Prospective analysis of outcomes and complications of 300 consecutive microvascular reconstructions.
OBJECTIVE
To prospectively follow up patients requiring microvascular reconstruction of head and neck defects to determine preoperative factors predictive of surgical complications.


METHODS
A prospectively collected database comprising 300 consecutive microvascular head and neck reconstructions performed by a single surgeon (D.S.A.) in a tertiary care hospital over a 6-year period was reviewed in a retrospective manner. Data collected included preoperative medical and surgical history (presence of documented cardiac disease, diabetes mellitus, and hypertension) and previous cancer treatment (surgery or radiation therapy). Postoperative data, including early or late complications, hematocrit during hospitalization, and functional status, were also collected. A multiple linear regression was used to identify predictors of surgical complications and secondarily crossed to determine the strength of the prediction. Statistical significance was set at P = .05.


RESULTS
Patients were stratified into 4 groups based on (1) previous radiation therapy, (2) previous surgery, (3) no previous radiation therapy or surgery, and (4) both previous radiation therapy and previous surgery, with an increased predictability of complications with both. Diabetes also added to the predictability of complications, with a smaller effect. Cardiac disease and hypertension were not predictive.


CONCLUSIONS
Previous radiation therapy and surgery are positive predictors for wound complications after microvascular reconstruction. Diabetes may add further risk in this setting.
Nuara
Michael J
MJ
Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Sauder
Cara L
CL
Alam
Daniel S
DS
D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology; D016378:Tissue Transplantation; D016896:Treatment Outcome