Value of the Post-Operative CT in Predicting Delayed Flap Failures Following Head and Neck Cancer Surgery

• Published in: Korean journal of radiology Vol. 18; no. 3; pp. 536 - 542
• Main Authors: Kim, Bitna, Yoon, Dae Young, Seo, Young Lan, Park, Min Woo, Kwon, Kee Hwan, Rho, Young-Soo, Chung, Chul Hoon
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.05.2017; 대한영상의학회
• Subjects: Adult; Age; Aged; Cancer surgery; Failure; Female; Fistula; Head & neck cancer; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Humans; Male; Medical imaging; Middle Aged; Neuroimaging and Head & Neck; Patients; Postoperative Complications - etiology; Predictive Value of Tests; Radiation therapy; Reconstructive Surgical Procedures; Retrospective Studies; Success; Surgeons; Surgical Flaps - adverse effects; Tomography; Tomography, X-Ray Computed; Treatment Failure; Variables; 방사선과학; Flap reconstruction; Post-operative CT; Surgical flaps; Head and neck cancer; Reconstructive surgical procedures; Flap failure; Post-operative period
• ISSN: 1229-6929; 2005-8330; 2005-8330
• DOI: 10.3348/kjr.2017.18.3.536

To identify post-operative computed tomography (CT) findings associated with delayed flap failures following head and neck cancer surgery. We retrospectively reviewed 60 patients who underwent flap reconstruction after head and neck cancer surgery and post-operative (3-14 days) contrast-enhanced CT scans for suspected complications. Patients were divided into two groups: delayed flap failure patients (patients required flap revision) (n = 18) and flap success patients (n = 42). Clinical data (age, sex, T-stage, type of flap, and time interval between reconstruction surgery and CT) and post-operative CT findings of flap status (maximum dimension of the flap, intra- or peri-flap fluid collection and intra- or peri-flap air collection, fat infiltration within the flap, fistula to adjacent aerodigestive tract or skin, and enhanced vascular pedicle) were assessed and compared between the two groups. CT findings showed that the following flap anomalies were observed more frequently in the delayed flap failure group than in the flap success group: intra- or peri-flap fluid collection > 4 cm (61.1% vs. 23.8%, < 0.05), intra- or peri-flap air collection > 2 cm (61.1% vs. 2.4%, < 0.001), and fistula to adjacent aerodigestive tract or skin (44.4% vs. 0%, < 0.001). The maximum dimension of the flap, fat infiltration within the flap, and enhanced vascular pedicle were not associated with delayed flap failures. A large amount of fluid or air collection and fistula are the CT findings that were associated with delayed flap failures in patients with suspected post-operative complications after head and neck cancer surgery.