AHNS061 - Perioperative Complications in Scapula, Fibula, and Osteocutaneous Radial Forearm Free Flaps: A Multicenter Study
Thursday, April 28, 2022
9:00 AM – 9:45 AM CT
Location: Landmark B
AHNS Program Number: AHNS37 | Abstract ID: 119907
1Rutgers Robert Wood Johnson Medical School; 2Washington University in St. Louis; 3Vanderbilt University Medical Center; 4University of Tennessee Health Science Center; 5University of Louisville; 6University of Kansas Medical Center; 7University of Missouri School of Medicine; 8PRISMA Health
Importance: Osteocutaneous free flaps have become the optimal method of reconstruction for most major bony head and neck defects. Nationally, the scapula free flap (SFF), fibula free flap (FFF), and osteocutaneous radial forearm free flap (OCRFFF) represent the most commonly utilized osseous flaps. Existing literature on perioperative complications between these three donor sites has been limited by insufficient sample size of SFF or OCRFFF.
Objective: To compare perioperative complications between patients receiving FFF, OCRFFF, and SFF in a large multi-institutional cohort.
Design: Retrospective analysis of patients with major osseous defects undergoing reconstruction with a FFF, OCRFFF, or SFF over a continuous timeframe between 2005-2019
Main Outcome and Measure: Patients were stratified based on the type of free flap performed. Baseline clinical factors were compared between groups using the chi squared test for categorical variables, and ANOVA or nonparametric tests depending on the normality of the distribution. Perioperative complications assessed included overall acute wound complications, acute surgical site infection (SSI), wound dehiscence, fistula, hematoma, flap re-exploration, and flap failure. Clinical factors associated with these outcomes were analyzed using univariable and multivarible logistic regression.
Results: After exclusions, a total of 1022 patients were available for analysis: 510 (49.9%) FFF, 376 (36.8%) OCRFFFF, and 136 (13.3%) SFF. Median operative time (IQR) differed significantly between flap types [OCRFFF: 527 (467-591) min, FFF: 592 (507-714) min, SFF: 691 (610-816) min, p < 0.001]. Rates of overall acute wound complications, SSI, dehiscence, and hematomas did not significantly differ between groups. Compared to OCRFFF, FFF (Odds Ratio [OR]: 2.49, 95% Confidence Interval [CI] 1.36-4.55) and SFF (OR: 3.02, 95% CI: 1.40- 6.54), were independently associated with a higher rate of flap failure. Other independently associated variables with flap loss included acute SSI (OR: 3.19, 95% CI: 1.96- 5.19), female gender (OR: 2.01, 95% CI: 1.24- 3.26), and current tobacco use (OR: 1.69, 95% CI: 1.04- 2.74). FFF were associated with a higher rate of fistula (OR: 1.76, 95% CI: 1.07- 2.91) versus OCRFFF. Other independently associated variables with fistula included acute SSI (OR: 8.71, 95% CI: 5.72- 13.26) and multiple bone segments (OR: 2.04, 95% CI: 1.22- 3.41).
Conclusions and Relevance: This multi-institutional study suggests that OCRFF compare favorably with FFF and SFF and were associated with lower rates of free flap failure and fistula.