Predictors of free flap loss in the head and neck region: A four-year retrospective study with 451 microvascular transplants at a single centre

Mücke, Thomas; Ritschl, Lucas M.; Roth, Maximilian; Güll, Florian D.; Rau, Andrea; Grill, Sonja; Kesting, Marco; Wolff, Klaus‐Dietrich; Loeffelbein, Denys J.

doi:10.1016/j.jcms.2016.04.029

Cited by 49 publications

(48 citation statements)

References 35 publications

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“…Microvascular free‐flap transfer has become a standard procedure for complex defect coverage and reconstruction after head and neck cancer resection. Surgical techniques have undergone many developments that have made free‐flap reconstruction a safe and effective procedure, with a success rate of 91–99% (Bui et al, ; Mucke et al, ; Offodile 2nd, Aherrera, Wenger, Rajab, & Guo, ). However, due to the complex nature and long operative time of the procedure, as well as the underlying medical issues in these patients, the patients are subjected to the development of surgical complications, such as infection, hematoma, wound disruption, fistula, pedicle thrombosis, partial flap gangrene, and total flap loss.…”

Section: Introductionmentioning

confidence: 99%

Association between operation‐ and operator‐related factors and surgical complications among patients undergoing free‐flap reconstruction for head and neck cancers: A propensity score‐matched study of 1,865 free‐flap reconstructions

Kuo

Yen

et al. 2019

Microsurgery

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Objective: Efforts have been devoted to clarify the possible factors related to postoperative complications in free-flap reconstruction. While patient-related factors have been widely discussed, studies regarding the operation/operatorrelated factors are rather limited in the literature. This study was designed to investigate the relationship between operation/operator-related factors and the surgical complications in free-flap reconstruction following head and neck cancer resection. Methods: Data of 1,841 patients with a total of 1,865 free-flap reconstructions (24 double free-flap reconstructions) between March 2008 and February 2017 were retrieved from the registered microsurgery database of the hospital. The association of operation/operator-related factors (including flap length and length-width ratio, flap types, use of vein graft, opposite side microanastomosis, number of microanastomoses, operators, operator experience, and operation time) with surgical complications was assessed by 1:1 propensity score-matched study groups.Results: After propensity score matching of the patient-related factors, the rate of vein grafting was significantly higher (0.6% vs. 2.2%, p = .038) and the operation time was longer (7.0 [5.8-8.5] vs. 7.4 [6.1-8.8] hr, p = .006) in the complication group. In addition, flap length and length-width ratio, flap types, opposite side microanastomosis, number of microanastomoses, operators, and operator experience were not associated with surgical complications. Conclusions:In a hospital that consisted of surgeons with high-volume or very-highvolume experience, the operators or operation experience were not significantly associated with the surgical complications. Only a longer operation time was associated with surgical complications in the patients who underwent free-flap reconstruction for head and neck cancer.

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Section: Introductionmentioning

confidence: 99%

Association between operation‐ and operator‐related factors and surgical complications among patients undergoing free‐flap reconstruction for head and neck cancers: A propensity score‐matched study of 1,865 free‐flap reconstructions

Kuo

Yen

et al. 2019

Microsurgery

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“…Since its introduction, microvascular technology and technique have undergone developments that have made free flap repairs safe and effective, with a success rate of 91% to 99%. [1][2][3] However, patients are still subject to postoperative complications that result from the complex nature of the procedure, long operative course, and suboptimal preoperative health status. These complications may contribute to the rare flap failure, which is associated with substantial morbidity and significant cost to the patient and health care system.…”

