October 2021

ENT

CONSENSUS OF FREE FLAP COMPLICATIONS: USING A NOMENCLATURE PARADIGM IN MICROVASCULAR HEAD AND NECK RECONSTRUCTION

Featuring: ​ Urjeet Patel, MD
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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."
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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.


This abstract was originally published in Head and Neck on October, 2021. ​
Urjeet Patel, MD​, professor of Otolaryngology - Head and Neck Surgery  in the Department of Medicine.

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