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

Head and neck free flap (HNFF) surgery is essential in reconstructive surgery, addressing complex defects with tailored approaches. Despite high success rates, complications remain significant, influenced by patient comorbidities, flap types, and surgical complexity. This study aimed to analyze predictors of postoperative complications to improve patient outcomes.

This monocentric retrospective cohort study included patients undergoing microvascular free flap reconstruction for head and neck defects between April 2017 and July 2023. The primary outcome was flap-specific postoperative complications, including flap loss, recipient site wound healing disorders (WHD), partial flap necrosis, or anastomotic insufficiency.

Among 1050 patients, the free flap success rate was 94%, with 59 flap losses. Complications occurred in 44% of patients, most commonly WHD (29%). Prior head and neck radiotherapy was associated with anastomosis revision (OR 2.13; p = 0.02) and flap loss (OR 2.06; p = 0.02). Female sex increased the risk of flap loss (OR 2.24; p = 0.004). Alcohol abuse elevated the risk of WHD (OR 1.81; p = 0.003) and partial flap necrosis (OR 2.19; p = 0.001). Infection risk was influenced by age (OR 0.98; p = 0.01), bleeding disorders (OR 5.37; p = 0.003), and prior microvascular reconstruction (OR 2.08; p = 0.008). Increased surgical experience only slightly correlated with higher flap loss rates (OR 1.06; p = 0.02).

Free flap surgery is effective in head and neck reconstruction, though specific risk factors contribute to complications. Further research is needed to mitigate these risks. Surgical experience is essential for complex cases but is not a primary, clinically relevant predictor of complications in high-volume training centers.