Vascular Complications and Free Flap Salvage in Head and Neck Reconstructive Surgery: Analysis of 150 Cases of Reexploration.
BACKGROUND
Despite the excellent reliability of free tissue transfer, flap failure is devastating, and in addition to patient morbidity, it may increase hospital stay and associated costs. Previous studies have evaluated factors related to flap salvage, regarding the operative strategy for flap salvage surgery. The present study aimed to share our experience of reexploration and describe operative standards dealing with vascular thrombosis.


METHODS
We retrospectively reviewed 150 (of 1258) free flaps for head and neck reconstruction that showed signs of vascular compromise at our institution during a 13-year period between 2002 and 2015. Patient demographics, including sex, age, premorbid health status, personal history, indication for reexploration, flap type, and number of recipient vessels, were analyzed. Days between the end of initial surgery and salvage surgery were also recorded. The incidence of postsalvage complications (hematoma formation, wound dehiscence, and infection requiring surgical intervention) and the overall flap survival were recorded.


RESULTS
Of the 150 flaps, 87 flaps had evident arterial or venous thrombosis; 34 of these failed and required a second free flap or pedicle flap reconstruction. The remaining 53 were successfully salvaged. Although vascular thrombosis was found to be a major contributing factor in flap loss, no significant differences in any factor were found between patients with salvageable flaps and those with unsalvageable flaps.


CONCLUSIONS
Vascular thrombosis is a major contributing factor in flap loss. The incidence of venous thrombosis is higher, but arterial thrombosis may be more severe. Improvements in the surgical technique and perioperative management are highly reliable. We believe that strict models of flap monitoring; well-trained, dedicated staff; and immediate reexploration will potentially further improve flap survival and optimize the quality of life.
From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital; †School of Medicine, National Yang-Ming University; ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital Taiwan, Republic of China.
Yen-Hao
YH
Chiu
Dun-Hao
DH
Chang
Cherng-Kang
CK
Perng
D000328:Adult; D000368:Aged; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome