Head Reconstruction Research Articles

Challenges in Radial Forearm Free Flap Surgery: A Comprehensive Case Analysis of Septic Complications at the Donor Site.

The radial forearm free flap (RFFF) has emerged as a leading option for microvascular reconstruction of head and neck soft-tissue defects. Despite the favorable outcomes conferred by RFFFs, complications such as skin graft loss and tendon exposure can occur. We present the case of a 77-year-old man who underwent RFFF reconstruction after excision of squamous cell carcinoma from the head and neck. The patient subsequently developed flexor tenosynovitis, septic arthritis of the wrist, and osteomyelitis of several carpal bones as a direct result of partial skin graft loss and prolonged tendon exposure at the donor site. To the best of our knowledge, this is the first reported case of this specific complication. Review of the literature reveals the need for continued research into RFFF donor site complications to mitigate the incidence of significant morbidity.

Unfractionated Heparin Administered Every 8 h Outperforms 12 Hourly Administration for Venous Thromboembolism Prophylaxis in Reconstructive Head and Neck Tumor Patients: A 12 Year Retrospective Cohort Study.

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant risk of morbidity and mortality in surgical patients, especially those undergoing head and neck cancer surgery with microvascular free flap reconstruction. These patients are at a heightened risk of VTE due to numerous patient and surgical risk factors. VTE chemoprophylaxis guidelines in these patients are limited due to a distinct paucity of research. This study aims to contribute to this scarcity of information, providing guidance for surgeons. This retrospective cohort study evaluated the efficacy and safety of subcutaneous unfractionated heparin administered every 8 h versus every 12 h for postoperative VTE prophylaxis in patients undergoing head and neck resections with immediate free flap reconstruction. Data was collected from hospital medical records between January 2010 to December 2021. Patient demographics, operative details, and outcomes, including incidence of VTE and bleeding complications, were analyzed. Among 622 patients, those receiving heparin every 8 h (n = 393) demonstrated a significantly lower rate of VTE (0.8%) compared to 12-hourly group (n = 229; 3.9%) (p = 0.006). Additionally, there were no significant differences in the rates of postoperative hematoma between the two groups (9.4% versus 7.9% respectively, p = 0.510). Our study suggests that an increased daily dose of unfractionated heparin every 8 h for VTE chemoprophylaxis is superior to a 12-hourly regimen with comparable bleeding profiles. Further multicentre, prospective studies are needed to validate these results and compare the efficacy and safety of unfractionated heparin with other agents such as low-molecular-weight heparin in this patient group.

Humeral Head Bone Grafting of a Large Off-Track Hill-Sachs Lesion Using Femoral Condyle Osteochondral Allograft Through a Percutaneous Posterior Approach

Hill-Sachs lesions (HSLs) are commonly associated with anterior shoulder instability with or without glenoid bone defects. Treatment decision mainly depends on the size and location of the defect on the humeral head. Osteochondral allograft transplantation has been described for the treatment of large off-track HSLs. However, concerns have been raised due to concerns accessing the HSL and associated complications, predominantly due to the anterior aspect of the deltopectoral approach and subscapularis tenotomy used to gain access to these lesions. In addition, most of the studies used a lemon-wedge-shaped allograft to restore the defect, which can be technically demanding and time-consuming. This Technical Note aims to describe a posterior approach to the humeral head through an infraspinatus split that allows for accurate humeral head reconstruction with cylindrical osteochondral allografts in the setting of primary or recurrent anterior shoulder instability with large, off-track HSLs.

High hydrostatic pressure treatment for advanced tissue grafts in reconstructive head and neck surgery.

