Factors Associated with Free Flap Failures in Head and Neck Reconstruction
Research article published in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2019)
Abstract
OBJECTIVE: To investigate causes of failure of free flap reconstructions in patients undergoing reconstruction of head and neck defects. STUDY DESIGN: Case series with chart review. SETTING: Single tertiary care center. SUBJECTS AND METHODS: Patients underwent reconstruction between January 2007 and June 2017 (n = 892). Variables included were clinical characteristics, social history, defect site, donor tissue, ischemia time, and postoperative complications. Statistical methods used include univariable and multivariable analysis of failure. RESULTS: The overall failure rate was 4.8% (n = 43). Intraoperative ischemia time was associated with free flap failures (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.019-1.107; P = .004) for each addition of 5 minutes. Free flaps that required pedicle revision at time of initial surgery were 9 times more likely to fail (OR, 9.953; 95% CI, 3.242-27.732; P < .001). Patients who experienced alcohol withdrawal after free flap placement were 3.7 times more likely to experience flap failure (OR, 3.690; 95% CI, 1.141-10.330; P = .031). Ischemia time remained an independent significant risk factor for failure in nonosteocutaneous free flaps (OR, 1.105; 95% CI, 1.031-1.185). Alcohol withdrawal was associated with free flap failure in osteocutaneous reconstructions (OR, 5.046; 95% CI 1.103-19.805) while hypertension was found to be protective (OR, 0.056; 95% CI, 0.000-0.445). CONCLUSION: Prolonged ischemia time, pedicle revision, and alcohol withdrawal were associated with higher rates of flap failure. Employing strategies to minimize ischemic time may have potential to decrease failure rates. Flaps that require pedicle revision and patients with a history of significant alcohol use require closer monitoring.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
In this single-center chart review of 892 head-and-neck free-flap reconstructions, the overall failure rate was 4.8%, and prolonged intraoperative ischemia time, the need for pedicle revision at initial surgery, and postoperative alcohol withdrawal were independently associated with higher odds of flap failure, leading the authors to recommend minimizing ischemia time and closer monitoring of higher-risk flaps. This matters to hirudotherapy because venous congestion is a recognized mode of flap compromise that can prompt adjunctive leech therapy, and the risk factors identified here help define which flaps warrant the intensive monitoring during which congestion (and any leech salvage) would be detected. As a retrospective single-institution case series, the associations are observational and not causal, and the study does not address leech therapy.
Citation
Factors Associated with Free Flap Failures in Head and Neck Reconstruction.
Crawley et al. · Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2019
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