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Article
Factors Impacting Successful Salvage of the Failing Free Flap
Head & Neck
(2020)
Abstract
Background: Understanding factors impacting successful salvage of a compromised free flap.
Methods: Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764).
Results: Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P < .001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P = .035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P < .0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P < .0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P < .0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P = .04).
Conclusions: There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.
Keywords: free flap; free flap salvage; head and neck reconstruction; outcomes; surgical complications.
Disciplines
Publication Date
August 26, 2020
Citation Information
Megan Crawley and Additional authors and institutional affiliations. "Factors Impacting Successful Salvage of the Failing Free Flap" Head & Neck Vol. 42 Iss. 12 (2020) p. 3568 - 3579 Available at: http://works.bepress.com/megan-crawley/2/