The increasing importance of regenerative medicine has resulted in a growing need for advanced tissue replacement materials in head and neck surgery. Allo- and xenogenic graft processing is often time-consuming and can deteriorate the extracellular matrix (ECM). High hydrostatic pressure (HHP)-treatment could allow specific devitalization while retaining the essential properties of the ECM. Porcine connective tissue and cartilage were HHP-treated at 100-400 MPa for 10 min. Structural modifications following HHP-exposure were examined using electron microscopy, while devitalization was assessed through metabolism and cell death analyses. Furthermore, ECM alterations and decellularization were evaluated by histology, biomechanical testing, and DNA content analysis. Additionally, the inflammatory potential of HHP-treated tissue was evaluated in vivo using a dorsal skinfold chamber in a mouse model. The devitalization effects of HHP were dose-dependent, with a threshold identified at 200 MPa for fibroblasts and chondrocytes. At this pressure level, HHP induced structural alterations in cells, with a shift toward late-stage apoptosis. HHP-treatment preserved ECM structure and biomechanical properties, but did not remove cell debris from the tissue. This study observed a pressure-dependent increase of markers suggesting the occurrence of immunogenic cell death. In vivo investigations revealed an absence of inflammatory responses to HHP-treated tissue, indicating a favorable biological response to HHP. In conclusion, application of HHP devitalizes fibroblasts and chondrocytes at 200 MPa while retaining the essential properties of the ECM. Prospectively, HHP may simplify the preparation of allo- and xenogenic tissue replacement materials and increase the availability of grafts in head and neck surgery.

Infrahyoid myocutaneous flap for reconstruction in head and neck cancer patients

Background: Reconstruction of head and neck defects following tumor excision is one of the most challenging surgeries due to multiple reasons, such as associated cosmetic and functional impairments. The three-dimensional aspect of the defect makes it more difficult. Although in modern settings, microvascular surgery is preferred in many conditions, it requires the presence of resources and expertise. Locoregional flaps are workhorse flaps in head and neck reconstruction. In this article, we present an uncommonly used flap with high acceptability and success rate in head and neck reconstruction. Aim: To find outcomes of using infrahyoid flap reconstruction in head and neck defects following cancer excision. Materials and Methods: The retrospective study was conducted in the surgical oncology department of our institute. Patients with squamous cell carcinoma of the oral cavity, clinically T1–T3 and N0–N1 stage, with anticipated defects of small to medium defects were included in the study. The study was conducted from July 2020 to June 2022, including a follow-up of 1 year. A total of 14 patients were included in the study. All patients had squamous cell carcinoma of the oral cavity involving different subsites. Patients were operated on by a single surgeon, using the same technique. Result: A total of 14 patients were included with a male-to-female ratio of 11:3 and age between 45 and 60 years. None of the patients underwent revision surgery, and none of the patients had total flap loss. Four patients had minor flap complications, of which three patients had partial, superficial skin necrosis of the flap which was managed conservatively and epithelized later. None of the patients developed major complications, oro-cutaneous fistula, or radiation necrosis. None of the patients developed recurrence after 1 year of surgery. Conclusion: The infrahyoid myocutaneous flap (IHF) is a fairly reliable and easy-to-perform flap for small- and medium-sized defects of the oral cavity, without requiring additional incisions and donor site reconstruction.

Factors affecting the risk of trismus following maxillary ablative surgery comparing free flap reconstruction to prosthetic obturation: a retrospective observational study

The reconstruction of post-ablative maxillary defects is controversial. It is accepted that quality of life indicators are poorer for maxillary reconstruction compared with mandibular reconstruction. One factor highlighted is that of post-treatment trismus. Rates of trismus are reviewed comparing free tissue transfer to that of prosthetic obturation. A retrospective review was undertaken comparing rates of trismus at twelve months post-surgery between free tissue transfer and prosthetic obturation. A total of 85 patients were identified who met the inclusion criteria. Both reconstruction techniques were significant for developing trismus, with a higher rate in the free flap reconstruction cohort than the prosthetic obturation cohort by a factor of 2.51. Modern reconstructive head and neck surgery has moved away from ‘filling a hole’ to a more bespoke, patient-specific reconstruction. The evidence presented here should allow the reconstructive surgeon to better discuss outcomes with patients when considering surgical options for Class II maxillary defects.

