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Prognostic Factors for Free Flap Failure in Head and Neck Reconstruction
Quentin Hennocq1,2, Jean-Baptiste Caruhel3, Mourad Benassarou2
1Sorbonne University, Paris, France.
Head & Neck
|February 6, 2025
Summary
Free flap reconstruction in head and neck surgery has variable failure rates. Venous anastomosis choice, not patient factors, significantly impacts microvascular transfer success, guiding surgical decisions.
Area of Science:
- Microsurgery
- Plastic Surgery
- Head and Neck Reconstruction
Background:
- Free flap failure rates in head and neck reconstruction range from 0.8% to 10.6%.
- Identifying prognostic factors for free flap failure is crucial for improving patient outcomes.
Purpose of the Study:
- To identify prognostic factors associated with free flap failure in head and neck reconstruction.
- To determine the influence of surgical technique versus patient characteristics on flap survival.
Main Methods:
- Prospective cohort study including 307 consecutive free flaps from August 2021 to January 2024.
- Multivariate Cox proportional hazard model utilized for statistical analysis.
Main Results:
- Patient age, cardiovascular risk, radiotherapy history, flap type, arterial anastomosis type, and ischemia duration were not statistically significant predictors of flap failure.
- Venous anastomosis to the anterior jugular vein or superior thyroid vein, and per/postoperative revisions of anastomoses were associated with increased risk of flap failure.
Conclusions:
- The selection of venous anastomosis site significantly influences microvascular free flap success.
- Venous anastomosis choice appears to be a more critical factor in flap survival than patient-related characteristics.
