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Updated: Dec 10, 2025
A Model of Free Tissue Transfer: The Rat Epigastric Free Flap
Published on: January 15, 2017
Factors impacting successful salvage of the failing free flap
Larissa Sweeny1, Joseph Curry2, Meghan Crawley2
1Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Science Center - New Orleans, New Orleans, Louisiana, USA.
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.
