Fluid Therapy Regimen and Free Flap Failure in Post-Resection Reconstruction for Head and Neck Cancer: A Systematic Review

Abstract Background The importance of developing standardized approaches away from wide-range fluid administration regimens has been growing. The aim of the following study is to evaluate the current evidence with regards to fluid therapy regimens and their effects on flap complications in free-flap reconstruction of head and neck cancer. Method A systematic database search was conducted of original articles that included fluid therapy regimens in free-flap reconstruction of head and neck cancer in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to January 2021. Our main outcomes were presence of a flap complication or failure and total length of hospital stay. Results We identified 327 studies from our search, of which 11 studies met the inclusion criteria, comprising a total of 1,133 patients. Five studies showed that greater perioperative fluid volume was associated with higher rates of flap complication, with one drawing a cut-off at 5.5 L to predict any flap complication and 7 L to predict a major complication that required re-operation. Three studies assessed goal directed fluid therapy, with two showing significantly reduced intraoperative fluid volume within this group, but no significant difference in flap outcomes. Two studies comparing crystalloid and colloid fluids concluded that there was no significant difference in outcomes when using either. Conclusions Excessive fluid administration negatively impacts surgical outcomes. Goal directed therapy presents insufficient evidence as a method for reducing flap complications and length of hospital stay. The clinical benefit of colloid fluid intra-operatively over crystalloids have not been unanimously demonstrated in this review.