Effect of Preoperative Medical Status on Microsurgical Free Flap Reconstructions: A Matched Cohort Analysis of 969 Cases

Ehrl, Denis; Heidekrueger, Paul I.; Ninković, Milomir; Broer, P. Niclas

doi:10.1055/s-0037-1607309

Cited by 17 publications

(14 citation statements)

References 34 publications

(88 reference statements)

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“…While it is widely agreed upon that smoking negatively affects free flap outcomes, a few papers showed there were no differences in complications between active smokers (AS), former smokers (FS), and nonsmokers (NS). Ehlr et al performed a retrospective analysis between AS and NS undergoing free flap reconstruction and found that there were no statistical differences in major or minor complications (Ehrl et al, 2017;Goltsman et al, 2017). Both cohorts had similar rates and types of comorbidities, and similar ASA scores.…”

Section: Discussionmentioning

confidence: 99%

Not all flaps are created equal: Assessing the impact of active smoking in muscle‐only versus perforator flaps for patients undergoing nonelective extremity‐free tissue transfer—A case control study

et al. 2021

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Introduction: Active smoking is known to impair wound healing following free tissue transfer for reconstruction due to its vasoconstrictive effect on the microcirculation.The aim of this study was to evaluate the impact of flap selection on flap loss, in nonelective, traumatic extremity-free soft tissue transfer in active smokers. Methods: All patients undergoing a free tissue transfer for acute trauma of the extremity at a level I trauma center from 2011 to 2017 were identified. Breast reconstruction and osseous/osseocutaneous flaps were excluded. The study population was divided in two groups based on the type of flap used (muscle versus perforator flap). Factors known to be associated with impaired wound healing were extracted from the database. Primary outcome was major smoking related complications (complete/partial flap loss). Secondary outcomes included minor flaprelated complications (infection, dehiscence) and donor site complications. The impact of smoking was assessed for the different type of flaps using multivariate analyses. Results: A total of 118 flaps were identified during the study period. Out of those, 52 were perforator-based fasciocutaneous flaps, while 66 were muscle flaps. Active smoking status resulted in a statistically significant increase in the incidence of major and minor complications in the perforator flap group (36% vs. 4%, adjusted odds ratio, AOR [95%CI]: 2.31[1.48,19.30], adj-p = 0.021 and 32% vs. 17%, AOR [95% CI]: 1.23[1.11,14.31], adj-p = 0.034) but had no impact in the muscle group.Conclusions: The present study suggests a higher incidence of flap related complications in smokers when a perforator flap was selected but no impact when a muscle flap was utilized. | INTRODUCTIONCigarette smoking remains the leading cause of preventable disease in the United States accounting for nearly 500,000 deaths yearly. Despite the relative decline in number of smokers over recent decades, it is estimated that still 34.2 million Americans are active smokers (www.cdc. gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/ind ex.htm2019). Preoperative smoking status is associated with considerably higher intra and postoperative complications, including death.In prior studies, preoperative smoking was shown to be associated

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Section: Discussionmentioning

confidence: 99%

Not all flaps are created equal: Assessing the impact of active smoking in muscle‐only versus perforator flaps for patients undergoing nonelective extremity‐free tissue transfer—A case control study

et al. 2021

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“…This technique leads to significantly improved surgical reconstruction after extensive trauma, oncological resections, and after severe infections. Moreover, in the field of oncological surgery, a more radical tumor resection can be carried out as complex and large defects may be covered by using free flaps [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. The establishment of better microsurgical equipment, surgical techniques, operative techniques, and advanced monitoring systems has led to improved flap outcome, with a flap survival as high as 95–98% [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study

