Predicting risk factors that lead to free flap failure and vascular compromise: A single unit experience with 565 free tissue transfers.

Lese, Ioana; Biedermann, Raphael; Constantinescu, Mihai; Grobbelaar, Adriaan O.; Olariu, Radu (2021). Predicting risk factors that lead to free flap failure and vascular compromise: A single unit experience with 565 free tissue transfers. Journal of plastic, reconstructive & aesthetic surgery, 74(3), pp. 512-522. Elsevier 10.1016/j.bjps.2020.08.126

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BACKGROUND

Even though the benefit of free tissue transfer is uncontested in complex reconstructive cases, vascular compromise and/or flap failure remain a challenge for the surgeon and identification of possible risk factors can aid in the preoperative planning. The aim of this study was to identify the individual risk factors leading to flap failure and/or vascular compromise in free tissue transfers in a single institution over a period of 10 years and to create an index predicting these problems, as well as finding predictors of other postoperative complications.

METHODS

Data from all the patients undergoing free tissue transfers between 2009 and 2018 were retrospectively analyzed (demographics, comorbidities, flap failure, vascular compromise, and other complications). The results from the univariate and multivariate analyses were used to create an index.

RESULTS

A predictability index with three classes (low, moderate, and high risk) was calculated for each patient, based on defect etiology and the presence of coronary heart disease, diabetes, smoking, peripheral arterial vascular disease, and arterial hypertension. A patient with moderate-risk index had 9.3 times higher chances of developing vascular compromise than those in the low-risk group, while a high-risk index had 18.6 higher odds (p=0.001). American Society of Anesthesiologists (ASA) classification was found to be a predictor of complications in free tissue transfer (p=0.001).

CONCLUSION

If patients at a high risk of vascular compromise could be identified preoperatively through this predictability index, patient counseling could be improved and the surgeon might adapt the reconstructive plan and choose an alternative reconstructive strategy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Plastic, Reconstructive and Aesthetic Surgery
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery

UniBE Contributor:

Lese, Ioana; Constantinescu, Mihai Adrian; Grobbelaar, Adriaan Ockert and Olariu, Radu

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1748-6815

Publisher:

Elsevier

Language:

English

Submitter:

Veronika Picha

Date Deposited:

15 Oct 2020 17:43

Last Modified:

03 Mar 2021 01:31

Publisher DOI:

10.1016/j.bjps.2020.08.126

PubMed ID:

33039304

Uncontrolled Keywords:

Complications Flap failure Free flap Index Predictability

BORIS DOI:

10.7892/boris.147009

URI:

https://boris.unibe.ch/id/eprint/147009

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