Factors predicting fistula following radial forearm free flap reconstruction for head and neck cancer

The goal of this study was to evaluate the relationship between postoperative fistula formation and perioperative risk factors after radial forearm free flap (RFFF) reconstruction for head and neck cancer. A total of 180 patients underwent RFFF reconstruction after head and neck ablative surgery from October 1993 to July 2009. Age, gender, systemic disease, smoking status, tumor stage, preoperative radiotherapy, reconstruction site, concurrent neck dissection, flap shape and size, and partial or complete flap necrosis were recorded as potential prognostic variables. Twenty-one (11.7%) of the 180 patients developed a fistula. Significant correlations were found between fistula formation and diabetes mellitus (ρ = 0.015) and preoperative radiotherapy (ρ = 0.029). Reconstruction of the hypopharynx influenced fistula formation with borderline significance (ρ = 0.057). The multivariate analysis showed a significant association between fistula formation and diabetes mellitus (odds ratio = 5.4 [95% CI, 1.0-27.6]) and preoperative radiotherapy (odds ratio = 5.9 [95% CI, 1.1-32.6]). Spontaneous fistula closure occurred in 10 patients, but surgical closure with a local flap or pectoralis major myocutaneous flap was necessary in the other 11 patients. Diabetes mellitus and preoperative radiotherapy were found to be risk factors for fistula formation in patients that underwent RFFF reconstruction for head and neck cancer.