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Free flap volume changes: can we predict ideal flap size and future volume loss?
Steven K Dennis1, Zahrah Masheeb, Marianne Abouyared
1Department of Otolaryngology - Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA.
Current Opinion in Otolaryngology & Head and Neck Surgery
|August 29, 2022
Summary
Accurately predicting free flap volume is crucial for optimal surgical outcomes. Surgeons must balance flap size to prevent functional deficits and avoid airway compromise, considering factors like radiation and flap type.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Head and Neck Surgery
Background:
- Free flap volume estimation is critical for successful reconstruction.
- Inaccurate volume prediction can lead to suboptimal functional and aesthetic results.
- Overestimation may cause airway issues, while underestimation results in functional deficits.
Purpose of the Study:
- To review current understanding of free flap volume changes.
- To identify factors influencing postoperative flap volume.
- To provide guidance on appropriate flap volume anticipation.
Main Methods:
- Review of recent literature on free flap volume dynamics.
- Analysis of factors affecting flap volume, including radiation, flap composition, and patient weight.
- Synthesis of data to inform surgical planning.
Main Results:
- Free flap volume changes are multifactorial, influenced by radiation, flap composition, and patient weight.
- Radial forearm free flaps typically lose ~40% of volume.
- Muscle flaps show variable volume changes; adipose-prevalent flaps are more resistant to radiation but sensitive to weight fluctuations.
Conclusions:
- Current recommendations suggest anticipating 1.1 to 1.4 times the final volume.
- Patient-specific factors like radiation exposure, weight changes, and flap composition must guide intraoperative volume decisions.
- Personalized surgical planning is essential for optimizing free flap reconstruction outcomes.
