(A401) A Comparison of Osseous V Non-osseous Tissue Transfer at the DOD’s Largest Training Facility

Introduction: The largest healthcare training platform for the Department of Defense resides at Brooke Army Medical Center (BAMC) at Joint Base San Antonio-Fort Sam Houston, Texas. The purpose of this study is to report on free flap complications in a case series and to discuss how complication rates of osseous flaps (fibula or radial forearm) compare to osseous flaps (anterolateral thigh). In addition, to discuss the volume and complication rates of this facility compared to other tertiary care academic centers overall.

Methods: A single institution retrospective cohort of head and neck free tissue transfers completed at BAMC from the last 7 years (2017-2023). Examination of major v minor complications. Major being defined as requiring take-back to the operating room for revision.

Results: Forty-eight free flaps for head and neck reconstruction were completed between 2017-2023. The most common defect etiology was synchronous oncologic resection (90%). Perioperative outcome parameters extracted for both donor and recipient sites include: wound dehiscence (n=7, 15%), partial flap loss (n=6, 13%), hematoma (n=4, 8%), wound infection (n=3, 6%), vessel failure requiring re-anastomosis (n=3, 6%), fistula (n=3, 6%), and seroma (n=2, 4%). Additional events with n=1 (2%) include abscess, bony malunion, venous thrombosis, and retained foreign body. When comparing osseous flaps to non-osseous flaps, there were 39 osseous and 16 non-osseous flaps. The osseous flaps showed a major complication rate of 59% (23 cases) whereas non-osseous flaps had a major complication rate of 44% (7 cases). The most common major complication of osseous flaps was anastomosis failure (5 cases), followed by dehiscence and bony malunion (3 cases each).

Conclusions: Head and neck free tissue transfers completed at the largest healthcare training platform for the Department of Defense over the last 7 years are comparable to similar tertiary care academic centers in overall reconstruction outcome and complication rate, though with lower volume.