Analysis of thrombosis on postoperative day 5 or later after microvascular reconstruction for head and neck cancers

Abstract

Background: Because of the low incidence of late thrombosis in free flaps used for head and neck reconstruction, the risk factors, prognosis, and the optimal method of treatment are unclear.

Methods: The timing of thrombosis, types of flaps, occluded vessels, causative factors, previous irradiation, and salvage rates were reviewed and compared between 79 patients who had thrombosis on postoperative day 4 or earlier (early-thrombosis group) and 24 patients who had thrombosis on postoperative day 5 or later (late-thrombosis group).

Results: The main causative factor for thrombosis in the late-thrombosis group was wound infection (54%), whereas wound infection was present in only 1% of cases of thrombosis in the early-thrombosis group. None of the flaps could be salvaged in the late-thrombosis group.

Conclusion: Poor salvage rate in the late-thrombosis group is the most serious problem. Prevention, early detection, and appropriate management of wound infection are essential for avoiding late thrombosis.