et al. 2022

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Background: Microsurgical tissue transfer revolutionized reconstructive surgery after extensive trauma, oncological resections, and severe infections. Complex soft tissue reconstructions are increasingly performed in multimorbid and elderly patients. Therefore, it is crucial to investigate whether these patients benefit from these complex procedures. Objective: To evaluate the outcome for multimorbid patients who underwent microsurgical soft tissue reconstruction and to identify potential risk factors that may increase mortality. Methods: This single-center study retrospectively analyzed prospectively collected data of patients receiving free gracilis (GM) or latissimus dorsi muscle (LDM) flap reconstruction between September 2017 and December 2021. Cases were divided into two groups (dead vs. alive), depending on patient survival. Patient demographics, comorbidities and medication, perioperative details, free flap outcome, as well as microcirculation were determined. Results: A total of 151 flaps (LDM, n = 67; GM, n = 84) performed in 147 patients with a mean age of 61.15 ± 17.5 (range 19–94) years were included. A total of 33 patients (22.45%) passed away during the study period. Deceased patients were significantly older (Alive: 58.28 ± 17.91 vs. Dead: 71.39 ± 11.13; p = 0.001), were hospitalized significantly longer (Alive: 29.66 ± 26.97 vs. Dead: 36.88 ± 15.04 days; p = 0.046) and suffered from cardiovascular (Alive: 36.40% vs. Dead: 66.70%; p = 0.002) and metabolic diseases (Alive: 33.90% vs. Dead: 54.50%; p = 0.031) more frequently, which corresponded to a significantly higher ASA Score (p = 0.004). Revision rates (Alive: 11.00% vs. Dead: 18.20%; p = 0.371) and flap loss (Alive: 3.39% vs. Dead: 12.12%; p = 0.069) were higher in patients that died by the end of the study period. Conclusions: Free flap transfer is safe and effective, even in multimorbid patients. However, patient age, comorbidities, preoperative ASA status, and medication significantly impact postoperative patient survival in the short- and mid-term and must, therefore, be taken into account in preoperative decision-making and informed consent.

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“…Given the increasing cost of health services incurred by the health system, it is important to establish well-founded indications for complex surgeries, such as free flap transfer. 2 , 5 Thus, interest has grown in quantifying the measurements of quality, for example, by measuring the complication rates of medical procedures. Complications are related with increased mortality, hospitalization time, and reintervention rates.…”

Section: Introductionmentioning

confidence: 99%

“…Complications are related with increased mortality, hospitalization time, and reintervention rates. 5 …”

Section: Introductionmentioning

confidence: 99%

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study

Buitrago

Caballero

Montealegre

2020

Plastic and Reconstructive Surgery - Global Open

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Background: The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated. Methods: A retrospective cohort study was performed using administrative data from patients of all ages diagnosed with head and neck cancer who underwent FTT between 2013 and 2016 in Colombia’s contributory health system. Postoperative mortality rates were estimated at 30, 90, and 180 days, as well as reintervention rates at 30 and 90 days. Total healthcare costs were calculated. Generalized linear models were generated to determine prognostic factors associated with outcomes. Results: A total of 485 patients were included, 215 (44.33%) of which were women. Mean age was 61.4 years. Mortality rate was 3.09 at 30 days, 9.28 at 90 days, and 15.26 at 180 days, per 100 surgeries. Reintervention rate was 5.77 at 30 days and 8.25 at 90 days, per 100 surgeries. The 30-day reintervention rate was lower for 40- to 59-year-old group and for a Charlson Index ≤ 3. The median total healthcare cost of an episode was USD 12,403.68 (interquartile range, 5754–16,736). The bivariate and multivariate models determined that age, the Charlson Index, and geographic region were associated with outcomes. Conclusion: For patients undergoing FTT in Colombia, differences in reintervention and total costs incurred by the national health system exist, and these differences are associated with age, the Charlson Index, and the geographic region.

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Effect of Preoperative Medical Status on Microsurgical Free Flap Reconstructions: A Matched Cohort Analysis of 969 Cases

Cited by 17 publications

References 34 publications

Not all flaps are created equal: Assessing the impact of active smoking in muscle‐only versus perforator flaps for patients undergoing nonelective extremity‐free tissue transfer—A case control study

Not all flaps are created equal: Assessing the impact of active smoking in muscle‐only versus perforator flaps for patients undergoing nonelective extremity‐free tissue transfer—A case control study

Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study

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