title: Free-flap failures and complications in an American oral and maxillofacial surgery unit.
abstract: Free tissue transfer is a reliable surgical technique that enables primary reconstruction following ablative surgery. Widely practised in many European units, acceptance into mainstream oral and maxillofacial surgery in the USA has been slow. The authors reviewed free flap practice patterns and outcomes in a US oral and maxillofacial surgery training program with specific emphasis on failures and complications to illustrate obstacles encountered during the initial phase of practice implementation. The demographic and clinical data of 71 consecutive patients who underwent microvascular reconstruction over 3 years (2002-2005) were reviewed. The study group included 48 males and 23 females who underwent 72 free tissue transfer procedures. Fourteen patients required operative exploration in the perioperative period. Six patients were explored for clinically compromised flaps. Thrombotic events occurred in 4 patients; 1 flap was successfully salvaged. There were 4 flap failures and 9 complications related to the donor site. Two perioperative deaths occurred from non-flap-related complications. Prolonged hospital stay and ICU utilization was observed in patients with surgical complications. Complications in this study did not affect the overall success rates of free-flaps. Salvage rates from thrombotic events were unaffected despite rigid flap monitoring protocols.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore College of Dental Surgery, Baltimore, Maryland 21201, USA. arsalama@umaryland.edu
authors.forename: A R
authors.initials: AR
authors.lastname: Salama
authors.forename: S A
authors.initials: SA
authors.lastname: McClure
authors.forename: R A
authors.initials: RA
authors.lastname: Ord
authors.forename: A E
authors.initials: AE
authors.lastname: Pazoki
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006258:Head and Neck Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D055806:Microvessels / Q000601:surgery; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013524:Surgical Flaps / Q000098:blood supply; D013927:Thrombosis / Q000209:etiology; D017211:Treatment Failure; D014481:United States; D055815:Young Adult