Analysis of thrombosis on postoperative day 5 or later after microvascular reconstruction for head and neck cancers.
BACKGROUND
Because of the low incidence of late thrombosis in free flaps used for head and neck reconstruction, the risk factors, prognosis, and the optimal method of treatment are unclear.


METHODS
The timing of thrombosis, types of flaps, occluded vessels, causative factors, previous irradiation, and salvage rates were reviewed and compared between 79 patients who had thrombosis on postoperative day 4 or earlier (early-thrombosis group) and 24 patients who had thrombosis on postoperative day 5 or later (late-thrombosis group).


RESULTS
The main causative factor for thrombosis in the late-thrombosis group was wound infection (54%), whereas wound infection was present in only 1% of cases of thrombosis in the early-thrombosis group. None of the flaps could be salvaged in the late-thrombosis group.


CONCLUSIONS
Poor salvage rate in the late-thrombosis group is the most serious problem. Prevention, early detection, and appropriate management of wound infection are essential for avoiding late thrombosis.
Kadota
Hideki
H
Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan. kadohide@qent.med.kyushu-u.ac.jp
Sakuraba
Minoru
M
Kimata
Yoshihiro
Y
Yano
Tomoyuki
T
Hayashi
Ryuichi
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011184:Postoperative Period; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000150:complications; D013927:Thrombosis / Q000209:etiology*; D013997:Time Factors