AvatarWild: Fully controllable head avatars in the wild

Recent advancements in the field have resulted in significant progress in achieving realistic head reconstruction and manipulation using neural radiance fields (NeRF). Despite these advances, capturing intricate facial details remains a persistent challenge. Moreover, casually captured input, involving both head poses and camera movements, introduces additional difficulties to existing methods of head avatar reconstruction. To address the challenge posed by video data captured with camera motion, we propose a novel method, AvatarWild, for reconstructing head avatars from monocular videos taken by consumer devices. Notably, our approach decouples the camera pose and head pose, allowing reconstructed avatars to be visualized with different poses and expressions from novel viewpoints. To enhance the visual quality of the reconstructed facial avatar, we introduce a view-dependent detail enhancement module designed to augment local facial details without compromising viewpoint consistency. Our method demonstrates superior performance compared to existing approaches, as evidenced by reconstruction and animation results on both multi-view and single-view datasets. Remarkably, our approach stands out by exclusively relying on video data captured by portable devices, such as smartphones. This not only underscores the practicality of our method but also extends its applicability to real-world scenarios where accessibility and ease of data capture are crucial.

Reducing Length of Stay in Reconstructive Head and Neck Surgery Patients: A Quality Improvement Initiative.

To investigate whether a new preoperative education and discharge planning protocol reduced unexpected discharge delays for patients undergoing reconstructive surgery for head and neck cancer. A quality improvement (QI) intervention was implemented in January 2021 with several components to address historically prolonged observed lengths of stay (LOS) with head and neck cancer patients. The intervention added a preoperative educational visit with a head and neck cancer advanced practice provider, a standardized preoperative speech and swallow assessment, a personalized patient care plan document, discussion of inpatient hospital stay expectations, and early discharge planning. The intervention group included patients who underwent the preoperative education protocol from February to December 2021. For comparison, an age and sex-matched control group was constructed from inpatients who had been admitted for similar procedures in the 2 years prior to the QIintervention (2019-2020) and received standard of care counseling. Our study demonstrated a significant reduction in observed to expected LOSratio after implementation of the intervention (1.24 ± 0.74 control, 0.95 ± 0.52 intervention; P = .012). We discuss a preoperative education QI intervention at our institution. Our findings demonstrate that our intervention was associated with decreased LOS for patients undergoing head and neck reconstructive surgeries. This QI study shows the benefit of a new standardized preoperative education and discharge planning protocol for patients undergoing head and neck reconstructive surgeries.

Analisis Hasil Safire pada Imaging CT Scan Kepala

Background: Iterative Reconstruction (IR) method was first applied to CT in 1960 and successfully used for the first time in clinical research by reconstructing 128 x 128 images according to image metrics and using high-resolution images of 512 x 512 for special research activities such as image evaluation. artifacts and noise. In 2008, the development of IR can improve image quality and reduce the amount of radiation in clinical CT diagnosis. Iterative reconstruction promises to improve image quality while reducing radiation dose. This has been demonstrated in CT of the thorax, coronary arteries, abdomen, spine and neck, paranasal sinuses, and head. Sinogram-Afirmed Iterative Reconstruction (SAFIRE) is one of the iterative algorithm reconstruction methods that uses noise modeling techniques, Sinogram-Afirmed Iterative Reconstruction (SAFIRE), promises to improve Cranial CT (CCT). In this new technique, raw data-based iteration for artifact reduction is combined with image-based iteration using smooth regularization that estimates the variance of image noise in various directions at each image pixel and adjusts it with a spatial variance regularization function simultaneously. Methods: This study is a literature review, where literature exploration is carried out on various databases with keywords such as, Reference sources used in compiling this article include google scollar, as well as articles in English and Indonesian scientific journals. Results: Itarative Reconstruction (IR) Head CT Scan, SAFIRE includes reducing or adding noise to the image results, artifacts, acquisition time, increasing SNR and CNR and reducing dose in the examination. Conclusion: Analysis of Safire results in Head CT-Scan Imaging has an Itarative Reconstruction (SAFIRE) procedure, the role of safire in head CT scans is to optimize noise in the Reconstructed image and can reduce artifacts in the image and increase SNR, CNR in the Reconstructed results so that it can provide better information.

