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.
