Complication drivers in head and neck free flap surgery: A single-center predictive analysis

Area of Science:

• Reconstructive Surgery
• Microsurgery
• Head and Neck Surgery

Background:

• Head and neck free flap (HNFF) surgery is a cornerstone of reconstructive surgery for complex defects.
• Despite high success rates, postoperative complications significantly impact patient outcomes.
• Identifying predictors of these complications is crucial for improving surgical results.

Purpose of the Study:

• To analyze predictors of postoperative complications in head and neck free flap surgery.
• To identify patient and treatment-related factors associated with flap loss and other morbidities.
• To inform strategies for mitigating risks and enhancing patient outcomes in HNFF procedures.

Main Methods:

• A monocentric retrospective cohort study was conducted.
• Patients undergoing microvascular free flap reconstruction for head and neck defects between April 2017 and July 2023 were included.
• Primary outcomes assessed were flap-specific complications: flap loss, wound healing disorders (WHD), partial flap necrosis, and anastomotic insufficiency.

Main Results:

• The study included 1050 patients, with a 94% free flap success rate and 59 flap losses.
• Overall complication rate was 44%, with WHD being the most common (29%).
• Prior radiotherapy, female sex, and alcohol abuse were significantly associated with increased complication risks, including flap loss and WHD. Age, bleeding disorders, and prior microvascular reconstruction influenced infection risk. Increased surgical experience showed a slight correlation with higher flap loss rates.

Conclusions:

• Head and neck free flap surgery demonstrates high effectiveness in reconstruction.
• Specific patient factors like prior radiotherapy, female sex, and alcohol abuse are significant predictors of postoperative complications.
• While surgical experience is vital, it was not a primary predictor of complications in this high-volume training center setting, highlighting the importance of patient-specific risk stratification.