Usefulness of Serum C-reactive protein (CRP) Level for Predicting Flap Complication after Performing Free Microvascular Head and Neck Reconstruction

Abstract

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. 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, serum CRP

levels were daily measured for two 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. A Total of 25 patients were included in this study. The amount of time taken to

ii reach the peak of the CRP level is significantly less in the normal group (2.88 days) than the

complicated group (7 days) (p<0.001). Furthermore, the amount of time to reach half of the

peak was significantly different between groups (7.19 days vs. 10.14 days, 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 8 and

day 12 (p< 0.05). 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 serum CRP level and secondary rise in serial

CRP values.