Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis. (August 2022)

• Record Type: Journal Article
• Authors: Walia, Amit; Lee, Jake J.; Jackson, Ryan S.; Hardi, Angela C.; Bollig, Craig A.; Graboyes, Evan M.; Zenga, Joseph; Puram, Sidharth V.; Pipkorn, Patrik
• Is Part Of: Otolaryngology--head and neck surgery. Volume 167:Number 2(2022)
• Page Start: 224
• Page End: 235
• Publication Date: 2022-08
• Subjects: microvascular free flap -- free flap failure -- free tissue transfer -- free tissue transfer failure -- head and neck reconstruction -- management of failed free flap -- management of failed free tissue transfer -- head and neck reconstructive surgery -- free flap salvage; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998211044683
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management. Data Sources: Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019. Review Methods: Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications. Results: A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies, I 2 = 12.8%). There was no difference in hospitalization length after secondary reconstruction between free tissue transfer and locoregional flaps or conservative management (relative risk of hospitalization ≥2 weeks, 96%; 95% CI, 0.80-1.14; n = 3 studies, I 2 = 0). The pooled relative risk of perioperative complications following free tissue transfer was 0.60 when compared with locoregional flap or conservative management (95% CI, 0.40-0.92; n = 5 studies, I 2 = 0). Conclusion: Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.