Korean J Radiol.  2017 Jun;18(3):536-542. 10.3348/kjr.2017.18.3.536.

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

• Kim B
• Yoon DY
• Seo YL
• Park MW
• Kwon KH
• Rho YS
• Chung CH

• KMID: 2427309
• DOI: http://doi.org/10.3348/kjr.2017.18.3.536

Abstract

OBJECTIVE
To identify post-operative computed tomography (CT) findings associated with delayed flap failures following head and neck cancer surgery.
MATERIALS AND METHODS
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.
RESULTS
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%, p < 0.05), intra- or peri-flap air collection > 2 cm (61.1% vs. 2.4%, p < 0.001), and fistula to adjacent aerodigestive tract or skin (44.4% vs. 0%, p < 0.001). The maximum dimension of the flap, fat infiltration within the flap, and enhanced vascular pedicle were not associated with delayed flap failures.
CONCLUSION
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.

Keyword

Head and neck cancer; Post-operative CT; Flap reconstruction; Surgical flaps; Reconstructive surgical procedures; Flap failure; Post-operative period

MeSH Terms

Adult
Aged
Female
Head and Neck Neoplasms/*diagnostic imaging/pathology/surgery
Humans
Male
Middle Aged
Postoperative Complications/etiology
Predictive Value of Tests
Reconstructive Surgical Procedures
Retrospective Studies
Surgical Flaps/adverse effects
*Tomography, X-Ray Computed
Treatment Failure

Figure

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  Fig. 1 Flowchart showing process of showing inclusion of patients in study.

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  Fig. 2 59-year-old man with flap failure.Patient underwent reconstruction by radial forearm flap after resection of oropharyngeal cancer, and second flap surgery after 15 post-operative days due to flap failure.A. Contrast-enhanced CT scan 9 days after operation shows fat-containing flap (arrow) in retropharyngeal space and peri-flap fluid collection (long arrow) in left parapharyngeal space. Fistula from oropharyngeal wall to left submandibular space (arrowheads) is noted. B. Contrast-enhanced CT scan obtained at more caudal level than (A) shows fat-containing flap (arrow) and large peri-flap fluid collection with air collection (long arrow) in left submandibular space. Note enhanced vascular pedicles (arrowheads) of flap.

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  Fig. 3 35-year-old woman with flap failure.Patient underwent reconstruction by anterolateral thigh flap after resection of tongue cancer, and flap revision surgery after 20 post-operative days due to flap failure.A. Contrast-enhanced CT scan 6 days after operation shows fat-containing flap (arrows) with intra-flap fluid collection (long arrow) in left submandibular space and air collection (arrowhead) in left submandibular space. B. Contrast-enhanced CT scan obtained at more caudal level than (A) shows fat-containing flap (arrows) with fat infiltration. Cutaneous fistula (arrowhead) is also noted in left submandibular area.

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  Fig. 4 55-year-old man with flap success.Patient underwent reconstruction by radial forearm flap after resection of laryngeal cancer. Contrast-enhanced CT scan 7 days after operation shows fat-containing flap (arrows) and small peri-flap fluid collection (long arrow) with small air bubble in right submandibular space. Note enhanced vascular pedicles (black and white arrowheads) of flap.

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