Factors impacting successful salvage of the failing free flap.
Publication/Presentation Date
12-1-2020
Abstract
BACKGROUND: Understanding factors impacting successful salvage of a compromised free flap.
METHODS: Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764).
RESULTS: Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P < .001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P = .035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P < .0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P < .0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P < .0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P = .04).
CONCLUSIONS: There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.
Volume
42
Issue
12
First Page
3568
Last Page
3579
ISSN
1097-0347
Published In/Presented At
Sweeny, L., Curry, J., Crawley, M., Cave, T., Stewart, M., Luginbuhl, A., Heffelfinger, R., Krein, H., Petrisor, D., Bender-Heine, A., & Wax, M. K. (2020). Factors impacting successful salvage of the failing free flap. Head & neck, 42(12), 3568–3579. https://doi.org/10.1002/hed.26427
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
32844522
Department(s)
Administration and Leadership
Document Type
Article