Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19

Aaron Domack, Morgan M. Sandelski, Syed Ali, Keith E. Blackwell, Marisa Buchakjian, Andrés M. Bur, Steven B. Cannady, Carlos X. Castellanos, Yadranko Ducic, Tamer A. Ghanem, Andrew T. Huang, Ryan S. Jackson, Niels Kokot, Shawn Li, Patrik Pipkorn, Sidharth V. Puram, Rod Rezaee, Karthik Rajasekaran, Yelizaveta Shnayder, Uttam K. SinhaDaniel Sukato, Neeraj Suresh, Akina Tamaki, Carissa M. Thomas, Eric J. Thorpe, Mark K. Wax, Sara Yang, Andrea Ziegler, Amy L. Pittman

Research output: Contribution to journalArticlepeer-review


Introduction: Coronavirus disease 2019 (COVID-19) affects the vascular system, subjecting patients to a hypercoagulable state. This is of particular concern for the success of microvascular free flap reconstruction. This study aims to report head and neck free flap complications in patients with COVID-19 during the perioperative period. We believe these patients are more likely to experience flap complications given the hypercoagulable state. Methods: This is a multi-institutional retrospective case series of patients infected with COVID-19 during the perioperative period for head and neck free flap reconstruction from March 2020 to January 2022. Results: Data was collected on 40 patients from 14 institutions. Twenty-one patients (52.5%) had a positive COVID-19 test within 10 days before surgery and 7 days after surgery. The remaining patients had a positive test earlier than 10 days before surgery. A positive test caused a delay in surgery for 16 patients (40.0%) with an average delay of 44.7 days (9–198 days). Two free flap complications (5.0%) occurred with no free flap deaths. Four patients (10.0%) had surgical complications and 10 patients had medical complications (25.0%). Five patients (12.5%) suffered from postoperative COVID-19 pneumonia. Three deaths were COVID-19-related and one from cancer recurrence during the study period. Conclusion: Despite the heightened risk of coagulopathy in COVID-19 patients, head and neck free flap reconstructions in patients with COVID-19 are not at higher risk for free flap complications. However, these patients are at increased risk of medical complications. Level of Evidence: 4 Laryngoscope, 2023.

Original languageEnglish
StateAccepted/In press - 2023


  • coagulopathy in microvascular reconstruction
  • coronavirus
  • COVID-19
  • head and neck reconstruction
  • microvascular free flap
  • surgical complications in COVID-19


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