Perioperative risk factors that predict complications of radial forearm free flaps in oral and maxillofacial reconstruction

The aim of the study was to find out what perioperative risk factors predicted complications in patients having reconstructions with radial forearm free flaps (RFFF). We organised a retrospective study of 169 patients (mean (range) age 54 (22-86) years, 100 of whom were female) who had oral and maxillofacial tumours resected, and reconstructed with RFFF, from January 2011-December 2016. We recorded predictive variables, subdivided into: personal and clinical (sex, age, weight, coexisting conditions, history of smoking, radiotherapy, and primary lesions); haemodynamic (perioperative concentrations of haemoglobin and albumin, blood loss, blood transfusion, urinary output (ml), and rate (ml/kg/hour), and infusion rates for crystalloids and colloids (ml/kg/hour, and volumes given intraoperatively and postoperatively for 24 hours); and anaesthetic and surgical (American Society of Anesthesiologists(ASA) grade, visual analogue pain score (VAS), and duration of tourniquet and operation). The primary outcome was the presence of a postoperative complication, and the secondary outcome the types of complications (medical and surgical). The significance of differences among the variables was assessed by univariate and multivariate analysis, and probabilities of less than 0.05 were accepted as significant. There were 26 complications, of which 15 were surgical and 11 medical. Risk factors were: preoperative radiotherapy, postoperative haemoglobin and albumin concentrations, VAS for pain, and volume of crystalloids transfused during the first 24 hours. Although reconstruction with a RFFF is a common and safe treatment for patients with oral and maxillofacial tumours, regulating perioperative risk factors, particularly those related to anaesthesia (including VAS and management of fluids) is important in the reduction of the number of complications.