Analysis of Comorbid Factors Influencing Free Flap Viability in Microsurgical Reconstruction

A BSTRACT Introduction: Free flap reconstruction plays a vital role in modern reconstructive surgery, offering excellent outcomes in cases involving major trauma, cancer resections, and severe infections. It has become the preferred approach for repairing head-and-neck defects, boasting a high success rate of approximately 95%. Despite this, flap failure remains a risk, often influenced by patient-related factors. Comorbidities such as smoking, previous radiotherapy, advanced age, diabetes, obesity, hypertension, and prior head-and-neck surgeries have all been implicated in increasing complication rates. These concerns prompted the authors to conduct a retrospective study aimed at refining patient selection for free flap procedures. Methods: This retrospective study evaluated the medical records of patients who underwent free flap reconstruction by consultants specializing in Hand, Microsurgery, and Oncoplasty (HMO). The study included 38 patients treated at the Department of Plastic Reconstructive and Aesthetic Surgery between June 2020 and June 2024. Results: Among the 38 patients, 57.9% were between 19 and 59 years of age. The anterolateral thigh flap was the most frequently used, comprising 50% of cases. Overall, 73.7% of the flaps were viable. Fisher’s exact test revealed no statistically significant association between flap viability and the following comorbidities: age ( P = 0.050), hypertension ( P = 0.556), diabetes mellitus ( P = 0.064), smoking ( P = 0.298), and obesity ( P = 0.164). Conclusion: Comorbidities including age, hypertension, diabetes, smoking, and obesity did not significantly impact free flap viability in this patient cohort.