Risk Factors of Anastomotic Thrombosis in 200 Head and Neck Free Flaps among Asian Patients


Background: Despite excellent results from free flap transfers, postoperative thrombosis does occur and, although infrequent, causes total loss of the flap. We investigate the risk factors of anastomotic thrombosis in head and neck free flaps. Study design, Subjects and Methods: A retrospective analysis was carried out on 200 consecutive free flaps applied to patients who underwent head and neck reconstruction. Multiple logistic regression analysis was conducted to identify risk factors of anastomotic thrombosis, taking into account twelve factors: diabetes, obesity, hypertension, hypertriglyceridemia, proteinuria, age, gender, smoking habit, habitual alcohol intake, previous chemotherapy and radiation, and hypercholesterolemia. Results: Hypertension, female gender, aging, and drinking habit were statistically significant risk factors of postoperative thrombosis. Conclusions: Our data suggest that four factors mentioned above are possible predictors of anastomotic thrombosis in free flaps used for head and neck.

Share and Cite:

T. Makiguchi, K. Hashikawa, D. Sugiyama, S. Yokoo, H. Terashi, K. Nibu, S. Kumagai and S. Tahara, "Risk Factors of Anastomotic Thrombosis in 200 Head and Neck Free Flaps among Asian Patients," Surgical Science, Vol. 3 No. 5, 2012, pp. 237-241. doi: 10.4236/ss.2012.35046.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] B. Singh, P. G. Cordeiro, E. Santamaria, et al., “Factors Associated with Complications in Microvascular Reconstruction of Head and Neck Defects,” Plastic and Reconstructive Surgery, Vol. 103, No. 2, 1999, pp. 403-411. doi:10.1097/00006534-199902000-00007
[2] T. Nakatsuka, K. Harii, H. Asato, et al., “Analytic Review of 2372 Free Flap Transfers for Head and Neck Reconstruction Following Cancer Resection,” Journal of Reconstructive Microsurgery, Vol. 19, No. 6, 2003, pp. 363-368. doi:10.1055/s-2003-42630
[3] B. H. Haughey, E. Wilson, L. Kluwe, et al., “Free Flap Reconstruction of the Head and Neck: Analysis of 241 Cases,” Otolaryngology Head and Neck Surgery, Vol. 125, No. 1, 2001, pp. 10-17. doi:10.1067/mhn.2001.116788
[4] M. Y. Nahabedian, N. Singh, E. G. Deune, et al., “Recipient Vessel Analysis for Microvascular Reconstruction of the Head and Neck,” Annals of Plastic Surgery, Vol. 52, No. 2, 2004, pp. 148-155. doi:10.1097/01.sap.0000095409.32437.d4
[5] K. Bozikov and Z. M. Arnez, “Factors Predicting Free Flap Complications in Head and Neck Reconstruction July,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 59, No. 7, 2006, pp. 737-742. doi:10.1016/j.bjps.2005.11.013
[6] J. D. Suh, J. A. Sercarz, E. Abemayor, et al., “Analysis of Outcome and Complications In 400 Cases of Microvascular Head and Neck Reconstruction,” Archives of Otolaryngology, Vol. 130, No. 8, 2004, pp. 962-966. doi:10.1001/archotol.130.8.962
[7] K. H. Simpson, P. G. Murphy, P. M. Hopkins, et al., “Prediction of Outcomes in 150 Patients Having Microvascular Free Tissue Transfers to the Head and Neck,” British Journal of Plastic Surgery, Vol. 49, No. 5, 1996, pp. 267-273. doi:10.1016/S0007-1226(96)90154-X
[8] L. Palaniappan, M. Carnethan and S. P. Formann, “Associ- ation between Microalubuminuria and Metabolic Syndrome: NHANES III,” American Journal of Hypertension,” Vol. 16, No. 11, 2003, pp. 952-958. doi:10.1016/S0895-7061(03)01009-4
[9] L. Vernaglione, G. Mele, C. Cristofano, et al., “Comorbid Conditions and Gender Impact the Primary Survival of Distal Radio-Cephalic Arteriovenous Fistula Inpatients on Long-Term Hemodialysis,” Journal of Nephrology, Vol. 18, No. 3, 2005, pp. 276-281.
[10] T. Ikegami, Y. Hashikura, Y. Nakazawa, et al., “Risk Factors Contributing to Hepatic Artery Thrombosis Following Living-Donor Liver Transplantation,” Journal of Hepato-Biliary-Pancreatic Surgery, Vol. 13, No. 2, 2006, pp. 105- 109. doi:10.1007/s00534-005-1015-y
[11] S. C. Bonawitz, R. H. Schnarrs, A. I. Rosenthal, et al., “Free-Tissue Transfer in Elderly Patients,” Plastic and Reconstructive Surgery, Vol. 87, No. 6, 1991, pp. 1074-1079. doi:10.1097/00006534-199106000-00009
[12] L. B. Colen, A. Stevenson, V. Sidorov, et al., “Microvascular Anastomotic Thrombosis in Experimental Diabetes MelliTus,” Plastic and Reconstructive Surgery, Vol. 99, No. 1, 1997, pp. 156-162. doi:10.1097/00006534-199701000-00024
[13] R. K. Khouri, B. C. Cooley, A. R. Kunselman, et al., “A Prospective Study of Microvascular Free-Flap Surgery and Outcome,” Plastic and Reconstructive Surgery, Vol. 102, No. 3, 1998, pp. 711-721. doi:10.1097/00006534-199809030-00015
[14] S. Schultz-Mosgau, G. G. Grabenbauer, F. Wehrhan, et al., “Histomorphological Structural Changes of Head and Neck Blood Vessels after Pre or Postoperative Radiotherapy,” Strahlentherapie und Onkologie, Vol. 178, No. 6, 2002, pp. 299-306.
[15] J. A. Beckman, A. Thakore, B. H. Kalinowski, et al., “Radiation Therapy Impairs Endothelium-Dependent Vasodilation in Humans,” Journal of the American College of Cardiology, Vol. 37, No. 3, 2001, pp. 761-765. doi:10.1016/S0735-1097(00)01190-6
[16] B. P. Bengston, M. A. Shusterman, B. J. Baldwin, et al., “Influence of Prior Radiotherapy on the Development of Postoperative Complications and Success of Free Tissue Transfers in Head and Neck Reconstruction,” American Journal of Surgery, Vol. 166, No. 4, 1993, pp. 326-330. doi:10.1016/S0002-9610(05)80325-3

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.