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Examination of possible predictors of complications following free tissue transfer to the head and neck for oncologic defects
Ian C. Hoppe, BA, Brenon L. Abernathie, MD, Ramazi O. Datiashvili, MD.
New Jersey Medical School - UMDNJ, Newark, NJ, USA.

BACKGROUND: The use of free tissue transfer for reconstruction of oncologic head and neck defects has become a mainstay of treatment. Varying rates of flap failure and complications have been reported with little examination of what leads to these untoward results. This study seeks to examine variables that may influence flap failure and lead to complications.
METHODS: A retrospective chart review of all patients who underwent free tissue reconstruction of the head and neck following oncologic resection between 2001 and 2010 was performed. Twenty demographic and operative variables were collected. A comparison of means and multivariate logistic regression was performed. The outcome variables were flap failure and if a complication occurred (further broken down into recipient site and donor site complications). A significance level of 5% was utilized.
RESULTS: There were 107 free tissue transfers to the head and neck for oncologic defects during this time period. 7 (6.5%) flaps ultimately failed. 42 (39.2%) of flaps experienced some form of complication. No variables were shown to have a significant relationship with flap failure. Postoperative albumin, preoperative hemoglobin, and the difference between preoperative and postoperative hemoglobin were significantly different between those that had any form of complication and those that did not. Preoperative hemoglobin and the difference between preoperative and postoperative hemoglobin were significantly different between those that had a recipient site complication and those that did not. Preoperative radiation therapy did not adversely impact the outcome variables, but there was a relationship approaching significance with recipient site complications (p = 0.08). Any complication and recipient site complications were associated with flap failure (odds ratios, 12.8 and 23.1). Preoperative hemoglobin less than 13 was associated with any complication and recipient site complications (odds ratios, 2.54 and 4.40). A preoperative albumin of less than 3.5 and a postoperative albumin less than 3.0 were not associated with any of the outcomes under consideration.
CONCLUSIONS: Oftentimes it is difficult to evaluate factors that lead to free flap failure due to the low rate of occurrence, necessitating often unattainable sample sizes. This study found an increased rate of flap failure following complications. While this is not unexpected, it allows one to extrapolate variables that lead to increased rates of complications which may subsequently result in flap failure. Optimizing variables that are related to increased complications, such as preoperative hemoglobin, may lead to fewer flap failures. Minimizing blood loss, and the subsequent drop in hemoglobin, may contribute to minimizing complications.


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