(77) What Are the Risk Factors Associated With Late Failure of Free Flaps in Maxillofacial Reconstructive Surgeries: Multi-Center Systematic Review

Abstract:

Background: Oral and head and neck free flaps are commonly utilized in reconstructive surgery for patients undergoing oncological resections, trauma repair, or reconstruction due to congenital defects. While these flaps generally provide successful outcomes, late failure can occur, significantly impacting patient quality of life and surgical results. Identifying risk factors for late failure is essential to improving clinical outcomes and optimizing treatment strategies.

Methods: Following PRISMA guidelines, a comprehensive literature review was conducted to identify risk factors associated with late failure of oral and head and neck free flaps. A systematic search was performed across major medical databases, including PubMed, Medline, Embase, Scopus, and Google Scholar, with studies published up until March 4, 2025. Keywords such as “Flap failure,” “Salvage,” “Revision,” “Head and neck cancers,” “Microsurgery,” and variations like “Age,” “Radiotherapy,” and “Thrombosis” were used in the search. Published papers not addressing complicated flaps, abstracts, and incomplete articles were excluded. Data extracted from the selected studies and were analyzed for key themes and associations with flap failure, including patient-related factors, surgical factors, and postoperative complications.

Results: Out of 774 free tissue transfer surgeries reviewed, 618 free flaps were evaluated, and free flap failure occurred in 4.1% of cases. The χ² test and multivariate logistic regression analysis revealed that a history of irradiation and oral infections were statistically significant risk factors for free flap failure (0.36% and 0.24% respectively, P = .002). Additionally, co-morbid conditions such as diabetes, cardiovascular disease, preoperative thrombocytosis, along with increasing age and female gender were also identified as contributing factors and were associated with increased risk for complications. These findings were consistent across various cohort studies included in the review.

Conclusion: This multi-center systematic review highlights key risk factors for late failure of maxillofacial reconstructive surgeries, including a history of irradiation, oral infections, and co-morbidities such as diabetes mellitus and cardiovascular disease. Preoperative assessment and careful management of these risk factors are critical in reducing the incidence of flap failure. Tailoring surgical approaches and post-operative care to address these risk factors can significantly improve flap survival and overall patient outcomes in reconstructive head and neck surgery.