Neighborhood Socioeconomic Deprivation Predicts Poor Wound Healing Following Head and Neck Free Tissue Transfer in Children

Authors

Asli Pekcan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Melanie Bakovic, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Valeria Mejia, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Raina K. Patel, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Marvee Turk, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Priyanka Naidu, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Mark M. Urata, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Jeffrey A. Hammoudeh, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Document Type

Journal Article

Publication Date

6-11-2025

Journal

The American surgeon

DOI

10.1177/00031348251351006

Keywords

area deprivation index; free flap; free tissue transfer; head and neck reconstruction; neighborhood deprivation; pediatric microsurgical reconstruction; socioeconomic disadvantage

Abstract

BackgroundRecent studies have identified various socioeconomic disparities in postoperative outcomes among adults undergoing head and neck (H&N) microsurgical reconstruction. This study aimed to measure the impact of socioeconomic factors on outcomes of H&N free tissue transfer in a pediatric population.MethodsA retrospective review was conducted of children who underwent H&N free tissue transfer (FTT) at a tertiary children's hospital between 2007 and 2024. Socioeconomic status was quantified using Area Deprivation Index (ADI), a composite measure of disadvantage reported across ZIP codes. Patient health records were reviewed for postoperative flap outcomes, which were compared across ADI cohorts.ResultsA total of 59 patients, undergoing 75 FTTs, met inclusion criteria, among whom 43.1% were considered low deprivation and 56.9% high deprivation. Overall flap survival was 97.3%. Rates of flap failure, unanticipated revision, and readmission did not differ between cohorts. However, flap dehiscence was significantly more likely among high deprivation patients (25.6% vs 6.2%, P = 0.034). Furthermore, every 1 point increase in ADI over 5 was associated with a 7.8% increase in the odds of flap dehiscence (P < 0.05).DiscussionNeighborhood socioeconomic deprivation was independently predictive of flap dehiscence among children undergoing H&N FTT, but was not associated with flap failure, flap revisions, or 30-day readmissions. This finding underscores the broader impact of socioeconomic factors on pediatric health outcomes, particularly surgical wound healing.

APA Citation

Pekcan, Asli; Bakovic, Melanie; Mejia, Valeria; Patel, Raina K.; Turk, Marvee; Naidu, Priyanka; Urata, Mark M.; and Hammoudeh, Jeffrey A., "Neighborhood Socioeconomic Deprivation Predicts Poor Wound Healing Following Head and Neck Free Tissue Transfer in Children" (2025). GW Authored Works. Paper 7430.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7430

Department

School of Medicine and Health Sciences Student Works