A Multifactorial Comparative Study On The Correlation Between The Survival Rate Of Maxillofacial Free Flaps

Objective(s): Analyze the correlation between clinical factors during preoperative,intraoperative,and postoperative phases and the survival of free flaps in head and neck areas.Explore the factors that influence flap survival rate to enhance the surgical level for maxillofacial surgeons and increase the success rate of free flap reconstruction.Methods: The methodology employed in this study involved a retrospective review of medical records in collecting data on patients who underwent free flap surgery at the Stomatological Hospital of Kunming Medical University between May 2015 and December 2022.The study team gathered information on various variables,including patient demographics,medical history,flap-related factors(such as flap type and name),surgery-related factors(such as defect site,recipient vessel,surgeon,surgical approach,operating time,tracheostomy,neck lymph node dissection,blood transfusion,antibiotic use,titanium plate and stapler usage,postoperative drainage duration,and reoperation).The postoperative outcomes were recorded,including flap survival,flap crisis,necrosis,and any intraoperative or postoperative complications.Descriptive statistics,chi-square analysis,and logistic regression were used to analyze the data and explore the risk factors related to the survival of free flaps in the maxillofacial region.Results: In this study,male patients were the majority(n=162,64.8%)with female(n=88,36%),and the most commonly defect location was the mandible(n=76,30.4%).Among all patients,223(89.2%)had no complications,while 27(10.8%)had complications.Microvascular anastomosis was used in 110 cases,resulting in a failure rate of 4.54%(n=5),while manual suturing was used in 140 cases,with a failure rate of 4.29%(n=6).Univariate analysis revealed that flap survival was significantly associated with multiple factors,including flap type(p=0.019),sex(p=0.043),age(p=0.032),use of titanium plates(p=0.016),perioperative blood transfusion(p=0.001),postoperative complications(p=0.000),postoperative drainage duration(p=0.001),and reoperation(p=0.001).However,medical history,flap name,tissue pathology,defect site,selection of donor and recipient arteries and veins,number of anastomosed veins,stapler usage,surgeon,surgical time,antibiotic use scheme,tracheostomy,and neck lymph node dissection were not significantly correlated with flap survival.The multivariate logistic regression analysis demonstrated that postoperative drainage duration and reoperation were significantly associated with flap survival.Conclusion(s): The survival rate of flaps in this study was 95.6%.The use of microvascular anastomosis did not result in a higher success rate compared to manual vascular anastomosis,but it did reduce the operating time for doctors.Patient gender,age,flap type,use of titanium plates,blood transfusion during the perioperative period,postoperative complications,postoperative drainage time,and reoperation were significantly associated with flap survival and were identified as high-risk factors for free flap failure.However,medical history,donor and recipient vessel selection,number of anastomosed vessels,surgeon,type of antibiotic use scheme,and tissue pathology were not significantly correlated with flap survival.