Factors impacting successful salvage of the failing free flap

Larissa Sweeny, Joseph Curry, Meghan Crawley, Taylor Cave, Matthew Stewart, Adam Luginbuhl, Ryan Heffelfinger, Howard Krein, Daniel Petrisor, Adam Bender-Heine, Mark K. Wax

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Understanding factors impacting successful salvage of a compromised free flap. Methods: Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764). Results: Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P <.001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P =.035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P <.0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P <.0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P <.0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P =.04). Conclusions: There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.

Original languageEnglish (US)
Pages (from-to)3568-3579
Number of pages12
JournalHead and Neck
Issue number12
StatePublished - Dec 2020


  • free flap
  • free flap salvage
  • head and neck reconstruction
  • outcomes
  • surgical complications

ASJC Scopus subject areas

  • Otorhinolaryngology


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