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confidence: 99%

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

Brady

Desai

Crippen

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE Prolonged anesthesia and operative times have deleterious effects on surgical outcomes in a variety of procedures. However, data regarding the influence of anesthesia duration on microvascular reconstruction of the head and neck are lacking.OBJECTIVE To examine the association of anesthesia duration with complications after microvascular reconstruction of the head and neck. DESIGN, SETTING, AND PARTICIPANTS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to collect data. In total, 630 patients who underwent head and neck microvascular reconstruction were recorded in the NSQIP registry from January 1, 2005, through December 31, 2013. Patients who underwent microvascular reconstructive surgery performed by otolaryngologists or plastic surgeons were included in this study. Data analysis was performed from October 15, 2015, to January 15, 2016. EXPOSURES Microvascular reconstructive surgery of the head and neck. MAIN OUTCOMES AND MEASURES Patients were stratified into 5 quintiles based on mean anesthesia duration and analyzed for patient characteristics and operative variables (mean [SD] anesthesia time: group 1, 358.1 [175.6] minutes; group 2, 563.2 [27.3] minutes; group 3, 648.9 [24.0] minutes; group 4, 736.5 [26.3] minutes; and group 5, 922.1 [128.1] minutes). Main outcomes include rates of postoperative medical and surgical complications and mortality. RESULTS A total of 630 patients undergoing head and neck free flap surgery had available data on anesthesia duration and were included (mean [SD] age, 61.6 [13.8] years; 436 [69.3%] male). Bivariate analysis revealed that increasing anesthesia duration was associated with increased 30-day complications overall (55 [43.7%] in group 1 vs 80 [63.5%] in group 5, P = .006), increased 30-day postoperative surgical complications overall (45 [35.7%] in group 1 vs 78 [61.9%] in group 5, P < .001), increased rates of postoperative transfusion (32 [25.4%] in group 1 vs 70 [55.6%] in group 5, P < .001), and increased rates of wound disruption (0 in group 1 vs 10 [7.9%] in group 5, P = .02). No specific medical complications and no overall medical complication rate (24 [19.0%] in group 1 vs 22 [17.5%] in group 5, P = .80) or mortality (1 [0.8%] in group 1 vs 1 [0.8%] in group 5, P = .75) were associated with increased anesthesia duration. On multivariate analysis accounting for demographics and significant preoperative factors including free flap type, overall complications (group 5: odds ratio [OR], 1.98; 95% CI, 1.10-3.58; P = .02), surgical complications (group 5: OR, 2.46; 95% CI, 1.35-4.46; P = .003), and postoperative transfusion (group 5: OR, 2.31; 95% CI, 1.27-4.20; P = .006) remained significantly associated with increased anesthesia duration; the association of wound disruption and increased anasthesia duration was nonsignificant (group 5: OR, 2.0; 95% CI, 0.75-5.31; P = .16). CONCLUSIONS AND RELEVANCEIncreasing anesthesia duration was associated with significantly increased rates of surgical complic...

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“…The necessity for bone flap monitoring becomes clear in light of the success rates of bone flaps (90.8%) in comparison with soft-tissue flaps (anterolateral thigh flap 97% and radial forearm flap 97.2%). 12 Because of the limited supply of donor bone, losing a bone flap is all the more disadvantageous. But even losing a single fibula segment jeopardizes the entire functional outcome.…”

Section: Discussionmentioning

confidence: 99%

“…8 This decreased blood flow might also explain the considerably higher failure rate of FFF as compared with that of soft-tissue flaps. 12 In light of these considerations, intraoperative and postoperative monitoring of fibula flaps becomes all the more important. However, adequate tools for intraoperative assessment of bone perfusion are scarce.…”

mentioning

confidence: 99%

Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

Fichter

Ritschl

Georg

et al. 2018

J reconstr Microsurg

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This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.

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Predictors of free flap loss in the head and neck region: A four-year retrospective study with 451 microvascular transplants at a single centre

Cited by 49 publications

References 35 publications

Association between operation‐ and operator‐related factors and surgical complications among patients undergoing free‐flap reconstruction for head and neck cancers: A propensity score‐matched study of 1,865 free‐flap reconstructions

Association between operation‐ and operator‐related factors and surgical complications among patients undergoing free‐flap reconstruction for head and neck cancers: A propensity score‐matched study of 1,865 free‐flap reconstructions

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

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