Analysis of free flap viability based on recipient vein selection

Francis, David O.; Stern, Ryan E.; Zeitler, Daniel M.; Izzard, Mark; Futran, Neal D.

doi:10.1002/hed.21105

Cited by 30 publications

(18 citation statements)

References 16 publications

(25 reference statements)

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“…Flap failure during hospitalization was defined as partial or complete flap death, indicated by vascular compromise and any degree of necrosis after surgery [14]. Coronary artery disease was defined as a history of angina, myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery.…”

Section: Data Collection and Definitionmentioning

confidence: 99%

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Hong

Suh

et al. 2020

Nutrients

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The nutritional condition of patients is an important prognostic factor in various diseases. Free flap failure is a serious complication in patients undergoing free flap reconstruction, increasing morbidity and hospital costs. We evaluated the predictive factors, including the prognostic nutritional index (PNI), associated with free flap failure in extremity reconstruction. The PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3), with a PNI <40 defined as low. Univariate and multivariate logistic regression analyses were performed to evaluate factors predictive of free flap failure. Postoperative outcomes, including duration of hospital stay and rate and duration of intensive care unit admission, were also evaluated. Of the 625 patients included, 38 (6.1%) experienced free flap failure. Multivariate logistic regression analysis revealed that predictors of free flap failure were female (odds ratio: 2.094; p = 0.031) and a low PNI (odds ratio: 3.859; p <0.001). The duration of hospital stay was significantly longer in patients who did than those who did not experience free flap failure (62.1 ± 55.5 days vs. 28.3 ± 24.4 days, p <0.001). A low PNI is associated with free flap failure, leading to prolonged hospital stay. This result suggests that the PNI can be simply and effectively used to predict free flap failure.

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Section: Data Collection and Definitionmentioning

confidence: 99%

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Hong

Suh

et al. 2020

Nutrients

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“…No consensus has yet been reached regarding whether to use the internal jugular or the SVS. 15 Most authors reported that each system is equally reliable, 4,[15][16][17][18] while other studies supported that IJVS is the ideal recipient if technically feasible. [19][20][21] Although debates over which system is more adequate are currently in progress (summarized in ►Table 3), each system has its own advantages and disadvantages.…”

Section: Discussionmentioning

confidence: 99%

Impact of Recipient Vein Selection on Venous Patency and Free Flap Survival in 652 Head and Neck Reconstructions

Choi

Kim

Jeon

et al. 2019

J reconstr Microsurg

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Background This study was conducted to evaluate the impact of choosing a particular recipient venous system on venous patency and flap survival in 652 head and neck free flap reconstructions. Methods A retrospective review was performed. Patient factors investigated included: age, sex, type of flap, tumor location, history of radiation, presence of previous neck dissection, tumor stage, and any underlying disease. Data related with recipient vein including the number of anastomosis, the repair technique, the type of recipient vein, and the configuration of selected venous system were examined. The impact of patient factors and parameters related with recipient vein on the venous patency and flap survival were analyzed using bivariate and multivariate analyses. Results Of 652 free flaps, 36 flaps (5.5%) were re-explored due to venous congestion and 28 flaps (77.8%) were salvaged. The overall survival rate of total free flaps was 98.8%. The type of recipient venous system was found to be an insignificant factor with respect to venous congestion and flap survival in multivariate analysis. A history of radiation treatments was the only factor associated with a higher risk of venous compromise (odds ratio [OR] = 13.138, p < 0.001) and a lower rate of flap survival (OR = 20.182, p = 0.002). Conclusion The selection of recipient venous systems has no impact on venous patency and flap survival. History of radiation treatment was the only factor associated with venous congestion and flap failure. Since no single method can ensure a successful reconstructive result, selecting the optimal recipient vein should be based on individual patient factors and the surgeon's experience.

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“…Numerical distribution of recipient veins with their number of venous thromboses were recorded (Table 1). [1][2][3][4][5] The primary outcome was the venous thrombosis rate. Relevant studies were assigned a level of evidence according to the American Society of Plastic Surgeons Evidence Rating Scale for Therapy.…”

Section: External or Internal Jugular Vein? Recipient Vein Selection mentioning

confidence: 99%

External or Internal Jugular Vein? Recipient Vein Selection in Head and Neck Free Tissue Transfer

Cheng

Lin

Chang

2012

Plastic and Reconstructive Surgery

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Analysis of free flap viability based on recipient vein selection

Abstract: In this large cohort of patients, we found no difference in the odds of flap re-exploration or failure based on venous anastomotic configuration. Reconstructive surgeons should have both anastomotic techniques in their repertoire to optimize the success of every flap.

Cited by 30 publications

References 16 publications

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Impact of Recipient Vein Selection on Venous Patency and Free Flap Survival in 652 Head and Neck Reconstructions

External or Internal Jugular Vein? Recipient Vein Selection in Head and Neck Free Tissue Transfer

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