BACKGROUND: Risk factors and techniques for free flap salvage in head and neck reconstruction are poorly described. METHODS: We conducted a retrospective review of all head and neck free flaps performed from 2000 to 2010. RESULTS: Overall, 151 of 2296 flaps (6.6%) underwent salvage for microvascular complications. Age, comorbidities, surgeon experience (p = .88), vein grafts, and supercharging (p = .45) did not affect flap salvage. Muscle-only flaps (p = .002) were associated with significantly worse outcomes. Coupled venous anastomoses were superior to handsewn anastomoses (p = .03). Arteriovenous thrombosis had worse outcomes than a venous or arterial thrombosis alone (p < .0001). Anticoagulation, thrombolytics, and thrombectomy did not improve survival. Multiple takebacks (p = .003) and late takebacks (>3 days) had significantly worse outcomes (p = .003). Flap salvage was 60.3% successful with 60 total flap losses (2.6%). CONCLUSION: Although flap salvage should be attempted, multiple attempts are not recommended, especially for muscle-only flaps. Combined arteriovenous and late thrombosis has a dismal prognosis regardless of different salvage techniques.
BACKGROUND: Risk factors and techniques for free flap salvage in head and neck reconstruction are poorly described. METHODS: We conducted a retrospective review of all head and neck free flaps performed from 2000 to 2010. RESULTS: Overall, 151 of 2296 flaps (6.6%) underwent salvage for microvascular complications. Age, comorbidities, surgeon experience (p = .88), vein grafts, and supercharging (p = .45) did not affect flap salvage. Muscle-only flaps (p = .002) were associated with significantly worse outcomes. Coupled venous anastomoses were superior to handsewn anastomoses (p = .03). Arteriovenous thrombosis had worse outcomes than a venous or arterial thrombosis alone (p < .0001). Anticoagulation, thrombolytics, and thrombectomy did not improve survival. Multiple takebacks (p = .003) and late takebacks (>3 days) had significantly worse outcomes (p = .003). Flap salvage was 60.3% successful with 60 total flap losses (2.6%). CONCLUSION: Although flap salvage should be attempted, multiple attempts are not recommended, especially for muscle-only flaps. Combined arteriovenous and late thrombosis has a dismal prognosis regardless of different salvage techniques.
Authors: Steffen Auerswald; Stephan Schreml; Robert Meier; Alexandra Blancke Soares; Maximilian Niyazi; Sebastian Marschner; Claus Belka; Martin Canis; Frank Haubner Journal: Radiat Oncol Date: 2019-11-11 Impact factor: 3.481