{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:16:41Z","timestamp":1781068601167,"version":"3.54.1"},"reference-count":18,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Facial Plastic Surgery &amp; Aesthetic Medicine"],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Head and neck free flap survival relies on adequate tissue perfusion from the external carotid artery (ECA), and vessel length is inversely proportional to blood flow rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Investigate whether distance from the ECA (as a proxy for pedicle vessel length) predicts flap survival or complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Retrospective review of free flaps performed at three academic centers from 9\/2006 to 8\/2021. Flaps were categorized by distance from the ECA: orbit and above (zone 1), maxilla to parotid (zone 2), and mandible and below (zone 3). Secondary analysis assessed flap outcomes stratified by average historical pedicle length.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 2,369 flaps were identified in zones 1 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009109), 2 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20091878), and 3 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009382). Rates of flap failure (4.9%) and perioperative complications (36.3%) did not differ by zone or pedicle length. Zone 3 flaps, most commonly located in the larynx and hypopharynx, had significantly higher rates of fistula and infection. Conversely, 30-day readmission rates were significantly lower in patients with zone 2 flaps (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Rates of all other complications did not differ significantly between zones.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Proximity to mucosal anatomic sites was a more powerful predictor of free flap viability than pedicle length or ECA proximity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/fpsam.2022.0103","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T09:53:01Z","timestamp":1673949181000},"page":"200-205","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of Head and Neck Anatomic Zones with Microvascular Reconstruction Outcomes"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1076-1941","authenticated-orcid":false,"given":"Emma","family":"De Ravin","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."},{"name":"Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis-Xavier","family":"Barrette","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0186-2265","authenticated-orcid":false,"given":"Ryan M.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5181-5897","authenticated-orcid":false,"given":"Allison","family":"Slijepcevic","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Petrisor","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA."},{"name":"Oral and Maxillofacial Surgery Department, Oregon Health Sciences University, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farshid","family":"Taghizadeh","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ara C.","family":"Chalian","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G.","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabie M.","family":"Shanti","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."},{"name":"Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Curry","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Thomas Jefferson University, Philadelphia, 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Determinants of tumor blood flow: a review. 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