Predictors of wound complication in patients undergoing major head and neck cancer surgery who require free tissue transfer

Abstract

This study aims to improve the understanding of predictors of wound healing issues following major head and neck surgery with free flap repair and allow us to consider how we might mitigate these complications. Over a period of 14 years, 1461 patients had free flap reconstruction within a single oral and maxillofacial surgery unit. Data on patient demographics, comorbidities, factors indicative of the magnitude of the surgical insult, and postoperative complications were obtained and included in the analysis. Wound complications were graded using the Clavien-Dindo classification. In total, 48% experienced one or more donor or recipient site wound complication. Independent predictors were the donor flap selected (p < 0.001) (with bone-containing flaps and truncal donor sites associated with higher complication rates), the requirement for two flaps (p < 0.001), longer procedure duration (p < 0.039), reduced preoperative serum albumin (p < 0.001), recipient site (with laryngopharyngeal sites having higher rates and lateral skull base/ parotid lower rates compared with oral/oropharyngeal sites) (p = 0.001), higher ACE-27 co-morbidity score (p = 0.022), and surgical team (p < 0.001). This study supports the conceptual understanding of complications as a consequence of the interaction between acute and chronic comorbidity, magnitude of the surgical insult, and totality of the perioperative care package, including the importance of appropriate procedure selection for a given patient.