Abstract
Background Microvascular free tissue transfer is a common tool for the reconstruction of oncologic
head and neck defects. Adequate preoperative assessment can aid in appropriate risk
stratification and peri-operative optimization. The modified five-item frailty index
(mFI-5) is a validated risk-assessment scale; however, its utility in head and neck
free-flap reconstruction is unknown when compared with other common risk factors.
Methods A retrospective, single-institution chart review (2017–2020) was performed. Patient
demographics, defect and repair characteristics, pre- and peri-operative factors,
and flap outcomes were recorded. A high mFI-5 score was defined as greater than 2.
The total score, as well as other patient factors, was correlated to postoperative
flap complications.
Results A total of 214 patients were deemed appropriate for conclusion. The mean age was
63.9 ± 12.8 years. There were an even number of males (52.8%) and females (47.2%).
A fifth of subjects (20.8%) underwent preoperative radiotherapy. There were 21 cases
(9.8%) of complete flap loss. A total of 34 patients (29.4%) experienced any postoperative
complication related to flap outcomes. An elevated mFI-5 was significantly associated
with a higher overall rate of postoperative complications (39.7 vs. 29.4%, p < 0.019) and total flap loss (16.7% vs. 6.6%, p < 0.033). Preoperative radiation was found to be associated with an increased complication
rate (p < 0.003).
Conclusion The mFI-5 score may be a potentially significant tool in the risk stratification
of patients undergoing head and neck free-flap reconstruction as opposed to commonly
utilized risk factors. Preoperative radiotherapy is significantly associated with
postoperative complications. Appropriate preoperative assessment may help tailor patient
care preoperatively.
Keywords
microvascular surgery - head and neck - reconstruction
