Risk Factors for Free Flap Failure in Head and Neck Reconstruction: A Retrospective Analysis From a Single Medical...

Despite success rates exceeding 90% with microsurgical reconstruction, flap failure remains a serious complication. This study aims to identify risk factors for flap failure based on real-world data from a single Taiwanese center.

A retrospective analysis was conducted on 1015 patients who underwent their first free flap surgery for head and neck cancer at Taichung Veterans General Hospital from 2013 to 2021. Variables included demographics, comorbidities, preoperative radiotherapy or chemotherapy, and intraoperative ischemia time. Outcomes included flap failure, complications, take-back surgery, and hospital stay. Logistic and linear regression analyses were used to identify risk factors.

Among 1015 patients, flap failure occurred in 3.19%, complications in 16.85%, and take-back procedures in 8.80%. Longer ischemia time increased the risk of failure (odds ratio [OR] = 1.01, P < 0.001), complications (OR = 1.01, P = 0.023), and longer hospital stay (β = 0.08, P < 0.001). Preoperative radiotherapy or chemotherapy was associated with more complications (OR = 1.90, P = 0.002) and longer hospitalization (β = 6.91, P < 0.001).

This study, based on 1015 cases from a single institution over nearly a decade, minimizes systematic bias and confirms ischemia time as a key predictor of flap failure and prolonged hospitalization. Although preoperative radiotherapy or chemotherapy increases complication rates and length of hospital stay, it does not affect flap survival, providing valuable data for surgical planning and patient counseling.