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

Leila J Mady; Seerat K Poonia; Khalil Baddour; Vusala Snyder; Chareeni Kurukulasuriya; Ariel S Frost; Steven B Cannady; Steven B Chinn; Tanya Fancy; Neal Futran; Matthew M Hanasono; Carol M Lewis; Brett A Miles; Urjeet Patel; Jeremy D Richmon; Mark K Wax; Peirong Yu; Mario G Solari; Shaum Sridharan

doi:10.1002/hed.26789

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

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

Authors

Leila J Mady^{1

2}, Seerat K Poonia¹, Khalil Baddour³, Vusala Snyder³, Chareeni Kurukulasuriya⁴, Ariel S Frost¹, Steven B Cannady¹, Steven B Chinn⁵, Tanya Fancy⁶, Neal Futran⁷, Matthew M Hanasono⁸, Carol M Lewis⁹, Brett A Miles¹⁰, Urjeet Patel¹¹, Jeremy D Richmon¹², Mark K Wax¹³, Peirong Yu⁸, Mario G Solari^{3

14}, Shaum Sridharan^{3

14}

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
² Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
⁸ Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁹ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁰ Department of Otolaryngology, Northwell Health, New York, New York, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.
¹⁴ Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

PMID: 34145676
DOI: 10.1002/hed.26789

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.

MeSH terms

Consensus
Free Tissue Flaps* / surgery
Head and Neck Neoplasms* / surgery
Humans
Neck / surgery
Plastic Surgery Procedures*
Postoperative Complications
Retrospective Studies