Free-flap failures and complications in an American oral and maxillofacial surgery unit

• Published in: International journal of oral and maxillofacial surgery Vol. 38; no. 10; pp. 1048 - 1051
• Main Authors: Salama, A.R, McClure, S.A, Ord, R.A, Pazoki, A.E
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-10-2009; Elsevier
• Subjects: Adult; Aged; Anastomosis, Surgical; Biological and medical sciences; complications; Dentistry; Female; free flaps; Head and Neck Neoplasms - rehabilitation; Head and Neck Neoplasms - surgery; Humans; Length of Stay; Male; Medical sciences; microvascular surgery; Microvessels - surgery; Middle Aged; oral cavity; Oral Surgical Procedures - adverse effects; Otorhinolaryngology. Stomatology; Postoperative Hemorrhage - etiology; reconstruction; Reconstructive Surgical Procedures - adverse effects; Retrospective Studies; Surgery; Surgery Department, Hospital - statistics & numerical data; Surgical Flaps - blood supply; Thrombosis - etiology; Treatment Failure; United States; Young Adult; United States; oral cavity; free flaps; reconstruction; complications; microvascular surgery; Stomatology; Anatomical reconstruction; Maxillofacial surgery; Oral cavity; Microcirculation; Treatment; Free flap; Complication; Failure
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2009.05.002

Abstract Free tissue transfer is a reliable surgical technique that enables primary reconstruction following ablative surgery. Widely practised in many European units, acceptance into mainstream oral and maxillofacial surgery in the USA has been slow. The authors reviewed free flap practice patterns and outcomes in a US oral and maxillofacial surgery training program with specific emphasis on failures and complications to illustrate obstacles encountered during the initial phase of practice implementation. The demographic and clinical data of 71 consecutive patients who underwent microvascular reconstruction over 3 years (2002–2005) were reviewed. The study group included 48 males and 23 females who underwent 72 free tissue transfer procedures. Fourteen patients required operative exploration in the perioperative period. Six patients were explored for clinically compromised flaps. Thrombotic events occurred in 4 patients; 1 flap was successfully salvaged. There were 4 flap failures and 9 complications related to the donor site. Two perioperative deaths occurred from non-flap-related complications. Prolonged hospital stay and ICU utilization was observed in patients with surgical complications. Complications in this study did not affect the overall success rates of free-flaps. Salvage rates from thrombotic events were unaffected despite rigid flap monitoring protocols.