Risk factors for postoperative complications after reconstruction of head and neck defects with free and pedicled flaps

Introduction: Free and pedicled flap reconstructions of head and neck defects are highly successful. However, postoperative complications are common. The aim of this study is to investigate risk factors associated with complications after flap reconstruction.

Methods: Monocentric retrospective study of free and pedicled flap reconstructions between 2019 - 2022. Primary outcome variables were surgical and medical postoperative complications and risk factors.

Results: 125 patients underwent free (112), pedicled (13), or free and pedicled (3) flaps (male: 89 (71.2%); female: 36 (28.8%); mean age (range): 66 (37,93) years). Postoperative complications occurred in 29 (23.2%) patients: 23 (18.4%) surgical complications (hematoma, fistula, wound healing disorders, flap loss) and 10 (8%) medical complications (pulmonary embolism, resuscitation, stroke, myocardial infarction, death). The most common complications are hematoma (13; 10.83%), flap loss (6; 4.8%) and pulmonary embolism (5; 4%). Patients with pedicled flaps developed 17% fewer complications compared to free flaps. Several risk factors were identified, including obesity (19; 15.8%), diabetes mellitus (15; 12.5%) and administration of low-molecular-weight heparin at therapeutic doses (87; 71.9%). Peripheral arterial disease (7; 5.6%) is not a risk factor in this cohort. Obesity and low albumin (40; 32%) as a sign of impaired liver function or malnutrition were the strongest risk factors for surgical complications.

Discussion/Conclusion: Risks factors for developing postoperative complications after reconstruction of head and neck defects with free or pedicled flaps were identified. Early identification of these risk factors, e. g. by adjusting anticoagulation or supporting liver function, will improve the prognosis.

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