AHNS
Craig A. Bollig, MD
Rutgers Robert Wood Johnson Medical School
1) To compare late complications between patients receiving FFF, OCRFFF, and SFF in a large multi-institutional cohort.
2) To compare the prevalence of late complications based on minimum duration of follow-up.
Design: Retrospective analysis of patients with major osseous defects undergoing reconstruction with a FFF, OCRFFF, or SFF over a continuous timeframe between 2005-2019 with at least 6 months documented follow-up information.
Main Outcome and Measure: Patients were stratified based on the type of free flap performed. Baseline clinical factors were compared between groups using univariate tests. Evaluated long-term complications included overall late wound complications, late surgical site infection (SSI), hardware exposure, hardware removal, plate fracture, bone graft fracture, and osteonecrosis. Clinical factors associated with these outcomes were analyzed using univariable and multivariable logistic regression. Additionally, the frequency of late complications by the minimum duration of follow-up was assessed.
Results: After exclusions, a total of 617 patients were available for analysis: 312 (50.6%) FFF, 230 (37.3%) OCRFFFF, and 75 (12.2%) SFF. Compared to SFF, FFF (Odds Ratio [OR]: 2.49, 95% Confidence Interval [CI] 1.36-4.55) and OCRFFF (OR: 2.13, 95% CI: 1.10- 4.12) were independently associated with a higher rate of overall long-term wound complications. An early wound complication was also associated with late wound complications (OR: 2.12, 95% CI: 1.42- 3.14). SFF were associated with the lowest rate of hardware removal, compared to either FFF (OR: 2.63, 95% CI: 1.14- 6.03) or OCRFFF (OR: 2.42, 95% CI: 1.03- 5.70). An early wound complication was also associated with hardware removal (OR: 2.57, 95% CI: 1.70- 3.89). Rates of plate fracture, bone fracture, and osteonecrosis did not significantly differ between groups. The frequency of late complications increased as minimum duration of follow-up increased until about 36 months (p <0.001).
Conclusions and Relevance: This multi-institutional study suggests that the long-term complication profile of SFF compares favorably with FFF and OCRFFF.