Parameters predicting complications in flap surgery

doi:10.1016/j.oooo.2012.09.007

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Volume 115, Issue 5, May 2013, Pages 589-594

https://doi.org/10.1016/j.oooo.2012.09.007 Get rights and content

Objectives

The aim of this prospective study was to determine laboratory parameters predicting complications and/or failure in flap surgery.

Study Design

Fifty-seven patients undergoing reconstructive surgery with cutaneous free and pedicled flaps were included. Blood samples were taken 2 days before surgery and 1, 3, 5, 7, and 14 days after. Parameters associated with thrombophilia, bleeding disorders, and wound healing were determined.

Results

In 45 (77%) of 57 patients no complications occurred. Bleeding (9%) and venous thrombosis of the flaps (9%) led in 18% of the cases to surgical revisions. Activated protein C resistance showed a significant (P < .05) cluster in cases with venous thrombosis, whereas it was absent in all other cases. Fibrinogen, factor VIII:C, von Willebrand factor (vWF) activity, and VWF antigen were significantly (P < .05) higher in patients with venous thrombosis compared with all other patients.

Conclusions

Laboratory parameters of thrombosis and bleeding appear to be associated with complications in flap surgery.

Section snippets

Study design and patients

This investigation was designed and performed as a prospective study. From March 2011 to March 2012 all patients undergoing reconstructive surgery with cutaneous free and pedicled flaps were included if their informed consent was given to participate. Patients receiving bone-containing flaps without a cutaneous flap (e.g., fibula without skin island) were excluded. Postoperative care was performed following our standard procedure. Patients were kept sedated for 1 night on the intensive care

Results

Fifty-seven patients (23 female/34 male) participated in the study. In total, 61 flaps were used to perform the surgical reconstruction. The predominant type of flap was the radial forearm flap (n = 44 [72%]), followed by scapula (7 [11%]) and the pectoralis major flap (6 [10%]) (Figure 1) Three flaps in 2 patients had to be removed, so the total failures numbered 3 (4.9%). However, various complications were observed that made surgical revision necessary. In 77%, no complications and revisions

Discussion

The purpose of this prospective study was to determine laboratory parameters predicting complications and/or failure in flap surgery. The overall failure rate in this investigation is similar to other published data of 5%-10%.5, 9, 11 Moreover, the need for surgical revision reported in the literature is similar to our rate (10%-20%).5, 9 Despite generally excellent results, a small but clinically relevant risk remains necessitating urgent reexplorations because of complications (bleeding,

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Citation Excerpt :
Our results coincide with some of the latest studies, where complications were not influenced by gender,32 defect location,15 obesity,38 smoking11,14 or age.11 While isolated variables are unlikely to be reliable predictors for all forms of morbidity and since most of the results in the literature arise from statistical tests that do not take into account the confounding factors,27,33 we conducted the multivariate analysis. The increased risk of suffering postoperative complications in patients undergoing free fibula transfer in comparison to the ALT flap (Odds Ratio = 2.334, [95% CI] 1.3–4.2) was also reported in other studies, where reintervention, fistula, hematoma and partial necrosis rates were statistically significantly higher in bone-containing free flaps than in pure soft-tissue transfers.17,30
Even though the benefit of free tissue transfer is uncontested in complex reconstructive cases, vascular compromise and/or flap failure remain a challenge for the surgeon and identification of possible risk factors can aid in the preoperative planning. The aim of this study was to identify the individual risk factors leading to flap failure and/or vascular compromise in free tissue transfers in a single institution over a period of 10 years and to create an index predicting these problems, as well as finding predictors of other postoperative complications.
Data from all the patients undergoing free tissue transfers between 2009 and 2018 were retrospectively analyzed (demographics, comorbidities, flap failure, vascular compromise, and other complications). The results from the univariate and multivariate analyses were used to create an index.
A predictability index with three classes (low, moderate, and high risk) was calculated for each patient, based on defect etiology and the presence of coronary heart disease, diabetes, smoking, peripheral arterial vascular disease, and arterial hypertension. A patient with moderate-risk index had 9.3 times higher chances of developing vascular compromise than those in the low-risk group, while a high-risk index had 18.6 higher odds (p=0.001). American Society of Anesthesiologists (ASA) classification was found to be a predictor of complications in free tissue transfer (p=0.001).
If patients at a high risk of vascular compromise could be identified preoperatively through this predictability index, patient counseling could be improved and the surgeon might adapt the reconstructive plan and choose an alternative reconstructive strategy.
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View full text

Oral and maxillofacial surgeryParameters predicting complications in flap surgery

Objectives

Study Design

Results

Conclusions

Section snippets

Study design and patients

Results

Discussion

Br J Oral Maxillofac Surg

Int J Radiat Oncol Biol Phys

Oral Oncol

Int J Oral Maxillofac Surg

J Plast Reconstr Aesthet Surg

Clin Plast Surg

Oral Oncol

Blood

Transfus Apher Sci

Thromb Res

Am J Pathol

Lancet

Lancet

Lancet

Adenomatoid odontogenic tumor of the mandible: review of the literature and report of a rare case

Head Face Med

Comparative study of the postoperative complications of microvascular surgery in elderly and young patients

J Reconstr Microsurg

Is there an association between comorbidities and the outcome of microvascular free tissue transfer?

J Reconstr Microsurg

Clinical reliability of radial forearm free-flap procedure in reconstructive head and neck surgery

J Craniofac Surg

The survival curve: factors impacting the outcome of free flap take-backs

Plast Reconstr Surg

Oral and maxillofacial surgery
Parameters predicting complications in flap surgery