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Predictors of Complications following Forehead Flaps for Nasal Reconstruction
Viren Patel MD, Shannon Wu BS, Temiloluwa Oladeji BS, Rebecca Knackstedt MD, Brian Gastman MD
Cleveland Clinic Foundation
2022-01-15
Presenter: Viren Patel
Affidavit:
I certify that the material in this abstract has not been published/presented elsewhere. Viren Patel has been the lead on this project, from conception, data collection, analysis and manuscript preparation.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background
Forehead flaps are a workhorse for nasal reconstruction, but complications are common. Here, we aimed to identify risk factors for complications, and provide clinicians a risk-stratification tool to improve shared-decision making.
Methods
This retrospective, multicenter study included patients who underwent forehead flap for nasal or periorbital reconstruction between 2007-2020. Demographic, treatment characteristics were abstracted, in addition to clinical outcomes data. Multivariable regression was conducted, with step-wise variable elimination to determine inclusion in the final model. From the final regression, a risk-stratification scheme was developed.
Results
197 patients underwent forehead flap reconstruction, with a mean age of 68.5 years. Mean follow-up time was 42 months. There were 50 (25.4%) patients who developed a complication, most commonly impaired nasal function (18.7%), distal flap necrosis (12.7%), or surgical site infection (2.53%) On multivariate analysis, female sex (OR 3.42, p=0.008), poor nutritional status (Albumin<3.5 g/dL) (OR 4.61, p=0.002), and prior wide local excision (OR 5.82, p=0.004) were predictors of complications. A risk-stratification scheme was developed incorporating these risk factors, with a C-statistic of 0.86, indicating strong predictive value. Low, intermediate and high-risk groups were found to have complication rates of 4.7, 28, and 79%, respectively (p<0.001).
Conclusion
In this study, we identified multiple risk factors for development of a complication following forehead flap reconstruction. While complications are common, not all patients are at equal risk. With the risk stratification tool, surgeons will be better equipped to provide individualized complication risks to patients, and thus improve shared-decision making.
