Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis

Overview

Journal Otolaryngol Head Neck Surg

Publisher Wiley

Specialties General Surgery
Otorhinolaryngology

Date 2021 Sep 7

PMID 34491852

Citations 8

Authors

Amit Walia

Jake J Lee

Ryan S Jackson

Angela C Hardi

Craig A Bollig

Evan M Graboyes

Joseph Zenga

Sidharth V Puram

Patrik Pipkorn

Affiliations

Soon will be listed here.

Abstract

Objective: To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management.

Data Sources: Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019.

Review Methods: Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications.

Results: A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies, = 12.8%). There was no difference in hospitalization length after secondary reconstruction between free tissue transfer and locoregional flaps or conservative management (relative risk of hospitalization ≥2 weeks, 96%; 95% CI, 0.80-1.14; n = 3 studies, = 0). The pooled relative risk of perioperative complications following free tissue transfer was 0.60 when compared with locoregional flap or conservative management (95% CI, 0.40-0.92; n = 5 studies, = 0).

Conclusion: Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.

Citing Articles

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Comprehensive analysis of risk factors for flap necrosis in free flap reconstruction of postoperative tissue defects in oral and maxillofacial tumors.

Ouyang S, Wu Z, Zhang Y, Lu X Sci Rep. 2024; 14(1):18676.

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Maxillofacial Microvascular Free-Flap Reconstructions in Pediatric and Young Adult Patients-Outcomes and Potential Factors Influencing Success Rate.

Lech D, Matysek J, Maksymowicz R, Straczek C, Margula R, Krakowczyk L J Clin Med. 2024; 13(7).

PMID: 38610780 PMC: 11012962. DOI: 10.3390/jcm13072015.

Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) Score as a Predictive Model for the Success of Reconstruction of Head and Neck Defects with Free Microvascular Flaps.

Tarle M, cvrljevic I, Raguz M, Luksic I J Clin Med. 2023; 12(16).

PMID: 37629355 PMC: 10455496. DOI: 10.3390/jcm12165314.

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