Development and validation of a predictive nomogram for vascular crises in oral and maxillofacial cancer patients undergoing free flap surgery

Objective: To develop and validate a predictive model for identifying vascular crises following free tissue flap transplantation in patients undergoing surgery for oral and maxillofacial tumors. Methods: This retrospective cohort study utilized medical records from the Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, covering the period from January 2014 to December 2021. The analysis included 1,786 cases, divided into a training group (n = 1,251) and a validation group (n = 535). Variables included demographic factors, clinical characteristics, and surgical details. Univariate and multivariate logistic regression analyses were performed to identify significant predictors, which were then incorporated into a nomogram. The model’s performance was assessed using the concordance index (C-index), receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Results: The incidence of vascular crisis was 5.8% in the training group and 4.9% in the validation group. Significant predictors included tissue flap width, D-dimer levels, preoperative hemoglobin, hemoglobin difference before and after surgery, and type of venous anastomosis. The nomogram showed strong predictive performance with an AUC of 0.780 in the training group and 0.701 in the validation group. Calibration curves indicated excellent fit, and DCA demonstrated clinical applicability. Conclusion: A user-friendly model was developed for detecting vascular crises in oral and maxillofacial tumor patients. This model exhibits robust discriminative ability, precise calibration, high specificity, and significant clinical applicability, effectively identifying high-risk patients prone to vascular crises.