Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Understanding factors impacting successful salvage of a compromised free flap.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Multi‐institutional review of free flap reconstructions for head and neck defects (n = 1764).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; <jats:italic>P</jats:italic> < .001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; <jats:italic>P</jats:italic> = .035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; <jats:italic>P</jats:italic> < .0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (<jats:italic>P</jats:italic> < .0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; <jats:italic>P</jats:italic> < .0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (<jats:italic>P</jats:italic> = .04).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.</jats:p></jats:sec>