Predicting risk factors that lead to free flap failure and vascular compromise: A single unit experience with 565 free tissue transfers

Abstract

Background: Even though the benefit of free tissue transfer is uncontested in complex reconstructive cases, vascular compromise and/or flap failure remain a challenge for the surgeon and identification of possible risk factors can aid in the preoperative planning. The aim of this study was to identify the individual risk factors leading to flap failure and/or vascular compromise in free tissue transfers in a single institution over a period of 10 years and to create an index predicting these problems, as well as finding predictors of other postoperative complications. Methods: Data from all the patients undergoing free tissue transfers between 2009 and 2018 were retrospectively analyzed (demographics, comorbidities, flap failure, vascular compromise, and other complications). The results from the univariate and multivariate analyses were used to create an index. Results: A predictability index with three classes (low, moderate, and high risk) was calculated for each patient, based on defect etiology and the presence of coronary heart disease, diabetes, smoking, peripheral arterial vascular disease, and arterial hypertension. A patient with moderate-risk index had 9.3 times higher chances of developing vascular compromise than those in the low-risk group, while a high-risk index had 18.6 higher odds ( p = 0.001). American Society of Anesthesiologists (ASA) classification was found to be a predictor of complications in free tissue transfer ( p = 0.001).

Risk Factors of Free Flap Complications in Reconstruction for Head and Neck Cancer

“…The safety of reconstruction surgery for head and neck cancer using free flap transplantation has been established through advancement in surgical skills and instruments. 1,2 However, the incidence rate of flap complications (FC) ranges from 1 to 20%, [1][2][3][4][5] indicating that the flap success rate does not reach 100%. Additionally, FC in head and neck cancer may lead to local infections and cause delayed wound healing and deterioration of the patients' general condition, delaying postoperative adjuvant therapy.…”

National Outcomes of Prophylactic Lymphovenous Bypass during Axillary Lymph Node Dissection

“…Factors that further stood out in both regression and classification analyses were increased BMI and ASA class, both of which have also been reported as being associated with increased complication rates after plastic and reconstructive procedures. 29,30 Notably, neither model shows LVB to be independently associated with reoperations.…”

New proposal for skin grafts on tendon-exposed wounds

“…Because flap surgery transfers tissue components together with blood vessels, the recipient’s vascular status must be considered. Thus, flap surgery in patients with comorbidities who have poor systemic vascular status may be dangerous [ 6 ]. In addition, the donor-site morbidity in flap surgery should be considered, because if this procedure fails, more serious complications may occur.…”

“…The failure rate is reported to be very high when skin grafts are performed on tendon-exposed wound beds because tendons are fibrous connective tissues with a relatively poor blood supply 3 4 5 . However, flap surgery also shows a poor prognosis in patients with diabetes who have poor peripheral blood vessels 6 . Thus, this study presents a surgical technique that can increase the success rate of skin grafts on tendon-exposed defects.…”