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

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.