An exploration into the factors resulting in secondary free flap requirement in flap transfer in oral and maxillofacial surgery in the UK: Literature review

Free flap surgery is the gold standard for complex oral and maxillofacial reconstruction. However, complications may necessitate secondary procedures, adversely impacting patient outcomes. This review examines how preoperative radiotherapy, previous head and neck surgery, and female sex influence complication rates in free flap procedures. It also examines the input of the surgical team, methods of reconstruction & anatomical location of the defect and how these affect the secondary surgery. A literature review was conducted using systematic reviews, clinical trials, retrospective studies, and laboratory research to evaluate the impact of these three risk factors on postoperative outcomes and how surgical teams manage adverse ones. Preoperative radiotherapy increases the risk of flap failure by 1.8 times, primarily due to fibrosis and compromised vascularity, particularly when surgery is delayed beyond six weeks post-radiotherapy. Female patients demonstrate a 1.58-fold higher complication risk, potentially due to hormonal fluctuations, anemia, and menstrual cycle-related changes. A history of head and neck surgery raises complication rates by 1.64 times, attributed to scar formation, altered anatomy, and impaired vascular supply. Timing surgery appropriately following radiotherapy and considering menstrual cycles in female patients, alongside cautious flap selection in previously operated regions, may reduce complications. The data underscores the need for standardized surgical protocols and more research into sex-specific physiological factors. Tailored perioperative planning based on patient-specific risk factors is essential to minimize complications, reduce flap failure rates, and improve functional and aesthetic outcomes in oral and maxillofacial free flap reconstruction.