Usefulness of serum C-reactive protein level for predicting flap complication after performing free microvascular head and neck reconstruction.

Abstract

BACKGROUND: Free microvascular head and neck reconstruction requires minimal

complication and safety. However, clinical observation of the wound in head and

neck area is very difficult because of its narrow and inaccessible anatomy. Serum

C-reactive protein (CRP) level is commonly used as a marker of acute inflammatory

response and quantitative test that shows predictable kinetics. Therefore,

awareness of natural CRP trend of free microvascular head and neck reconstruction

may help in the early diagnosis of postoperative complications. The goal of this

study is to describe the time course of serum CRP level and prove the usefulness

of CRP as a predictor of postoperative flap wound complication after performing

free microvascular reconstruction in head and neck area. METHODS: Between June

2009 and November 2012, we retrospectively analyzed the data of 25 patients who

received free microvascular tissue transfer for head and neck reconstruction at

Ajou University Hospital. The characteristics of patients and surgical

information were analyzed. From the first day after surgery, CRP levels were

daily measured for 2 weeks. The average CRP values were daily calculated for the

normal group and the complicated group and compared between each groups. The

amount of time taken to reach the peak CRP level and to reach half of the peak

was compared. RESULTS: A total of 25 patients were included in this study. The

amount of time taken to reach the peak of the CRP level is significantly less in

the normal group (2.9 d) than the complicated group (7 d) (P < 0.001).

Furthermore, the amount of time to reach half of the peak was significantly

different between groups (7.2 d vs. 10.1 d, respectively, P < 0.05). In the

normal group (17/25), there were 14 cases which reached peak CRP level before

postoperative day 4. However, in the complicated group (8/25), there was only 1

case which reached peak CRP level before postoperative day 4 (P < 0.05). The

complication rate is 32.7 times higher when CRP value reaches peak on or after

postoperative day 4 (95% confidence interval, 30.26-35.14; P = 0.002). Patients

in the complicated group showed significantly elevated CRP levels compared to

those in the normal group at day 6 to 9 and day 12 to 13 (P < 0.05). CONCLUSION:

In head and neck reconstructions, the high probability of flap wound

complications are indicated through the result of having highest CRP values on or

after postoperative day 4, slow normalization of plasma CRP level, and secondary

rise in serial CRP values.