Predictors of complications of free flap reconstruction in head and neck surgery: Analysis of 304 free flap reconstruction procedures

Abstract

Objectives:The objectives of this study were to classify and analyze perioperative complications following free flap reconstruction in the head and neck and investigate potential predictors of these complications.Methods:A retrospective chart analysis of 304 consecutive free flap reconstructions for defects in the head and neck were examined. Patient and operative characteristics as well as complications were recorded prospectively and analyzed using ordinal logistic regression.Results:The overall complication rate was 32.6% with a perioperative mortality rate of 0.3%. The flap loss rate was 2.0% and the partial flap necrosis rate was 1.0%. Multivariate analysis demonstrated a significant correlation between perioperative complication and tumor stage as well as reconstruction site.Conclusions:The rate and grade of complications with free flap reconstruction in the head and neck were found to be low. Higher tumor stage and pharyngoesophageal reconstruction were found to be associated with increased complication grades, whereas preoperative radiation alone and chemoradiation were not. Smoking and alcohol use, age, diabetes mellitus, peripheral vascular disease, and preoperative myocardial infarction as well as preoperative cerebrovascular accident were not found to be associated with increased complications. No statistically significant difference in complication grades was found with different flap types or indications for reconstruction.

Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions

“…A previously published study on 185 patients reconstructed with free flaps for head and neck defects reports 53% overall complications and 40% severe complications, 16 whereas a similar study on 304 patients reconstructed with similar techniques reports an overall complication rate of 32.5% and a severe complication rate of 20%. 17 Although seemingly favorable, the rates of severe complications in this study need to be considered in the context of the modified CD classification that reports complications only as severe that are rather prolonging hospital stay. It is likely that if the original CD classification would have been used, the results would have been similar to the published literature.…”

“…A convincing association with flap type and indication was not found, neither with preoperative radiation nor with chemoradiation therapy. 17 …”

Reconstrucción de cabeza y cuello mediante colgajos libres microvascularizados. Indicaciones, aspectos técnicos y resultados

“…Estas cifras son similares a las halladas en la literatura 28 . No hay evidencia de asociación entre el desarrollo de complicaciones y factores como la histología tumoral, el tipo de colgajo o la RT pre o postoperatoria.…”

Marking of tumor resection borders for improved radiation planning facilitates reduction of radiation dose to free flap reconstruction in head and neck cancer surgery

“…Scarring of connective tissue and vessels might influence and reduce blood flow, but clinical studies suggest that radiotherapy does not have any obvious effect on the viability of microvascular flap reconstruction (Chao et al, 2012;Hohlweg-Majert et al, 2012;le Nobel et al, 2012;Benatar et al, 2013). Controversy remains as to the effect of radiotherapy on the rate and severity of local surgical bed complications after free tissue transfer (Choi et al, 2004;Geretschlager et al, 2012;le Nobel et al, 2012). An essential prerequisite of external beam irradiation is the accurate localization of tumor resection margins.…”