Factors impacting successful salvage of the failing free flap.

Background Understanding factors impacting successful salvage of a compromised free flap. Methods Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764). Results Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P 8 hours (40%) (P = .04). Conclusions There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.