Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Aug;167(2):224-235.
doi: 10.1177/01945998211044683. Epub 2021 Sep 7.

Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis

Amit Walia  1 , Jake J Lee  1 , Ryan S Jackson  1 , Angela C Hardi  2 , Craig A Bollig  3 , Evan M Graboyes  4   5 , Joseph Zenga  6 , Sidharth V Puram  1   7 , Patrik Pipkorn  1
Affiliations
Meta-Analysis

Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis

Amit Walia et al. Otolaryngol Head Neck Surg. 2022 Aug.

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, I2 = 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, I2 = 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, I2 = 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.

Keywords: free flap failure; free flap salvage; free tissue transfer; free tissue transfer failure; head and neck reconstruction; head and neck reconstructive surgery; management of failed free flap; management of failed free tissue transfer; microvascular free flap.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: None

Figures

FIGURE 1:
FIGURE 1:
Flow Diagram for Assessment of Eligible Studies in the Systematic Review and Meta-Analysis
FIGURE 2:
FIGURE 2:
Meta-analysis of studies evaluating survival rate of free flap following initial free flap failure for head and neck reconstruction.
FIGURE 3:
FIGURE 3:
Meta-analysis of studies evaluating pooled relative risk of hospitalization length ≥ 2 weeks for free tissue transfer compared to locoregional reconstruction / conservative management following initial free flap failure for head and neck reconstruction.
FIGURE 4:
FIGURE 4:
Meta-analysis of studies evaluating perioperative complications of free tissue transfer compared to locoregional reconstruction / conservative management following initial free flap failure for head and neck reconstruction.
FIGURE 5:
FIGURE 5:
Funnel plot analysis of survival rate of free tissue transfer after free flap failure for head and neck reconstruction.
See this image and copyright information in PMC

References

    1. Blackwell KE. Unsurpassed Reliability of Free Flaps for Head and Neck Reconstruction. Archives of Otolaryngology–Head & Neck Surgery. 1999;125(3):295–299. - PubMed
    1. Urken ML, Weinberg H, Buchbinder D, et al. Microvascular Free Flaps in Head and Neck Reconstruction: Report of 200 Cases and Review of Complications. Archives of Otolaryngology–Head & Neck Surgery. 1994;120(6):633–640. - PubMed
    1. Copelli C, Tewfik K, Cassano L, et al. Management of free flap failure in head and neck surgery. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2017;37(5):387–392. - PMC - PubMed
    1. Coleman JJ, Searles JM, Hester TR, et al. Ten years experience with the free jejunal autograft. The American Journal of Surgery. 1987;154(4):394–398. - PubMed
    1. Pohlenz P, Blessmann M, Heiland M, Blake F, Schmelzle R, Li L. Postoperative complications in 202 cases of microvascular head and neck reconstruction. Journal of Cranio-Maxillofacial Surgery. 2007;35(6):311–315. - PubMed

Publication types

MeSH terms