Predictive factors of postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to intensive care unit: a retrospective cohort study

BackgroundThe epidemiology and risk factors for postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to the Intensive Care Unit (ICU) are unknown.MethodsWe performed a retrospective cohort study of patients with free flap reconstruction of head and neck cancer between September 2015 and April 2023 admitted to the ICU of Beijing Tongren Hospital. The univariate and multivariate analyses were used to explore the risk factors for postoperative complications related to free flap reconstruction admitted to ICU, including flap necrosis, bleeding, fistula, and infection.ResultsA total of 239 patients were included in this study, and 38 (15.9%) patients had postoperative complications related to free flap reconstruction. The median length of ICU stay was 1 day (interquartile range, 1–2 days). Multivariate analysis found that low BMI (P < 0.001), high postoperative CRP (P = 0.005), low hemoglobin (P = 0.012), and inadequate fluid intake (P < 0.05) were independent risk factors for complications.ConclusionsPostoperative complications related to free flap reconstruction were common in this ICU population. Careful fluid management and monitoring of CRP and hemoglobin levels may reduce complications.

Microvascular Free-Flap Head and Neck Reconstruction: The Utility of the Modified Frailty Five-Item Index.

Microvascular free tissue transfer is a common tool for the reconstruction of oncologic head and neck defects. Adequate preoperative assessment can aid in appropriate risk stratification and peri-operative optimization. The modified five-item frailty index (mFI-5) is a validated risk-assessment scale; however, its utility in head and neck free-flap reconstruction is unknown when compared with other common risk factors. A retrospective, single-institution chart review (2017-2020) was performed. Patient demographics, defect and repair characteristics, pre- and peri-operative factors, and flap outcomes were recorded. A high mFI-5 score was defined as greater than 2. The total score, as well as other patient factors, was correlated to postoperative flap complications. A total of 214 patients were deemed appropriate for conclusion. The mean age was 63.9 ± 12.8 years. There were an even number of males (52.8%) and females (47.2%). A fifth of subjects (20.8%) underwent preoperative radiotherapy. There were 21 cases (9.8%) of complete flap loss. A total of 34 patients (29.4%) experienced any postoperative complication related to flap outcomes. An elevated mFI-5 was significantly associated with a higher overall rate of postoperative complications (39.7 vs. 29.4%, p < 0.019) and total flap loss (16.7% vs. 6.6%, p < 0.033). Preoperative radiation was found to be associated with an increased complication rate (p < 0.003). The mFI-5 score may be a potentially significant tool in the risk stratification of patients undergoing head and neck free-flap reconstruction as opposed to commonly utilized risk factors. Preoperative radiotherapy is significantly associated with postoperative complications. Appropriate preoperative assessment may help tailor patient care preoperatively.

A comparative prospective study between the outcomes of one-stage Pelnac reconstruction and full thickness skin graft on donor site healing in the radial forearm and fibula flaps

ObjectivesDermal substitutes are classically used in a 2-stage procedure followed by skin graft for wound healing. This study aims to evaluate the possibility to use an alternative technique for radial forearm and fibula donor sites coverage using one-stage Pelnac reconstruction. Materials and methods21 patients who underwent radial forearm and fibula flaps harvest for reconstruction of head and neck defects after oncological surgery were enroled in the study. 13 patients were treated by one-stage Pelnac reconstruction of the donor site defect, 8 patients underwent full thickness skin graft. The Vancouver Scar Scale was used to evaluate the scar quality. ResultsMost patients treated with one-stage Pelnac reconstruction showed good healing of the flap donor site, with minor complications, scar quality comparable to other treatment options and unimpaired function of the implicated limb. One patient had wound dehiscence at the radial forearm site, which was treated with secondary full thickness skin graft. In the group treated with FTSG we had three patients that developed complications, such as dehiscence of the graft and seroma. Overall, we reported comparable satisfaction with donor sites both for aesthetic and functional outcomes, in both groups of patients. ConclusionThe use of Pelnac without a following skin graft provides a viable method for the reconstruction of radial forearm and fibula flaps donor site. A longer postoperative care is needed, but the long-term aesthetic and functional results are satisfactory in comparison with full thickness skin graft.

Application of Free Flaps in Reconstruction of Head and Neck Soft Tissue Defects With Bone Exposure.

