Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction.
Risk factors and techniques for free flap salvage in head and neck reconstruction are poorly described.



We conducted a retrospective review of all head and neck free flaps performed from 2000 to 2010.



Overall, 151 of 2296 flaps (6.6%) underwent salvage for microvascular complications. Age, comorbidities, surgeon experience (p = .88), vein grafts, and supercharging (p = .45) did not affect flap salvage. Muscle-only flaps (p = .002) were associated with significantly worse outcomes. Coupled venous anastomoses were superior to handsewn anastomoses (p = .03). Arteriovenous thrombosis had worse outcomes than a venous or arterial thrombosis alone (p < .0001). Anticoagulation, thrombolytics, and thrombectomy did not improve survival. Multiple takebacks (p = .003) and late takebacks (>3 days) had significantly worse outcomes (p = .003). Flap salvage was 60.3% successful with 60 total flap losses (2.6%).



Although flap salvage should be attempted, multiple attempts are not recommended, especially for muscle-only flaps. Combined arteriovenous and late thrombosis has a dismal prognosis regardless of different salvage techniques. © 2015 Wiley Periodicals, Inc. Head Neck 38: E771-E775, 2016.
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Edward I
EI
Chang
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Hong
H
Zhang
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jun
J
Liu
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Peirong
P
Yu
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Roman J
RJ
Skoracki
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Matthew M
MM
Hanasono
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D058752:Free Tissue Flaps / Q000637:transplantation*; D006084:Graft Rejection / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D013927:Thrombosis / Q000473:pathology
free flap salvage; free flap success; free flap thrombosis; head and neck reconstruction; microvascular complication