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

Abstract

Background

Recent 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.

Methods

A 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.

Results

A 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).

Discussion

Neighborhood 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.