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Background: The failure rate of free flaps varies from 0.8% to 10.6% in the literature in head and neck reconstruction. The primary objective was to identify prognostic factors for free flap failure.
Methods: We prospectively included all consecutive free flaps performed between August 2021 and January 2024, and used a multivariate Cox proportional hazard model.
Results: We included 307 free flaps, performed on 274 patients. Age, cardiovascular risk, radiotherapy history, type of flap, type of arterial anastomosis, and ischemia duration were not statistically linked to the risk of flap failure. In multivariate analysis, a venous anastomosis to the anterior jugular vein or to the superior thyroid vein were associated with an increased risk of flap failure, such as per- or postoperative revision of the anastomoses.
Conclusions: The choice of venous anastomosis, appear to have a greater influence on the success or failure of a microvascularized transfer than patient characteristics.
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http://dx.doi.org/10.1002/hed.28095 | DOI Listing |
Plast Reconstr Surg
September 2025
Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, CA, USA.
Reconstruction of large full-thickness medial lower eyelid margin defects often requires centrally-based tarsoconjunctival pedicle flaps from the ipsilateral upper eyelid in combination with anterior lamellar grafting. However, centrally-based flaps may result in temporary obstruction of the visual axis in the affected eye. We present a novel modified surgical technique utilizing a medially-based tarsoconjunctival pedicle flap from the upper eyelid for the reconstruction of large full-thickness medial lower eyelid defects.
View Article and Find Full Text PDFMicrosurgery
September 2025
Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
Background: Free flap transfer is an essential technique for head and neck reconstruction after oncological ablative resection. Selection of recipient vessels can be challenging in patients with a history of neck dissection and/or radiotherapy. We analyzed outcomes with regard to recipient vessel selection and flap failure, referring to patients' histories of radiotherapy and/or neck dissection.
View Article and Find Full Text PDFJ Stomatol Oral Maxillofac Surg
September 2025
Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, P. R. China; National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China. Electronic address:
Background: Maintaining appropriate blood pressure during head and neck free tissue transfer surgery is important for both organ and flap perfusion. However, the use of vasopressors to treat intraoperative hypotension is controversial. The purpose of this prospective cohort study is to evaluate the impact of intraoperative vasopressors on the incidence of flap necrosis.
View Article and Find Full Text PDFHead Neck
September 2025
Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Objective: Reconstruction of complex midface defects is challenging. Vascularized composite flaps are often needed to replace missing premaxilla and palatal bone, oral and sinonasal lining, as well as external facial skin in these defects. The submental flap has the potential to provide all these various tissues with the added advantage of matching facial skin color and hair-bearing qualities and is available within the surgical field.
View Article and Find Full Text PDFInjury
August 2025
Suzhou Ruihua Orthopedic Hospital, Suzhou, 215104, China; Suzhou Medical College of Soochow University, Suzhou, 215123, China. Electronic address:
Background: Major limb amputation salvage procedures exhibit an increased risk of failure when revascularization is delayed beyond 360 min. Institutional delays persist as critical barriers, even with advancements in surgical techniques.
Methods: Retrospective cohort study (November 2022- December 2024) at Level I Trauma Center.