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. 2021 Oct;43(10):3032-3041.
doi: 10.1002/hed.26789. Epub 2021 Jun 18.

Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction

Leila J Mady  1   2 , Seerat K Poonia  1 , Khalil Baddour  3 , Vusala Snyder  3 , Chareeni Kurukulasuriya  4 , Ariel S Frost  1 , Steven B Cannady  1 , Steven B Chinn  5 , Tanya Fancy  6 , Neal Futran  7 , Matthew M Hanasono  8 , Carol M Lewis  9 , Brett A Miles  10 , Urjeet Patel  11 , Jeremy D Richmon  12 , Mark K Wax  13 , Peirong Yu  8 , Mario G Solari  3   14 , Shaum Sridharan  3   14
Affiliations
Free article

Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction

Leila J Mady et al. Head Neck. 2021 Oct.
Free article

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.

Keywords: free flap complications; head and neck; microvascular reconstruction; outcomes; quality improvement.

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References

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