Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

Objectives The objective of this study was to identify the factors that influence free flap survival after head and neck reconstructive surgery in pediatric patients. Methods One hundred thirty consecutive cases of head and neck reconstruction with free flaps in pediatric patients at the Department of Oral and Maxillofacial Surgery at Peking University School and Hospital of Stomatology, Beijing, People's Republic of China, between 1999 and 2017 were reviewed. A single head and neck surgical team performed all the included surgeries. Demographic and surgical patient data with possible associations with free flap survival were recorded. Relevant influencing factors were determined using the chi(2) test and logistic regression analysis. Results There were 135 free flap transfers performed in the patients, with an overall success rate of 95.6%. Free flap failure occurred in six flaps (4.4%). Arterial crisis was the main cause of flap failure. The overall complication rate was 7.0%. Patient age (5-9 years old; odds ratio, 13.397; 95% confidence interval, 1.167-153.838; P = 0.037) was a statistically significant risk factor influencing free flap survival. Donor site, defect region, recipient vessel, and surgery time were not associated with free flap outcome. Conclusion Free flap transfer for head and neck reconstruction in pediatric patients is safe and reliable. However, special attention should be paid to pediatric patients under 9 years of age when performing head and neck reconstruction. Level of Evidence 4 Laryngoscope, 129:1915-1921, 2019