Perioperative Deep Vein Thrombosis Risk Stratification: A Comparative Analysis of Free and Pedicled Flap Patients

Abstract

Patients with head and neck cancer who undergo reconstructive surgery are at risk for deep venous thrombosis (DVT), but the risk profile for patients undergoing major flap reconstruction is highly variable. Herein, we report our findings from a retrospective analysis of head and neck cancer patients (n = 517) who underwent free (n = 384) or pedicled (n = 133) flap reconstructive operations at a major tertiary care center from 2011 to 2014. DVTs developed perioperatively in 9 (1.7%) patients. Compared with pedicled flap patients, free flap patients had a longer mean operative time (421.4 ± 4.4 vs 332.7 ± 10.7 min, P < .0001), but the DVT incidence did not differ significantly between free and pedicled flap patients (1.6% vs 2.2%, respectively, P = .28). These data suggest that perioperative DVT risk in head and neck oncology patients may be largely similar regardless of the reconstructive strategy pursued.

Prolonged operative time predicts postoperative deep venous thrombosis in head and neck cancer patients who undergo free flap reconstruction

“… 2 Sinha et al found a DVT incidence of 1.7% in their institutional cohort ( n = 384), and when they compared free and pedicled flap patients there were no significant differences (1.6% vs. 2.2%, p = .28). 11 Our findings are also congruent with DVT rates in the general population of HNC surgical patients, suggesting that free flap reconstruction may not be an independent risk factor for DVT. Hennessey et al examined DVT/PE in all patients undergoing ablative HNC procedures using the Nationwide Inpatient Sample, and they found a 2% incidence of DVT/PE.…”

“…Thai et al performed a single‐center retrospective cohort of 134 HNC free flap patients and reported a similar 1.4% incidence of confirmed VTE 2 . Sinha et al found a DVT incidence of 1.7% in their institutional cohort ( n = 384), and when they compared free and pedicled flap patients there were no significant differences (1.6% vs. 2.2%, p = .28) 11 . Our findings are also congruent with DVT rates in the general population of HNC surgical patients, suggesting that free flap reconstruction may not be an independent risk factor for DVT.…”

Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review

“…Groups were comparable in 14 studies. Five articles showed that patients were significantly younger in the FF group compared to PF ( p < 0.05) [10–14]. Gender representation was similar between both groups in the 20 studies reporting gender, as one study [15] showed fewer males in the FF group (70.8% vs 100%, p < 0.05) and another [16] showed fewer males in the PF group (88% vs 32%, p < 0.05).…”

“…In contrast, another study [7] demonstrated a higher incidence of diabetes mellitus in the FF group compared to PF (31% vs 0, p < 0.05). The only study reporting the incidence of atrial fibrillation [14] showed less patient with atrial fibrillation in the FF group compared to PF (7% vs 15%, p < 0.05).…”

Pedicled Flaps versus Free Flaps for Oral Cavity Cancer Reconstruction: A Comparison of Complications, Hospital Costs, and Functional Outcomes

“…3 5 7 8 9 13 19 21 22 23 24 25 However, some studies reported that patients in the pedicled flap group were significantly older than those in the free flap group. 4 16 26 In addition, the proportion of patients with ASA class I-II to those with ASA class III-IV was variably reported as lower, 4 similar, 5 or higher, 6 27 in the pedicled flap group compared with in the free flap group. Concerning disease characteristics, there were no differences in primary tumor location, T staging, and overall N staging, which are similar to those recorded in previous studies.…”