Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction. Issue 10 (18th June 2021)

• Record Type: Journal Article
• Authors: Mady, Leila J.; Poonia, Seerat K.; Baddour, Khalil; Snyder, Vusala; Kurukulasuriya, Chareeni; Frost, Ariel S.; Cannady, Steven B.; Chinn, Steven B.; Fancy, Tanya; Futran, Neal; Hanasono, Matthew M.; Lewis, Carol M.; Miles, Brett A.; Patel, Urjeet; Richmon, Jeremy D.; Wax, Mark K.; Yu, Peirong; Solari, Mario G.; Sridharan, Shaum
• Is Part Of: Head & neck. Volume 43:Issue 10(2021)
• Page Start: 3032
• Page End: 3041
• Publication Date: 2021-06-18
• Subjects: free flap complications -- head and neck -- microvascular reconstruction -- outcomes -- quality improvement; Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.26789
• Languages: English
• ISSNs: 1043-3074

Abstract

Abstract: Background: We aim to define a set of terms for common free flap complications with evidence‐based descriptions. Methods: Clinical consensus surveys were conducted among a panel of head and neck/reconstructive surgeons ( N = 11). A content validity index for relevancy and clarity for each item was computed and adjusted for chance agreement (modified kappa, K ). Items with K < 0.74 for relevancy (i.e., ratings of "good" or "fair") were eliminated. Results: Five out of nineteen terms scored K < 0.74. Eliminated terms included "vascular compromise"; "cellulitis"; "surgical site abscess"; "malocclusion"; and "non‐ or mal‐union." Terms that achieved consensus were "total/partial free flap failure"; "free flap takeback"; "arterial thrombosis"; "venous thrombosis"; "revision of microvascular anastomosis"; "fistula"; "wound dehiscence"; "hematoma"; "seroma"; "partial skin graft failure"; "total skin graft failure"; "exposed hardware or bone"; and "hardware failure." Conclusion: Standardized reporting would encourage multi‐institutional research collaboration, larger scale quality improvement initiatives, the ability to set risk‐adjusted benchmarks, and enhance education and communication.