What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure. 2010

Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
Department of Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287-0910, USA.

OBJECTIVE The purpose of this article is to discuss the various factors related to poor outcome in free flap reconstructions of the head and neck (H&N). Free tissue transfer has become the standard reconstruction technique for complex H&N defects. With the evolution of free flap use in H&N surgery, numerous factors have been proposed that adversely affect flap outcome, many with the support of only anecdotal experience. We seek to critically review the literature to assess what evidence exists for the relation of various intraoperative factors to free flap complications. METHODS Literature review. METHODS A review of the contemporary literature (1995 to present) on free flap reconstruction of the H&N was undertaken. A PubMed search using the terms head and neck, reconstruction, free flap, microvascular, failure, complications, fluids, intraoperative, hypertension, hypotension, nitrous oxide, temperature, and morbidity in various combinations was completed. Appropriate articles were selected and analyzed. RESULTS Studies report various factors thought to influence flap outcomes, often with divergent conclusions. Nonetheless, the body of evidence implicates several intraoperative factors to contribute to free flap complications including: >7 L intraoperative fluid administration, significant medical comorbidity, and prolonged operative time. There is no evidence supporting hypotension, pressors, colloids, and nitrous use in free flap failure. CONCLUSIONS Although various dogmas related to the intraoperative care of free flap patients exist, including avoidance of hypotension and pressor use, there is no available clinical evidence to support these practices. Although free flap failure is uncommon, a better understanding of its causes is necessary to avoid this disastrous complication.

UI MeSH Term Description Entries
D007432 Intraoperative Period The period during a surgical operation. Intraoperative Periods,Period, Intraoperative,Periods, Intraoperative
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D006085 Graft Survival The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. Graft Survivals,Survival, Graft,Survivals, Graft
D006258 Head and Neck Neoplasms Soft tissue tumors or cancer arising from the mucosal surfaces of the LIP; oral cavity; PHARYNX; LARYNX; and cervical esophagus. Other sites included are the NOSE and PARANASAL SINUSES; SALIVARY GLANDS; THYROID GLAND and PARATHYROID GLANDS; and MELANOMA and non-melanoma skin cancers of the head and neck. (from Holland et al., Cancer Medicine, 4th ed, p1651) Cancer of Head and Neck,Head Cancer,Head Neoplasm,Head and Neck Cancer,Head and Neck Neoplasm,Neck Cancer,Neck Neoplasm,Neck Neoplasms,Neoplasms, Upper Aerodigestive Tract,UADT Neoplasm,Upper Aerodigestive Tract Neoplasm,Upper Aerodigestive Tract Neoplasms,Cancer of Head,Cancer of Neck,Cancer of the Head,Cancer of the Head and Neck,Cancer of the Neck,Head Neoplasms,Head, Neck Neoplasms,Neoplasms, Head,Neoplasms, Head and Neck,Neoplasms, Neck,UADT Neoplasms,Cancer, Head,Cancer, Neck,Cancers, Head,Cancers, Neck,Head Cancers,Neck Cancers,Neoplasm, Head,Neoplasm, Neck,Neoplasm, UADT,Neoplasms, UADT
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D013524 Surgical Flaps Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region. Island Flap,Island Flaps,Flap, Surgical,Flaps, Surgical,Pedicled Flap,Surgical Flap,Flap, Island,Flap, Pedicled,Flaps, Island,Flaps, Pedicled,Pedicled Flaps
D018570 Risk Assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988) Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments
D019651 Plastic Surgery Procedures Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures. Cosmetic Reconstructive Surgical Procedures,Cosmetic Surgical Procedures,Esthetic Reconstructive Surgical Procedures,Esthetic Surgical Procedures,Plastic Surgical Procedures,Reconstructive Surgical Procedures,Reconstructive Surgical Procedures, Cosmetic,Cosmetic Reconstructive Surgery,Procedure, Reconstructive Surgical,Procedures, Reconstructive Surgical,Reconstructive Surgical Procedure,Reconstructive Surgical Procedures, Esthetic,Surgical Procedure, Reconstructive,Surgical Procedures, Reconstructive,Cosmetic Reconstructive Surgeries,Cosmetic Surgical Procedure,Esthetic Surgical Procedure,Plastic Surgery Procedure,Plastic Surgical Procedure,Procedure, Cosmetic Surgical,Procedure, Esthetic Surgical,Procedure, Plastic Surgery,Procedure, Plastic Surgical,Procedures, Cosmetic Surgical,Procedures, Esthetic Surgical,Procedures, Plastic Surgery,Procedures, Plastic Surgical,Reconstructive Surgeries, Cosmetic,Reconstructive Surgery, Cosmetic,Surgeries, Cosmetic Reconstructive,Surgery Procedure, Plastic,Surgery Procedures, Plastic,Surgery, Cosmetic Reconstructive,Surgical Procedure, Cosmetic,Surgical Procedure, Esthetic,Surgical Procedure, Plastic,Surgical Procedures, Cosmetic,Surgical Procedures, Esthetic,Surgical Procedures, Plastic

Related Publications

Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
February 2008, Trends in genetics : TIG,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
August 1970, Psyche,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
June 2015, ONS connect,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
September 2005, European journal of immunology,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
January 1986, The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
January 2023, The Veterinary record,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
October 2012, ONS connect,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
November 1973, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
March 1983, Dental management,
Kavita M Pattani, and Patrick Byrne, and Kofi Boahene, and Jeremy Richmon
November 1997, Nature,
Copied contents to your clipboard!