Factors impacting successful salvage of the failing free flap
Larissa Sweeny, Joseph Curry, Meghan B. Crawley, Taylor Cave, Matthew Stewart, Adam Luginbuhl, Ryan Heffelfinger, Howard Krein, Daniel Petrisor, Adam Bender‐Heine, Mark K. Wax
Abstract
BACKGROUND: Understanding factors impacting successful salvage of a compromised free flap. METHODS: Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764). RESULTS: Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P < .001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P = .035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P < .0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P < .0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P < .0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P = .04). CONCLUSIONS: There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.