TY - JOUR
T1 - Association of Head and Neck Anatomic Zones with Microvascular Reconstruction Outcomes
AU - De Ravin, Emma
AU - Barrette, Louis Xavier
AU - Carey, Ryan M.
AU - Slijepcevic, Allison
AU - Petrisor, Daniel
AU - Taghizadeh, Farshid
AU - Elliott, Zachary
AU - Rajasekaran, Karthik
AU - Chalian, Ara C.
AU - Brody, Robert M.
AU - Newman, Jason G.
AU - Shanti, Rabie M.
AU - Curry, Joseph
AU - Wax, Mark K.
AU - Cannady, Steven B.
N1 - Publisher Copyright:
© 2023, American Academy of Facial Plastic and Reconstructive Surgery, Inc.
PY - 2023
Y1 - 2023
N2 - Background: Head and neck free flap survival relies on adequate tissue perfusion from the external carotid artery (ECA), and vessel length is inversely proportional to blood flow rate. Objective: Investigate whether distance from the ECA (as a proxy for pedicle vessel length) predicts flap survival or complications. Methods: Retrospective review of free flaps performed at three academic centers from 9/2006 to 8/2021. Flaps were categorized by distance from the ECA: orbit and above (zone 1), maxilla to parotid (zone 2), and mandible and below (zone 3). Secondary analysis assessed flap outcomes stratified by average historical pedicle length. Results: A total of 2,369 flaps were identified in zones 1 (n = 109), 2 (n = 1878), and 3 (n = 382). Rates of flap failure (4.9%) and perioperative complications (36.3%) did not differ by zone or pedicle length. Zone 3 flaps, most commonly located in the larynx and hypopharynx, had significantly higher rates of fistula and infection. Conversely, 30-day readmission rates were significantly lower in patients with zone 2 flaps (p < 0.001). Rates of all other complications did not differ significantly between zones. Conclusions: Proximity to mucosal anatomic sites was a more powerful predictor of free flap viability than pedicle length or ECA proximity.
AB - Background: Head and neck free flap survival relies on adequate tissue perfusion from the external carotid artery (ECA), and vessel length is inversely proportional to blood flow rate. Objective: Investigate whether distance from the ECA (as a proxy for pedicle vessel length) predicts flap survival or complications. Methods: Retrospective review of free flaps performed at three academic centers from 9/2006 to 8/2021. Flaps were categorized by distance from the ECA: orbit and above (zone 1), maxilla to parotid (zone 2), and mandible and below (zone 3). Secondary analysis assessed flap outcomes stratified by average historical pedicle length. Results: A total of 2,369 flaps were identified in zones 1 (n = 109), 2 (n = 1878), and 3 (n = 382). Rates of flap failure (4.9%) and perioperative complications (36.3%) did not differ by zone or pedicle length. Zone 3 flaps, most commonly located in the larynx and hypopharynx, had significantly higher rates of fistula and infection. Conversely, 30-day readmission rates were significantly lower in patients with zone 2 flaps (p < 0.001). Rates of all other complications did not differ significantly between zones. Conclusions: Proximity to mucosal anatomic sites was a more powerful predictor of free flap viability than pedicle length or ECA proximity.
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U2 - 10.1089/fpsam.2022.0103
DO - 10.1089/fpsam.2022.0103
M3 - Article
C2 - 36648341
AN - SCOPUS:85159163836
SN - 2689-3614
VL - 25
SP - 200
EP - 205
JO - Facial Plastic Surgery and Aesthetic Medicine
JF - Facial Plastic Surgery and Aesthetic Medicine
IS - 3
ER -