Preoperative Predictors of Free Flap Failure

Stevens, Madelyn N.; Freeman, M.H.; Shinn, Justin R.; Kloosterman, Nicole; Carr, Shane; Mannion, Kyle; Rohde, Sarah L.

doi:10.1177/01945998221091908

Cited by 10 publications

(13 citation statements)

References 26 publications

(75 reference statements)

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“…14 Two recent studies have found an increased risk of flap failure in those with elevated platelets undergoing lower extremity reconstruction and those undergoing head and neck reconstruction. 15,16 In this study of 502 patients undergoing free tissue transfer, our data echo the mixed consensus in the literature but may offer a hypothesis for these findings.…”

Section: Discussionsupporting

confidence: 85%

“…In a large NSQIP analysis, free tissue transfer in the setting of thrombocytosis was found to increase the need for blood transfusions, prolonged hospital stays, and increased reoperations; however, there was no evidence of increased flap failure 14 . Two recent studies have found an increased risk of flap failure in those with elevated platelets undergoing lower extremity reconstruction and those undergoing head and neck reconstruction 15,16 . In this study of 502 patients undergoing free tissue transfer, our data echo the mixed consensus in the literature but may offer a hypothesis for these findings.…”

Section: Discussionsupporting

confidence: 74%

“…In their analysis, 54 patients had thrombocytosis preoperatively, and they were found to have an increased risk of complications including need for transfusion, need for reoperation, and increased length of stay; however, they were unable to stratify for specific flap complications, reason for return to the operating room (OR), or free flap failure rates. In the head and neck literature, a recent study by Stevens et al 15 found a 2.65 odds ratio for free flap failure in patients with platelets >450,000. In addition, in lower extremity free tissue transfer, preoperative thrombocytosis was found to be associated with intraoperative pedicle thrombosis and postoperative pedicle thrombosis 16 …”

Section: Introductionmentioning

confidence: 99%

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Reevaluating Thrombocytosis as a Risk Factor in Free Flap Surgery

Fisher,

Jones,

Malta

et al. 2023

Ann Plast Surg

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Introduction Thrombocytosis, defined as a platelet count >400,000, has been implicated as a risk factor in free flap failure. Despite proposed mechanisms of pedicle thrombosis, recent studies have suggested that thrombocytosis has no effect on free tissue transfer viability. Risk factors that may compromise successful free tissue transfer should be understood and elucidated, with particular attention to thrombocytosis and its conflicting evidence in the literature. We hypothesize that thrombocytosis has no bearing on free flap success or the rates of pedicle thrombosis. Methods Our institution performed a retrospective chart review on all patients who underwent free flap reconstruction over the past 6 years. Patient demographics, medical history, type and location of free tissue transfer, preoperative platelets, postoperative platelets, and flap outcomes and complications (wound dehiscence, infection, hematoma, seroma, and need for blood transfusion) were recorded. Independent t test, Mann-Whitney U tests, χ 2 test, and Fisher exact tests were used to determine P values to compare flap outcomes in patients with thrombocytosis (platelet count >400,000) and those with platelet counts less than 400,000. Results In our 502-patient cohort, 71 were found to have a platelet count >400,000 (35 preoperatively and 36 postoperatively) and 431 patients had platelet counts <400,000. There were 42 reconstructive failures (flap success rate of 91.6%) and 111 returns to the operating room (OR). For patients with postoperative thrombocytosis, 24 flaps returned to the OR (44.4%), whereas in patients without thrombocytosis, 87 flaps returned to the OR (19.4%; P < 0.001). In patients with postoperative thrombocytosis, 10 OR returns were due to pedicle venous thrombosis (18.5%), in comparison to 10 returns for venous thrombosis in those with normal platelets (2.2%; P < 0.001). There was a small difference in free flap success rates between those with postoperative thrombocytosis and normal platelets, 88.7% versus 92.11%; however, this was not statistically significant (P = 0.71). The thrombocytosis group had a higher incidence of overall postoperative complications (P = 0.002). Conclusions Thrombocytosis has historically been cited as a risk factor for free flap reconstruction failure with recent conflicting evidence in the literature. In patients with postoperative thrombocytosis, we found an increased risk of venous thrombosis; however, this did not result in increased flap failure. There was an increase in postoperative complications, which corresponds with National Surgical Quality Improvement Program data reported in the literature. We suspect that thrombocytosis is not a harbinger of free flap failure but rather a marker for overall inflammation, which may confer a higher rate of venous thrombosis requiring reoperation and postoperative complications.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reevaluating Thrombocytosis as a Risk Factor in Free Flap Surgery

