Author(s)
John P. Marinelli BS
Jaime A. Aponte-Ortiz MS
Matthew M. May, MD
Joshua R. Labott BS
Eric J. Moore MD
Christine M. Lohse MS
Jeffrey R. Janus MD
Affiliation(s)
Mayo Clinic School of Medicine
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the influence intraoperative tourniquet duration during free flap harvesting for radial forearm and fibular free flaps has on primary site, donor site, and major postoperative complications. Objectives: To determine the impact of tourniquet duration on donor site, reconstructive site, and major postoperative complications in patients undergoing free flap reconstructive head and neck oncologic surgery with either fibular or radial forearm free flaps. Study Design: Retrospective review. Methods: Review of all patients who underwent either radial forearm or fibular free flap reconstruction for head and neck oncologic surgery treated at a large tertiary referral center from 1/1/2000-12/31/2016. Results: Of 509 patients meeting inclusion criteria, 256 underwent fibular free flap reconstruction and 253 radial forearm free flaps. With every 15 minute increase in tourniquet duration, patients undergoing radial forearm free flap reconstruction were significantly more likely to experience primary site postoperative complications (HR, 1.14; p=0.035), whereas these results were not similarly observed for fibular free flaps (HR, 1.04; p=0.54). Neither donor site nor major postoperative complications were significantly impacted by tourniquet duration for both fibular and radial forearm free flaps. There was a statistically significant positive correlation between BMI and tourniquet time for fibula flaps (Pearson correlation coefficient 0.22; p<0.001) and for radial forearm flaps (Pearson correlation coefficient 0.16; p=0.010), indicating that tourniquet time increased as BMI increased. After adjusting for BMI, primary site complications were still associated with increasing tourniquet duration (HR, 1.13; p=0.060). Conclusions: Radial forearm free flaps may be more susceptible to prolonged intraoperative tourniquet duration compared to fibular free flaps. Taken together, these data facilitate improved understanding of postoperative risk stratification of patients undergoing fibular and radial forearm free flap reconstructive head and neck cancer surgery.