The role of postoperative hematoma on free flap compromise. (15th April 2015)

• Record Type: Journal Article
• Authors: Ahmad, Faisal I.; Gerecci, Deniz; Gonzalez, Javier D.; Peck, Jessica J.; Wax, Mark K.
• Is Part Of: Laryngoscope. Volume 125:Number 8(2015:Aug.)
• Page Start: 1811
• Page End: 1815
• Publication Date: 2015-04-15
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.25285
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary25285-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>Hematomas may develop in the postoperative setting after free tissue transfer. When hematomas occur, they can exert pressure on surrounding tissues. Their effect on the vascular pedicle of a free flap is unknown. We describe our incidence of hematoma in free flaps and outcomes when the flap is compromised.</p> </sec> <sec id="lary25285-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective chart review of 1, 883 free flaps performed between July 1998 and June 2014 at a tertiary referral center.</p> </sec> <sec id="lary25285-sec-0003" sec-type="section"> <title>Methods</title> <p>Patients with free flap compromise due to hematoma were identified. Etiology, demographic data, and outcomes were evaluated.</p> </sec> <sec id="lary25285-sec-0004" sec-type="section"> <title>Results</title> <p>Eighty‐eight (4.7%) patients developed hematomas. Twenty (22.7%) of those had flap compromise. Twelve compromises (60%) showed evidence of pedicle thrombosis. The salvage rate was 75% versus 54% in 79 flaps with compromise from other causes (<italic>P</italic> = .12). Mean time to detection of the hematoma was 35.3 hours in salvaged flaps compared to 91.6 hours in unsalvageable flaps (<italic>P</italic> = .057). Time to operating room (OR) from detection was 2.8 hours in salvageable flaps compared to 12.4 hours in nonsalvageable flaps (<italic>P</italic> = .053). The salvage rate for flaps that returned to the OR in <5 hours was 93.3% compared to 20% (<italic>P</italic> = .0049) for those that did not. Vascular thrombosis reduced salvage rate to 58.3% from 100% (<italic>P</italic> = .002) when there was no thrombosis.</p> </sec> <sec id="lary25285-sec-0005" sec-type="section"> <title>Conclusions</title> <p>In our series hematomas developed rarely. When they did, 23% went on to develop flap compromise. Prompt recognition and re‐exploration allowed for a high salvage rate. Vessel thrombosis predicted inability to salvage the flap.</p> </sec> <sec id="lary25285-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4 <italic>Laryngoscope</italic>, 125:1811–1815, 2015</p> </sec> </abstract>