Arch Craniofac Surg.  2023 Aug;24(4):159-166. 10.7181/acfs.2023.00325.

Clinical analysis of factors affecting the failure of free flaps used in head and neck reconstruction

• Lim BJ
• Shin JY
• Roh SG
• Lee NH
• Chung YK

• KMID: 2545280
• DOI: http://doi.org/10.7181/acfs.2023.00325

Abstract

Background
Free tissue transfer is the preferred method of reconstructing head and neck defects, with a success rate of approximately 95%. Although flap failure is uncommon, it has a major impact on patient morbidity and diminishes quality of life, making it is important to investigate the causes of flap failure.
Methods
This retrospective chart review analyzed patients who underwent free tissue transfer during head and neck reconstruction at a single institution between 2016 and 2021.
Results
During the study period, 58 patients underwent 60 free flap procedures. Revision surgery was needed in 14 patients. Subsequent free flap surgery was performed in one patient, and three free flaps (5%) could not be salvaged. Cardiovascular disease was significantly associated with flap failure, and venous congestion (thrombosis) was the most common reason for revision surgery.
Conclusion
Cardiovascular disease clearly emerged as a factor related to the failure of free flap surgery, and this issue warrants particular attention in patients for whom free tissue transfer is planned.

Keyword

Free tissue flaps / Head and neck neoplasms / Microsurgery / Reconstructive surgery