American Society of Hirudotherapy

Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction

Consensus survey study published in Head & neck (2021)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportClinical LiteratureDrug DevelopmentMady et al. · Head & neck, 2021

Abstract

BACKGROUND: We aim to define a set of terms for common free flap complications with evidence-based descriptions. METHODS: Clinical consensus surveys were conducted among a panel of head and neck/reconstructive surgeons (N = 11). A content validity index for relevancy and clarity for each item was computed and adjusted for chance agreement (modified kappa, K). Items with K < 0.74 for relevancy (i.e., ratings of "good" or "fair") were eliminated. RESULTS: Five out of nineteen terms scored K < 0.74. Eliminated terms included "vascular compromise"; "cellulitis"; "surgical site abscess"; "malocclusion"; and "non- or mal-union." Terms that achieved consensus were "total/partial free flap failure"; "free flap takeback"; "arterial thrombosis"; "venous thrombosis"; "revision of microvascular anastomosis"; "fistula"; "wound dehiscence"; "hematoma"; "seroma"; "partial skin graft failure"; "total skin graft failure"; "exposed hardware or bone"; and "hardware failure." CONCLUSION: Standardized reporting would encourage multi-institutional research collaboration, larger scale quality improvement initiatives, the ability to set risk-adjusted benchmarks, and enhance education and communication.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleConsensus Statement
Indexed MeSH termsFree Tissue FlapsHead and Neck NeoplasmsHumansNeckPostoperative ComplicationsPlastic Surgery ProceduresRetrospective Studies

Summary

Eleven head and neck surgeons completed consensus surveys that retained 14 terms for free flap complications, including flap failure, arterial/venous thrombosis, fistula, and hematoma, while eliminating five terms such as vascular compromise, enabling standardized reporting.

Why This Matters for Hirudotherapy

This consensus statement used clinical consensus surveys among 11 head and neck/reconstructive surgeons to define standardized nomenclature for free flap complications, achieving consensus on terms including 'venous thrombosis,' 'arterial thrombosis,' and 'hematoma,' while eliminating five terms that lacked adequate inter-rater agreement. The abstract makes no mention of leeches, hirudotherapy, or leech-derived compounds. The study is focused entirely on establishing standardized terminology for surgical complication reporting and does not address any therapeutic modalities. No content in the abstract supports any relevance to hirudotherapy or the leech secretome.

Citation

Reference (Vancouver style)

Mady LJ, Poonia SK, Baddour K, Snyder V, Kurukulasuriya C, Frost AS, et al. Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction. Head Neck. 2021;43(10):3032-3041. doi:10.1002/hed.26789. PMID: 34145676

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

DOIPubMed

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