(0501) A Comprehensive Review of the Use of Free Flap Surgeries in Cases of Facial Trauma

Introduction: Facial trauma is commonly managed with the use of free flap tissue repairs for reconstruction of the facial anatomy. The current study evaluates literature on the use of free flaps in the case of facial trauma to examine the commonality of different free flaps used as well as common complications and reconstructive outcomes for patients undergoing these surgeries.

Methods: A systematic review of 20 studies was performed with the following inclusion criteria: free flap surgery used for the reconstruction of facial trauma and relevant patient outcomes objectively measured, including but not limited to peri and postoperative complications, need for reoperation, and final diet 3. The majority of cases included patients 18 years of age or older.

Studies examining reconstruction of congenital defects, operative malignancies, or predominantly pediatric populations were excluded from evaluation.

Results: A majority of the patients were male. The average age of patients was 37.7 years of age. The most common cause of trauma was by gunshot. The most common area of tissue harvest was the radial forearm. While complications were rare, the most common complication was the presence of a hematoma at the site of free flap acceptance.

Analysis using a random intercept logistic regression model revealed a pooled flap survival rate of 0.94 (95% CI: 0.91; 0.96) and pooled revision rate of 0.072 (95% CI: 0.035; 0.145). Of the patients, 75% returned to a normal diet, while 22% of patients remained on a soft/blended diet and 3% continued to receive nutrition through tube feeding. The mortality rate per free flap performed was 0.0053 (95% CI: 0.0002, 0.1189). There was a flap salvage rate of 0.0194 (95% CI: 0.047, 0.0774) and a flap failure rate of 0.0171 (95% CI: 0.0033, 0.0847).

Conclusions: Prompt management of facial trauma is key to patient success. Free flap surgeries are a viable option when managing patients with facial trauma. Limitations of this study include differing methods of data collection between studies and more recent surgeries being impacted by improved overall patient care through standardized protocol.