Characteristics and Intraoperative Treatments Associated with Head and Neck Free Tissue Transfer Complications and Failures

Abstract

Objective To investigate the association between perioperative patient characteristics and treatment modalities (eg, vasopressor use and volume of fluid administration) with complications and failure rates in patients undergoing head and neck free tissue transfer (FTT). Study Design A retrospective review of medical records. Setting Perioperative hospitalization for head and neck FTT at 1 tertiary care medical center between January 1, 2009, and October 31, 2011. Subjects and Methods Consecutive patients (N = 235) who underwent head and neck FTT. Demographic, patient characteristic, and intraoperative data were extracted from medical records. Complication and failure rates within the first 30 days were collected Results In a multivariate analysis controlling for age, sex, ethnicity, reason for receiving flap, and type and volume of fluid given, perioperative complication was significantly associated with surgical blood loss (P = .019; 95% confidence interval [CI], 1.01-1.16), while the rate of intraoperative fluid administration did not reach statistical significance (P = .06; 95% CI, 0.99-1.28). In a univariate analysis, FTT failure was significantly associated with reason for surgery (odds ratio, 5.40; P = .03; 95% CI, 1.69-17.3) and preoperative diagnosis of coronary artery disease (odds ratio, 3.60; P = .03; 95% CI, 1.16-11.2). Intraoperative vasopressor administration was not associated with either FTT complication or failure rate. Conclusions FTT complications were associated with surgical blood loss but not the use of vasoactive drugs. For patients undergoing FTT, judicious monitoring of blood loss may help stratify the risk of complication and failure.

Intraoperative goal‐directed hemodynamic management in free tissue transfer for head and neck cancer

“…Our group recently published a retrospective review undertaken in an attempt to determine risk factors associated with suboptimal outcomes after head and neck FTT . We found little evidence that further optimization could be accomplished without challenging the existing treatment paradigm, namely i.v.…”

“…However, recent work has repeatedly shown an association between fluid overload and increased perioperative morbidity, leaving the anesthesia team with few evidence‐based options for blood pressure management in these operations . In addition, retrospective studies have shown that vasopressor use occurs at a high frequency (>50%) in FTT reconstruction cases, despite surgical policies discouraging their use …”

Short‐stay hospital admission after free tissue transfer for head and neck reconstruction

“…Various authors have attempted to quantify risk of flap failure preoperatively by using the American Society of Anesthesiologists (ASA) grade or Charlson Comorbidity Index (CCI) . And although coronary artery disease (CAD) has been tied to increased risk of flap failure in two independent studies, there is a lack of consensus on the impact this has on free flap success.…”

Experience with pharmacologic leeching with bivalirudin for adjunct treatment of venous congestion of head and neck reconstructive flaps

“…Venous congestion occurs more commonly due to slower flow, more compressible vessels, and lower pressure of blood flow compared to the artery. Flaps may become venously engorged secondary to a number of processes including problems with the pedicle and anastomosis, large flap size, poor perforators, excessive fluid administration, dependency, and lymphedema (Hand et al, ; Urken et al, ). Some cases of venous congestion have been successfully managed using adjuvant leech therapy (Whitaker et al, ).…”