Preventing Free Flap Complications: Key Factors to Keep in Mind.

IF 1.9 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2025-08-27 DOI:10.1002/jso.70067

Jonas Kornmann, Rasmus Schug, Lena Huber, Anne Lammert, Frederic Jungbauer, Annette Affolter, Nicole Rotter, Lena Zaubitzer, Luis Bugia, Grietje Beck, Claudia Scherl

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引用次数: 0

Abstract

Background and objectives: Reconstruction of head and neck defects using free flaps is successful, but complications occur. This study aims to identify factors preventing complications to support clinical decision-making.

Methods: Retrospective study for free flap reconstructions (2019 to 2022, tertiary referral center). Univariate and multivariate regression models assessed predictors of complication-free survival (CFS) and odds ratios (OR) measured risk correlations.

Results: Of 125 identified cases, most patients were male (71.8%) with a median age of 66 years (37-93 years). Common complications were wound healing disorders (10.9%), hematoma (10%), total (7.3%) or partial (1.8%) flap necrosis, cardiovascular events (5.5%), and pulmonary artery embolism (4.5%). 30-day CFS was 63%. On multivariable analysis, female gender (HR: 9.4, CI: 2.6-33.5), alcohol abuse (HR: 3.5, CI: 1.4-8.4), N2-3 (HR: 2.4, CI: 1.3-4.4), obesity (HR: 2.1, CI: 0.9-5.1), preoperative anticoagulation (HR: 2.5, CI: 1.1-5.9) were significant prognosticators. Positive factors increasing CFS included high albumin (OR 0.21, p = 0.02), intraoperative i.v. heparin bolus (OR 0.15, p = 0.08), intraoperative catecholamine treatment (OR 0.15, p = 0.009), and nonsmoking (OR 0.18, p = 0.1).

Conclusion: Key preventive measures against complications include optimizing nutritional status and albumin levels, administering intraoperative heparin and catecholamines, and abstaining from alcohol. Females should also be screened for undiagnosed cardiovascular risks.

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预防游离皮瓣并发症：应牢记的关键因素。

背景与目的：应用游离皮瓣重建头颈部缺损是成功的，但也存在并发症。本研究旨在找出预防并发症的因素，以支持临床决策。方法：回顾性研究2019 ~ 2022年三级转诊中心游离皮瓣重建病例。单变量和多变量回归模型评估无并发症生存（CFS）的预测因子，优势比（OR）测量风险相关性。结果：125例确诊病例中，男性居多（71.8%），中位年龄66岁（37 ~ 93岁）。常见的并发症是伤口愈合障碍（10.9%）、血肿（10%）、皮瓣全部（7.3%）或部分（1.8%）坏死、心血管事件（5.5%）和肺动脉栓塞（4.5%）。30天CFS占63%。在多变量分析中，女性（HR: 9.4, CI: 2.6-33.5）、酗酒（HR: 3.5, CI: 1.4-8.4）、N2-3 （HR: 2.4, CI: 1.3-4.4）、肥胖（HR: 2.1, CI: 0.9-5.1）、术前抗凝（HR: 2.5, CI: 1.1-5.9）是重要的预后因素。增加CFS的阳性因素包括高白蛋白（OR 0.21, p = 0.02）、术中静脉注射肝素（OR 0.15, p = 0.08）、术中儿茶酚胺治疗（OR 0.15, p = 0.009）和不吸烟（OR 0.18, p = 0.1）。结论：优化营养状况和白蛋白水平，术中应用肝素和儿茶酚胺，戒酒是预防并发症的关键措施。女性也应筛查未确诊的心血管风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.