Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction

Leila J. Mady, Seerat K. Poonia, Khalil Baddour, Vusala Snyder, Chareeni Kurukulasuriya, Ariel S. Frost, Steven B. Cannady, Steven B. Chinn, Tanya Fancy, Neal Futran, Matthew M. Hanasono, Carol M. Lewis, Brett A. Miles, Urjeet Patel, Jeremy D. Richmon, Mark K. Wax, Peirong Yu, Mario G. Solari, Shaum Sridharan

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: We aim to define a set of terms for common free flap complications with evidence-based descriptions. Methods: Clinical consensus surveys were conducted among a panel of head and neck/reconstructive surgeons (N = 11). A content validity index for relevancy and clarity for each item was computed and adjusted for chance agreement (modified kappa, K). Items with K < 0.74 for relevancy (i.e., ratings of “good” or “fair”) were eliminated. Results: Five out of nineteen terms scored K < 0.74. Eliminated terms included “vascular compromise”; “cellulitis”; “surgical site abscess”; “malocclusion”; and “non- or mal-union.” Terms that achieved consensus were “total/partial free flap failure”; “free flap takeback”; “arterial thrombosis”; “venous thrombosis”; “revision of microvascular anastomosis”; “fistula”; “wound dehiscence”; “hematoma”; “seroma”; “partial skin graft failure”; “total skin graft failure”; “exposed hardware or bone”; and “hardware failure.”. Conclusion: Standardized reporting would encourage multi-institutional research collaboration, larger scale quality improvement initiatives, the ability to set risk-adjusted benchmarks, and enhance education and communication.

Original languageEnglish
Pages (from-to)3032-3041
Number of pages10
JournalHead and Neck
Issue number10
StatePublished - Oct 2021
Externally publishedYes


  • free flap complications
  • head and neck
  • microvascular reconstruction
  • outcomes
  • quality improvement


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