Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction

Background Risk factors and techniques for free flap salvage in head and neck reconstruction are poorly described. Methods We conducted a retrospective review of all head and neck free flaps performed from 2000 to 2010. Results Overall, 151 of 2296 flaps (6.6%) underwent salvage for microvascular complications. Age, comorbidities, surgeon experience (p =.88), vein grafts, and supercharging (p =.45) did not affect flap salvage. Muscle-only flaps (p =.002) were associated with significantly worse outcomes. Coupled venous anastomoses were superior to handsewn anastomoses (p =.03). Arteriovenous thrombosis had worse outcomes than a venous or arterial thrombosis alone (p <.0001). Anticoagulation, thrombolytics, and thrombectomy did not improve survival. Multiple takebacks (p =.003) and late takebacks (>3 days) had significantly worse outcomes (p =.003). Flap salvage was 60.3% successful with 60 total flap losses (2.6%). Conclusion Although flap salvage should be attempted, multiple attempts are not recommended, especially for muscle-only flaps. Combined arteriovenous and late thrombosis has a dismal prognosis regardless of different salvage techniques.