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

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• 作者：Thomas Mü ; cke^a ; ¹ ; Lucas M. Ritschl^a ; ¹ ; ^{Lucas.Ritschl@tum.de" class="auth_mail" title="E-mail the corresponding author} ; Maximilian Roth^a ; Florian D. Gü ; ll^a ; Andrea Rau^a ; Sonja Grill^b ; Marco R. Kesting^a ; Klaus-Dietrich Wolff^a ; Denys J. Loeffelbein^a
• 关键词：Microvascular free flaps ; Radiotherapy ; Head and neck tumour ; Medication ; Risk factor analysis
• 刊名：Journal of Cranio-Maxillofacial Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：44
• 期：9
• 页码：1292-1298
• 全文大小：476 K

文摘

Microvascular free flaps have become an essential part of reconstructive surgery following head and neck tumour ablation. The authors' aim was to investigate the influence of cardiovascular risk factors, preoperative irradiation, previous operations and metabolically active medication on free flap loss in order to predict patients at risk and to improve their therapy.

Materials and methods

All patients who underwent reconstructive surgery with microvascular free flaps in the head and neck region between 2009 and 2013 were retrospectively analysed. Uni- and multivariate logistic regressions were performed to determine the association between possible predictor variables for free flap loss.

Results

We included 451 patients in our analysis. The overall free flap failure rate was 4.0%. Multivariate regression analysis revealed significantly increased risks of free flap failure depending on prior attempts at microvascular transplants (p < 0.001, OR = 14.21) and length of hospitalisation (p = 0.007, OR = 1.05).

Conclusions

With consistently low rates of flap failure, microvascular reconstruction of defects in the head and neck region has proven to be highly reliable, even in patients with comorbidities. The expertise of the operating team seems to remain the main factor affecting flap success. The only discerned independent predictor was previously failed attempts at microvascular reconstruction.