Korean J Otorhinolaryngol-Head Neck Surg.  2021 Nov;64(11):811-819. 10.3342/kjorl-hns.2020.00745.

Risk of Microvascular Anastomosis Performed in Previous Treated Neck

• Hyun SJ
• Ahn SH

• KMID: 2522832
• DOI: http://doi.org/10.3342/kjorl-hns.2020.00745

Abstract

Background and Objectives
This study aimed to determine if a microvascular anastomosis on the neck, which had previously been treated, increases the risk of early complications, such as flap failure or hemorrhage and venous congestion that necessitates re-exploration.
Subjects and Method
A retrospective review was conducted on 274 cases of tumor resection with simultaneous free flap reconstruction from 2005 to 2019. Flap failure and re-exploration rate was evaluated according to the clinical variables including treatment history of recipient vessels.
Results
Twenty-one (7.7%) cases of flap failure were identified and re-exploration was conducted in 51 (18.6%) cases. Although the failure rate appeared to be high when micro-anastomosis was performed in the neck, where neck dissection with radiotherapy was previously performed (22.7%), there was no statistical significance compared with no previous treatment group. Previous neck dissection with irradiation was found to influence re-exploration {odds ratio (OR)=3.674 [95% confidence interval (CI) 1.348–10.014, p=0.011]} compared to no treatment. However, previous radiotherapy or surgery only did not show any significant difference compared to the untreated group. Venous congestion was the most common cause of re-exploration (50.1%), followed by hematoma (33.3%), and previous neck dissection with radiotherapy increased the risk of both [OR for venous congestion=3.056 (95% CI 1.009–9.255)], p=0.048, OR for hematoma=6.286 (95% CI 1.679–23.526), p=0.006] compared with no previous treatment. Radiotherapy alone did not change the risk of early complication.
Conclusion
Micro-anastomosis in a previously treated neck is feasible in terms of flap failure. However, micro-anastomosis in a neck, where neck dissection with radiotherapy were performed, may be more likely to cause complications such as venous congestion and hematoma that necessitate re-exploration.

Keyword

Failure; Free flap; Microvascular anastomosis; Reoperation; Salvage