Perioperative Blood Pressure Kinetics and Hematoma Rates in Head and Neck Free Flaps

Area of Science:

• Plastic Surgery
• Head and Neck Surgery
• Surgical Complications

Background:

• Postoperative hematoma is a frequent complication after head and neck free flap reconstruction (HNFFR).
• Understanding the impact of perioperative blood pressure on hematoma development is essential for improving patient outcomes.

Purpose of the Study:

• To investigate the association between perioperative blood pressures and the incidence of postoperative neck hematoma in patients undergoing HNFFR.
• To determine the effect of hematoma on flap outcomes in HNFFR.

Main Methods:

• Retrospective chart review of 317 patients undergoing HNFFR from January 2020 to December 2023.
• Analysis of demographic data, comorbidities, flap details, complications, and blood pressure readings (preoperative, intraoperative, early, and late postoperative).

Main Results:

• A total of 329 flaps were analyzed; 27 patients developed neck hematoma, with significantly higher flap failure rates (11.1% vs. 2.4%).
• Higher preoperative systolic and pulse pressures, peak early postoperative systolic pressures, and peak late postoperative systolic, diastolic, and mean arterial pressures (MAP) were associated with hematoma.
• Late postoperative MAP was the sole independent predictor of hematoma (OR 1.04 per 1 mmHg rise; p=0.004), with MAP ≥117.8 indicating a 5-fold higher risk (OR 5.24).

Conclusions:

• Postoperative blood pressure management is critical for minimizing hematoma risk in HNFFR.
• Maintaining a late postoperative mean arterial pressure (MAP) below 110 mmHg may reduce hematoma incidence and associated flap failure.