Risk Factors Leading to Free Flap Failure

Sanati-Mehrizy, Paymon; Massenburg, Benjamin B.; Rozehnal, John; Ingargiola, Michael J.; Rosa, Jonatan Hernandez; Taub, Peter J.

doi:10.1097/scs.0000000000003026

Cited by 68 publications

(32 citation statements)

References 24 publications

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“…Free flap failure, however, can occur, even when reconstruction is performed by experienced surgeons. Various patient and surgical factors have been associated with free flap failure, including age, diabetes mellitus, smoking history, and operation time [3][4][5][6]. Free flap failure results in additional surgery, prolonged hospital stay, and increased hospital costs [7].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Hong

Suh

et al. 2020

Nutrients

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The nutritional condition of patients is an important prognostic factor in various diseases. Free flap failure is a serious complication in patients undergoing free flap reconstruction, increasing morbidity and hospital costs. We evaluated the predictive factors, including the prognostic nutritional index (PNI), associated with free flap failure in extremity reconstruction. The PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3), with a PNI <40 defined as low. Univariate and multivariate logistic regression analyses were performed to evaluate factors predictive of free flap failure. Postoperative outcomes, including duration of hospital stay and rate and duration of intensive care unit admission, were also evaluated. Of the 625 patients included, 38 (6.1%) experienced free flap failure. Multivariate logistic regression analysis revealed that predictors of free flap failure were female (odds ratio: 2.094; p = 0.031) and a low PNI (odds ratio: 3.859; p <0.001). The duration of hospital stay was significantly longer in patients who did than those who did not experience free flap failure (62.1 ± 55.5 days vs. 28.3 ± 24.4 days, p <0.001). A low PNI is associated with free flap failure, leading to prolonged hospital stay. This result suggests that the PNI can be simply and effectively used to predict free flap failure.

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Section: Introductionmentioning

confidence: 99%

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Hong

Suh

et al. 2020

Nutrients

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“…Features such as age, comorbidities, BMI, defect site, and risk factors for vascular disease (such as smoking or diabetes) make flap surgery (especially microsurgical tissue transfer) hazardous but should not be considered as absolute contraindications. 13 A retrospective review demonstrates that age alone is not an independent variable for increased risk in microvascular reconstruction; however, operative time, ASA risk score, and location of the reconstruction site are more associated with the overall success of free tissue transfers. 14 From this point of view, our results suggested that dermal substitutes can be used in a wide range of patients regardless of their general characteristics, as the final outcome is not influenced by the factors analyzed in our sample.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Full-thickness Soft Tissue Defects with Integra: Risk Factors and Treatment Algorithm

Scalise

Torresetti

Benedetto

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Despite the fact that dermal substitutes are widely used in reconstructive surgery, there have been no studies focused on predictors of complications or delayed matrix take. We propose an algorithm for management of soft tissue reconstruction with Integra dermal matrix, based on our 5-year-long clinical experience. Methods: An estimated 111 patients who underwent Integra reconstruction of full-thickness soft tissue defects of different anatomical sites and etiology were enrolled, and dichotomized in two groups according to complications. Participants were further studied according to the wound healing strategy: healing by secondary intention, skin graft (STSG), and flap surgery. A regression analysis was conducted in the whole sample to identify possible predictors of complications. Results: No significant differences according to complications were observed. The between-group statistical analysis showed significant differences in age, comorbidities, defect area, diagnosis, and defect site. The regression analysis revealed that the timing of split-thickness skin graft (STSG) was not influenced by age, comorbidities, body mass index (BMI), defect area, site, wound etiology, and risk factors in the subjects who underwent a two-step reconstruction. Healing by secondary intention is recommended for small post-oncological defects of the head, especially in elderly and multimorbid patients. Variables that may interfere with dermal substitutes’ incorporation are independent of the timing of STSG placement; therefore, no predictors of complications or delayed matrix take were identified. Conclusions: Our findings showed that Integra can be used in a wide range of patients regardless of their general features, thus acting as a useful alternative to conventional reconstructive techniques in selected cases.

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“…In those studies, the factors that are significantly associated with the loss of the flap are the need for an intraoperative transfusion of three or more units and an elevated surgical time. On the other hand, the relationship to other factors such as age, sex, BMI (body max index), smoking, a history of alcoholism, and the American Society of Anesthesiologist (ASA) score is not so clear [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Different studies have experimentally evaluated, in animal and human models, the effect of perioperative hematocrit on the microvascular success rate. They came up with contradictory results [5,[13][14][15][16]. The effect of anemia on microvascular reconstruction is controversial.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

Gil

Vintró

Fernández

et al. 2021

JCM

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Introduction: Perioperative transfusions are associated with complications of free flaps. The purpose of the present study was to find out whether there is a significant relationship between the risk of developing complications in vascular anastomoses and the history of transfusions. Methods: We studied 372 patients retrospectively with microsurgical reconstruction between 2009 and 2017 with regards to the number of red blood cell concentrates transfused. Complications were analyzed relative to flap loss and complications in microvascular anastomoses. Results: 130 patients (34.9%) received blood transfusions. Some 55% of them were transfused between the day of the intervention and the first postoperative day. Ninety-six patients were reoperated on (25.7%). Of those, thirty-six patients (37.5%) corresponded to anastomosis failure. The percentage of patients transfused among those who required reoperation was 55.2%. The percentage of patients transfused among those who were reoperated on within the first 72 h due to an alteration in the anastomosis was 60.6%, while it was 25.6% (Chi square P = 0.0001) for the rest of the patients. Conclusions: Although there is a strong association between transfusion and vascular anastomosis failure, it is not possible to establish the causation between the two.

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Risk Factors Leading to Free Flap Failure

Abstract: BMI, smoking, and operative time were identified as independent risk factors for free flap failure among all flaps or within flap subsets.

Cited by 68 publications

References 24 publications

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Reconstruction of Full-thickness Soft Tissue Defects with Integra: Risk Factors and Treatment Algorithm

The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

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