Clinical characteristics of free flaps for oral and maxillofacial reconstruction: a retrospective study of 700 flaps over 3 years

Objective This study investigated the clinical characteristics and management of free flaps for oral and maxillofacial reconstruction. Methods A total of 689 subjects were categorized into the no-flap crisis group (620 flaps in 620 subjects) and the flap crisis group (80 flaps in 69 subjects). Demographic and clinical data, including gender, age, disease types, body mass index, preoperative chemoradiotherapy, poor lifestyle habits, postoperative length of stay, medical cost, intraoperative blood loss, during of surgery, hypertension and diabetes mellitus, were analyzed. In the flap crisis group, the distribution characteristics of flap types and the timing of crisis were examined. Results The overall survival rate of free flaps was 95% (95% CI [93.4–96.6]), with a salvage rate of 49.28% (95% CI [37.2–61.4]). The two groups did not significantly differ in age, body mass index, preoperative chemoradiotherapy, hypertension, diabetes mellitus or poor lifestyle habits. However, significant differences were observed in postoperative length of stay, during of surgery, medical cost and intraoperative blood loss. Within the flap crisis group, 65 flaps (94.20%) underwent crisis within the first 84 hours, and flap crisis showed a strong association with flap failure. Conclusion Free flap reconstruction is a dependable method, with most crises occurring within 84 hours, highlighting the imperative for early surgical exploration to avert necrosis.