Reconstruction of head and neck soft tissue defects with bone exposure is both challenging and technically demanding for plastic surgeon. Objectives in head and neck soft tissue defects with bone exposure reconstruction are consistent restoration of functionality while also improving appearance. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 4 years. A retrospective analysis was conducted from June 2019 to June 2023 on 12 patients treated at our hospital for head and neck soft tissue defects with bone exposure due to various causes. These included 4 cases of trauma from car accidents, 1 burn case, and 7 postoperative malignant tumor removals. The defect sizes ranged from 4 × 6 to 15 × 45 cm. Different free flaps were used for repair based on the defect, including 6 anterolateral thigh flaps, 3 forearm flaps, 2 latissimus dorsi flaps, and 1 dorsalis pedis flap. Flaps were designed and harvested to match the defect size and transplanted via anastomosed vessels. All 12 flaps survived successfully. One patient required flap thinning surgery postoperatively. All patients were followed up for over 3 months, showing good color and texture of the transplanted flaps, satisfactory healing, and significant aesthetic improvement. Donor sites showed significant scarring without functional impairment. Free flap repair for head and neck soft tissue defects with bone exposure is feasible and yields good results.

TFL Perforator Flap Complementing and Completing the ALT-AMT Flap Axis.

Background Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility. Tensor fascia lata (TFL) perforator (TFLP) flap is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity, and lends itself with the ALT perforator. Methods This study was an analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP flap from July 2017 to May 2021. Results All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases, the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5), and multiple (3) free flaps manner. Most common perforator location was septocutaneous between the TFL and gluteus medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed. Conclusion TFLP can reliably complement the ALT/AMT axis. Chimeric ALT-TFL can be harvested for large, complex, multicomponent, and multidimensional defects.

Replacement of radial head versus reconstruction terrible triad elbow injury

The extraordinarily congruous nature of the joint and the interaction between the articular surfaces and soft-tissue stabilisers are the two factors that contribute to the stability of a normal elbow. A profoundly unstable elbow is the outcome of TTIE, which is characterised by the loss of the anterior coronoid buttress, the posterolateral stabilisation of the lateral ulnar collateral ligament (LUCL), and the valgus buttress of the radial head. This study aims to compare and evaluate the outcomes of patients who received radial head reconstruction (REC) or replacement (REP) following a TTIE in order to see if there are any changes in patient outcomes between the two treatment groups.

Managing complexity with chimerism: ALT-AMT flaps for complex head and neck reconstruction

BackgroundHead and neck cancer is the most common cancer in males and fifth most common in females in India. Inadequate screening programs and non-availability of local healthcare resources leads to late diagnosis and most cases present at an advanced stage. Surgical extirpation often results in complex, large defects. The concept of chimerism is useful in dealing with such extensive defects.MethodsBetween July 2013 and May 2017, all patients who underwent primary reconstruction of head and neck defects following cancer extirpative surgery, with ALT-AMT chimera flap at a tertiary care cancer centre were included in this study. The patient data of age, sex, etiology, defect size, flap size, perforator configuration, anastomotic details, donor site closure, and complications was retrospectively collected as per the designated proforma from the hospital electronic record, departmental case record forms and the first author’s personal logs, and analyzed.ResultsChimeric flaps based on the lateral circumflex femoral artery i.e. ALT plus AMT provide the desired qualities to address the complex defects. All thirteen patients had a large intraoral mucosal defect. Nine cases had a large extra oral skin defect. The average size of ALT was (112.5 cm2 area) and of AMT was (94.9 cm2 area). The combined area of ALT AMT was 28.5 X 9 = 256.5 cm2. All AMT pedicles were joining the ALT pedicle. 1 AMT was lost and all donor sites needed skin grafting.ConclusionChimeric ALT + AMT is a valuable option when complex, large, multidimensional and multicomponent defects need to be reconstructed. The advantage of utilising a single donor site and two independent flaps with a single microvascular anastomosis.Level of Evidence: Level IV, therapeutic study

Discussion: Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure.

Discussion: Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure.

Effect of Preoperative Neck Radiotherapy on the Reconstruction of Head and Neck Defects With the Supraclavicular Artery Island Flap.

