings in adults who have mainly venous crises . It is regrettable that the only flap with a venous crisis was salvaged successfully, whereas two cases with venous crises and all four cases with arterial crises failed.…”

Section: Discussionmentioning

confidence: 77%

“…Venous thromboses occurred in two facial veins and one internal jugular vein. Our research has identified that flap failure is not associated with the recipient vein . However, we questioned whether vascular crisis occurrence was associated with the recipient artery.…”

Section: Discussionmentioning

confidence: 92%

“…Additionally, benign tumor resection and trauma are dominant causes of head and neck defects in pediatric patients; thus, fewer patients have received radiotherapy preoperatively. This is also a factor that contributes to flap success because a history of irradiation is a potential risk factor for poor free flap survival in adults …”

Section: Discussionmentioning

confidence: 99%

“…So what factors influence pediatric free flap survival? According to our experience and literature, we suspect it might be related to patient age, flap type, defect region, recipient vessel, or surgery time. This study specifically assessed patient characteristics and surgical data for 130 patients who received 135 free flap transfers performed by a single surgical team in the Department of Oral and Maxillofacial Surgery at Peking University School and Hospital of Stomatology Beijing, People's Republic of China, with the goal of identifying factors that influence free flap survival in pediatric head and neck reconstruction.…”

Section: Introductionmentioning

confidence: 91%

See 4 more Smart Citations

Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

Liu

Zhang

et al. 2018

The Laryngoscope

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

See 3 more Smart Citations

Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

Liu

Zhang

et al. 2018

The Laryngoscope

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Association of Continuous Intraoperative Vasopressor Use With Reoperation Rates in Head and Neck Free-Flap Reconstruction

Gardner

Gau

Page

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Continuous vasopressor use in free-flap reconstruction is a point of contention among microvascular surgeons despite data demonstrating safety.OBJECTIVE To investigate the association between continuous vasopressor use and the incidence of reoperation in the early postoperative period. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, a retrospective medical record review was conducted of patients who underwent head and neck free-flap reconstructions between May 1, 2014, and October 31, 2019, in an academic tertiary care center. All patients undergoing free-flap reconstruction for head and neck defects were included. EXPOSURES Continuous intraoperative vasopressors.MAIN OUTCOMES AND MEASURES Patient medical records were queried for demographic variables; intraoperative use of vasopressors; vasopressor type, duration, and infusion rate; reoperation within the first 5 postoperative days; and reason for reoperation.RESULTS Four hundred forty-nine consecutive free-flap reconstructions were performed on 426 patients. The mean age was 62 years (IQR, 55.7-71.1); 293 patients were men (65.3%), 380 were White (84.6%), 55 were Black (12.2%), and 14 were of other race or ethnicity (3.1%). A total of 174 patients received a continuous vasopressor during their reconstruction. Twenty-three reoperations occurred within 5 days postoperatively, 8 of which included vasopressors during initial intervention. Vasopressor type had no association with reoperation (4.5% vs 5.5% [8/174 vs 15/275, respectively] for patients who received vasopressors vs those who did not) (dobutamine odds ratio [OR], 1.02 [95% CI, 0.21-2.91]; dopamine OR, 1.48 [95% CI,). No difference was seen in the duration (dobutamine OR, 1.50 [95% CI, 0.78-2.90]; dopamine OR, 0.87 [95% CI, 0.59-1.28]) or infusion rate (dobutamine OR, 1.50 [95% CI, 0.99-1.02]; dopamine OR, 1.00 [95% CI, 0.99-1.01]) of vasopressors between patients who underwent reoperation and those who did not. Analysis after the exclusion of reasons for reoperation that did not represent possible microvascular anastomosis failure (eg, Doppler malfunction, donor site complications) showed no increased propensity for reoperation (OR, 1.18; 95% CI, 0.27-3.9). CONCLUSIONS AND RELEVANCEIn this cohort study, use of vasopressors for extensive periods intraoperatively during free-tissue transfer appeared to have no association with the rate of reoperation within 5 days of intervention, regardless of agent used, simultaneous use of agents, type of free-flap operation performed, or reason for reoperation. This study adds to the body of literature supporting the judicious use of vasopressors in patients requiring intraoperative pharmacological pressure support during free-flap reconstruction.

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Perioperative Topical Antisepsis and Surgical Site Infection in Patients Undergoing Upper Aerodigestive Tract Reconstruction

Beydoun

Koss

Nielsen

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain.OBJECTIVE To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. MAIN OUTCOMES AND MEASURESThe primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model.RESULTS A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). CONCLUSIONS AND RELEVANCEFindings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction.

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Risk factors for free flap failure: a retrospective analysis of 881 free flaps for head and neck defect reconstruction

Cited by 88 publications

References 30 publications

Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

Association of Continuous Intraoperative Vasopressor Use With Reoperation Rates in Head and Neck Free-Flap Reconstruction

Perioperative Topical Antisepsis and Surgical Site Infection in Patients Undergoing Upper Aerodigestive Tract Reconstruction

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