Abstract
PurposeFree flaps have become the standard option in reconstructive surgery of the head and neck. Even though many authors have outlined the reliability of free transplants, there is an ongoing discussion about treatment options for patients bearing particular risks as previous irradiation treatment. In this analysis, we aim to address these patients with particular risk profiles by comparing different flap entity outcome parameters.MethodsWe retrospectively analyzed a cohort of 494 patients who underwent flap surgery between 2009 and 2018 in our department. Focusing on free microvascular transplants, we additionally analyzed the pectoralis major myocutaneous flap as the most frequently used vascular pedicled flap. Data analysis was performed by uni- and multivariate statistics.ResultsOverall flap success rate was 90%, with the radial forearm flap occurring to be most reliable (93%) in head and neck reconstruction. Previous radiation therapy (RT) and intraoperative revision of vascular anastomosis during primary surgery significantly resulted in impaired transplant outcome with a success rate of 91.8% (no RT) vs. 83.7% (RT), respectively. There was a negative linear correlation between incision to suture time and number of flaps per year (R2 = 0.67).ConclusionsPreoperative radiation therapy and intraoperative revision of anastomosis significantly impair outcome of microvascular flaps in the head and neck and oral cavity, whereas patient’s age is not a predictor of flap failure. Increasing case number and experience reduces time of flap surgery as well as rate of complications and flap failure.
Highlights
Even in times of microvascular surgery, large defects in the oral and maxillofacial area are challenging and represent one of the most difficult parts in head and neck surgery
During the 10-year timeframe of head and neck free tissue transplant surgeries in our institution, the number of microvascular flaps per year could be shown to increase from 30 cases in 2009 to 73 in 2018 (Fig. 1)
Postoperative revision of anastomosis was observed in 10% of radial forearm flaps while the free fibula flap and the anterolateral thigh flap (ALT) were ranging at 14% and 18%, respectively (Table 2)
Summary
Even in times of microvascular surgery, large defects in the oral and maxillofacial area are challenging and represent one of the most difficult parts in head and neck surgery. After introduction of microsurgery-based free tissue transfer in the 1970s, tremendous progress has been made to improve operative techniques and perioperative patient management. Regardless of distinct flap entities, success rates of microvascular flaps in the head and neck. We performed a 10-year monocentric retrospective study for microvascular flaps in the head and neck region from 2009 to 2018. Number of flaps 2009–2018 Gender Male Female Alcohol abuse Nicotin abuse
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