Purpose: The supraclavicular artery island (SAI) flap is commonly used in the reconstruction of head and neck defects. However, the safety of SAI flaps for neck irradiated patient needs to be verified. To investigate the safety of using the SAI flap for patients who have undergone neck radiotherapy, as well as the risk factors for flap complications. Materials and Methods: Sixty-one patients (16 irradiated and 45 nonirradiated) with SAI flap-reconstructed head and neck defects were included, and relevant data were collected retrospectively. The gender, age, body mass index, presence of diabetes mellitus, preoperative albumin level, and flap size between irradiated and nonirradiated patients had no significant difference. Results: No significant difference was observed in the incidence of complications (total, mild, or severe) between the radiotherapy and nonradiotherapy groups. In univariate analysis, preoperative radiotherapy was not associated with postoperative complications of the SAI flap procedure (P = 1.00), while a low preoperative albumin level was a significant risk factor for postoperative complications (P < .05). Conclusions: Our data suggest that preoperative radiotherapy does not increase the risk of SAI flap postoperative complications compared with surgical reconstruction alone.

ER-NeRF++: Efficient region-aware Neural Radiance Fields for high-fidelity talking portrait synthesis

Despite conditional Neural Radiance Fields (NeRF) achieving great success in modeling audio-driven talking portraits, the generation quality is increasingly hampered by the lack of efficient use of space information. This paper presents ER-NeRF, a novel conditional NeRF-based architecture for talking portrait synthesis, and its variant version ER-NeRF++ to concurrently achieve fast convergence, real-time rendering, and state-of-the-art performance with small model size. Inspired by the unequal contribution of spatial regions, we propose two modules in ER-NeRF to guide the talking portrait modeling: (1) A compact and expressive Tri-Plane Hash Representation to improve the accuracy of dynamic head reconstruction by pruning empty spatial regions with three planar hash encoders. (2) A Region Attention Module for the audio–visual feature fusion, including a novel cross-modal attention mechanism to connect audio features with different spatial regions explicitly for local motion priors. Additionally, to tackle the difficulty in learning large facial motions, we propose a deformable variant ER-NeRF++ by including a Deformation Grid Transformer to enable the reuse of cross-regional spatial features for large motion representation. Compared to ER-NeRF, our ER-NeRF++ framework achieves a significant improvement in facial motion quality while maintaining the ability of fast training and real-time rendering. For the torso part, a directAdaptive Pose Encoding is introduced to simplify the pose information for a better head-torso connection. Extensive experiments demonstrate that both of our proposed frameworks can efficiently render lifelike talking portrait videos with rich realistic details, performing better in image quality and audio-lip synchronization compared to previous methods.

Development and validation of a novel nomogram model for identifying risk of prolonged length of stay among patients receiving free vascularized flap reconstruction of head and neck cancer.

The aim of the present study was to build and internally validate a nomogram model for predicting prolonged length of stay (PLOS) among patients receiving free vascularized flap reconstruction of head and neck cancer (HNC). A retrospective clinical study was performed at a single center, examining patients receiving free vascularized flap reconstruction of HNC from January 2011 to January 2019. The variables were obtained from the electronic information system. The primary outcome measure was PLOS. Univariate and multivariate analyses were used to find risk factors for predicting PLOS. A model was then built according to multivariate results. Internal validation was implemented via 1000 bootstrap samples. The study included 1047 patients, and the median length of stay (LOS) was 13.00 (11.00, 16.00) days. Multivariate analysis showed that flap types ((radial forearm free flap (odds ratio [OR] = 2.238; 95% CI, 1.403-3.569; P = 0.001), free fibula flap (OR = 3.319; 95% CI, 2.019-4.882; P < 0.001)), duration of surgery (OR = 1.002; 95% CI, 1.001-1.003; P = 0.004), postoperative complications (OR = 0.205; 95% CI, 0.129-0.325; P = P < 0.001) and unplanned reoperation (OR = 0.303; 95% CI, 0.140-0.653; P = 0.002) were associated with PLOS. In addition to these variables, blood transfusion was comprised in the model. The AUC of the model was 0.78 (95% CI, 0.711-0.849) and 0.725 (95% CI, 0.605-0.845) in the primary and internal validation cohorts, respectively. The DCA revealed the clinical utility of the current model when making intervention decisions within the PLOS possibility threshold range of 0.2-0.8. Our study developed a nomogram that exhibits a commendable level of accuracy, thereby aiding clinicians in assessing the risk of PLOS among patients receiving free vascularized flap reconstruction for HNC.