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Late Flap Failure: Etiology and Management.

Matthew B Studer¹, Skylar H Trott¹, Sara Yang¹

¹Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|March 10, 2025

Summary

Late free flap failure, though uncommon, often results from postoperative complications like infection. Patients experiencing flap failure frequently require multiple surgeries, with intraoperative pedicle revisions increasing risk.

Keywords:

free flap failure late flap failure microvascular reconstruction surgical complications

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Area of Science:

Plastic Surgery
Head and Neck Surgery
Microsurgery

Background:

Late free flap failure is an infrequent but significant complication in reconstructive surgery.
Understanding the causes and management of late flap failure is crucial for improving patient outcomes.

Purpose of the Study:

To investigate the etiology and management strategies for late free flap failure.
To compare characteristics of patients with late flap failure to those with early failure or long-term survival.

Main Methods:

Retrospective review of 1959 free flaps for head and neck defects between 2010 and 2023.
Definition of late failure as vascular compromise detected on postoperative day 6 or later, leading to flap loss.
Comparison of late failure cohort with early failure and long-term survival cohorts.

Main Results:

Late free flap failure occurred in 1.6% of cases (31 patients), with 80.6% experiencing total loss.
Postoperative complications, particularly infection (41.9%), were the most common cause of late failure.
Late failure patients had higher rates of intraoperative pedicle revision and postoperative infections compared to early failure patients.

Conclusions:

Late free flap failure necessitates extensive surgical intervention, including debridement and secondary reconstruction.
Intraoperative pedicle revision is a risk factor for both early and late flap failure.
Postoperative infection is significantly more prevalent in cases of late free flap failure.