{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:59:39Z","timestamp":1792511979033,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Reconstruction of head and neck defects using free flaps is successful, but complications occur. This study aims to identify factors preventing complications to support clinical decision\u2010making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective study for free flap reconstructions (2019 to 2022, tertiary referral center). Univariate and multivariate regression models assessed predictors of complication\u2010free survival (CFS) and odds ratios (OR) measured risk correlations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 125 identified cases, most patients were male (71.8%) with a median age of 66 years (37\u201393 years). Common complications were wound healing disorders (10.9%), hematoma (10%), total (7.3%) or partial (1.8%) flap necrosis, cardiovascular events (5.5%), and pulmonary artery embolism (4.5%). 30\u2010day CFS was 63%. On multivariable analysis, female gender (HR: 9.4, CI: 2.6\u201333.5), alcohol abuse (HR: 3.5, CI: 1.4\u20138.4), N2\u20103 (HR: 2.4, CI: 1.3\u20134.4), obesity (HR: 2.1, CI: 0.9\u20135.1), preoperative anticoagulation (HR: 2.5, CI: 1.1\u20135.9) were significant prognosticators. Positive factors increasing CFS included high albumin (OR 0.21, <jats:italic>p<\/jats:italic>\u2009=\u20090.02), intraoperative i.v. heparin bolus (OR 0.15, <jats:italic>p<\/jats:italic>\u2009=\u20090.08), intraoperative catecholamine treatment (OR 0.15, <jats:italic>p<\/jats:italic>\u2009=\u20090.009), and nonsmoking (OR 0.18, <jats:italic>p<\/jats:italic>\u2009=\u20090.1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Key preventive measures against complications include optimizing nutritional status and albumin levels, administering intraoperative heparin and catecholamines, and abstaining from alcohol. Females should also be screened for undiagnosed cardiovascular risks.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.70067","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T12:00:10Z","timestamp":1756296010000},"page":"945-958","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Preventing Free Flap Complications: Key Factors to Keep in Mind"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1346-0480","authenticated-orcid":false,"given":"Jonas","family":"Kornmann","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim Heidelberg University Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasmus","family":"Schug","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim 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