Risk factors for postoperative vascular crisis in squamous cell carcinoma reconstruction using supraclavicular artery flaps.

OBJECTIVES

To identify risk factors associated with vascular crisis in patients undergoing reconstruction with supraclavicular artery flaps for squamous cell carcinoma (SCC) of the tongue and buccal mucosa.

METHODS

A retrospective analysis was conducted on 777 patients with tongue or buccal SCC who underwent supraclavicular artery flap reconstruction between January 2019 and December 2023. Patients were divided into two groups based on the occurrence of postoperative vascular crisis: Occurred Group (n = 101) and No Occurred Group (n = 676). Demographic data, clinical history, hematologic and biochemical parameters were collected. Pearson and Spearman correlation analyses, univariate analysis, and multivariate logistic regression were performed to identify independent risk factors. An external validation cohort was used to verify the findings, and a predictive model was developed using ROC curve and nomogram analysis.

RESULTS

Independent risk factors for vascular crisis included higher BMI, long-term smoking, long-term alcohol consumption, elevated fasting blood glucose, increased C-reactive protein, higher white blood cell count, and elevated SCC antigen (all P < 0.05). Platelet count was inversely associated with risk. Flap survival rate was significantly lower in the vascular crisis group. The predictive model demonstrated strong discriminatory power (AUC = 0.975).

CONCLUSIONS

Several modifiable clinical and biochemical factors are significantly associated with postoperative vascular crisis. Preoperative optimization of these variables may improve flap survival and surgical outcomes.