Fisher,

Jones,

Malta

et al. 2023

Ann Plast Surg

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“…In addition, prolonged ischemia time of free aps and subsequent ischemia-reperfusion injury can increase the risk of postoperative complications and eventual ap graft failure, but this study did not include it due to too many missing values of ischemia time. Elevated platelets are a risk factor for thrombosis, and Stevens, M. N. et al found a 2.67-fold increased risk of ap graft failure for every 1-unit rise in platelet count in patients with head and neck surgical free ap grafts, which is consistent with the ndings of Kalmar, C. L. et al who studied the association of thoracic microvascular repair failure with platelet counts in women [26,27] .…”

Section: Signi Cance Of Each Model Factorsupporting

confidence: 67%

A predictive model for vascular complications of free flap transplantation based on machine learning

YANG

Liang

WANG

et al. 2023

Preprint

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Objective: Exploring the risk factors for vascular complications after free flap transplantation and establishing a clinical auxiliary assessment tool for vascular complications in patients undergoing free flap transplantation based on machine learning methods. Methods:Collecting patients who underwent free flap transplantation at a tertiary hospital in Guizhou Province from January 1, 2019 to December 31, 2021, using synthetic minority oversampling technique to oversample the training set, and constructing Logistic regression model, random forest model and neural network model three machine learning models and verifying them using the sampled data. Using the test set to evaluate the performance of the model through the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity indices. Results: A total of 570 patients who underwent free flap transplantation were included in this study, of which 46 patients developed postoperative vascular complications. The neural network model performed best in the test set, with an AUC of 0.828. Multivariate logistic regression analysis showed that preoperative hemoglobin, preoperative fibrinogen, operation time, smoking history, number of anastomoses, and peripheral vascular injury were statistically significant independent risk factors for vascular complications after free flap transplantation. The top five predictive factors in the neural network were fibrinogen content, operation time, donor site, BMI, and platelet count. Conclusion: The predictive model for vascular complications of free flap transplantation constructed in this study has good predictive ability, which can provide reference for medical personnel to take preventive measures to prevent vascular complications in high-risk patients undergoing free flap transplantation.

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“…2,3 However, necrosis can occur if the color of the surgical site (tissue) changes owing to venous thrombosis (54%-57%), arterial thrombosis (20%-43%), or blood vessel flow disturbance (5%-25%). [4][5][6][7][8] In this case, surgery must be performed again, or a limb may have to be amputated. 4 Thus, an attending physician must continuously monitor a patient to prevent this situation.…”

Section: Introductionmentioning

confidence: 99%

Remote Monitoring System for Condition Management of Patients in Free Flap Surgery

et al. 2023

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Introduction Free flap surgery is inconvenient because an attending physician must observe a patient’s condition every day to ensure that normal tissue is restored within 72 h after the surgery. To address this problem, this paper proposes a remote monitoring technology to observe a patient’s condition in real time. Methods To design a monitoring system, the camera consists of MCU board, DC-DC converter, alarm performance, Wi-fil module, and server, and the camera and MCU part is connected to the server through the wi-fi network. A camera obtains the images of the surgical site once every 2 s, and the images are transmitted to the attending physician or nurse via Wi-Fi communication. The working distance between camera and surgical site is 56 cm, and the viewing angle of a camera is 60° (radius). Results A video shooting test is also performed, in which the images are obtained once per hour between 17:00 and 08:00 the next day; the results show that high-quality images are obtained in the video shooting test. The imaging error is zero (0 GB) in the video shooting test results. Discussion and Conclusion The imaging of the surgical site can be obtained by camera system, and the proposed method is that there no storage error occurs during the shooting process. In addition, the shooting performance has high velocity. It is possible to control the WD according to a patient’s body via a holding manipulator used for the camera. The new method is expected to be used for remote patient management, for a wide range of procedures, in the medical field.

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Preoperative Predictors of Free Flap Failure

Cited by 10 publications

References 26 publications

Reevaluating Thrombocytosis as a Risk Factor in Free Flap Surgery

Reevaluating Thrombocytosis as a Risk Factor in Free Flap Surgery

A predictive model for vascular complications of free flap transplantation based on machine learning

Remote Monitoring System for Condition Management of Patients in Free Flap Surgery

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