Influence of blood transfusion and hematocrit values on the survival of free flaps in reconstructive surgery of head and neck

Microvascular free flaps have become an increasingly popular technique in head and neck reconstruction. The survival of free flap depends on surgeon experience, adequate tissue perfusion, which is dictated by the patency of arterial and venous microvascular anastomosis and stable hemodynamic parameters. Total flap loss can be highly detrimental to the patient, causing considerable morbidity, prolonged hospitalization and mortality. In this study we retrospectively analyzed 61 patients who underwent free flap reconstructive surgery following neoplasm resection in the head and neck region, over a 5-year period (1997-2002) at the Dubrava University Hospital, Zagreb. The mean patient age was 54.2 years (range 22-78 years). Fifty-one patients were males (83.6%) and 10 were females (16.4%). Systolic blood pressure, hematocrit value, administration of blood products, fresh-frozen plasma and crystalloid solutions were monitored. The values were recorded intraoperatively and up to three days postoperatively. Comparison was made between the values in patients in whom the flap reconstructions were successful (group 1) as opposed to the group of patients in whom the flaps failed (group 2). All patients were given dextran 40 intraoperatively and up to three days postoperatively for the purpose of preventing thromboembolic complications. In the group of patients with failing flaps we documented more common blood transfusions resulting in hematocrit level which was 1-4% higher than in the first group. Eighteen patients were taken back to the operating room for flap revisions. Ten of these underwent flap necrectomies. Overall free flap success rate was 83.6% (51/61). The mortality rate was 9.8% (6/61).