Identification of Independent Risk Factors for Flap Failure

Reconstructive microsurgery is a powerful tool to treat various complex defects. However, flap loss remains a possibility, leading to additional surgery, hospitalisation, and costs. Consequently, it is important to know which factors lead to an increased risk of flap failure, so that measures can be undertaken to reduce this risk. Therefore, we analysed our results over a 20-year period to identify risk factors for flap failure after breast, head and neck, and extremity reconstruction. Medical files of all patients treated between 1992 and 2012 were reviewed. Patient characteristics, surgical data, and postoperative complications were scored and independent risk factors for flap loss were identified. A total of 1,530 free flaps were performed in 1,247 patients. Partial and total flap loss occurred in 5.5% and 4.4% of all free flaps, respectively. Signs of compromised flap circulation were a risk factor for flap failure in all flaps. More specifically, risk factors for flap failure in breast reconstruction were previous radiotherapy, venous anastomosis revision, GAP flap choice, and postoperative bleeding. In head and neck reconstruction, pulmonary comorbidity, anastomosis to lingual vein or superficial temporal artery were risk factors, while a radial forearm flap reduced the risk. In extremity reconstruction, diabetes, prolonged anaesthesia time, and postoperative wound infection were risk factors. Independent pre-, intra-, and postoperative risk factors for flap failure after microvascular breast, head and neck, and extremity reconstruction were identified. These results may be used to improve patient counselling and to adjust treatment algorithms to further reduce the chance of flap failure.

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