Complete Recovery from Complications of Microvascular Free-flap Transfers after Oral Tumour Extirpation

Abstract

Objective: In this retrospective study, all free-flap transfers done at the Kanagawa Dental College, Kanagawa, Japan, for reconstruction following ablation of head and neck tumours were analysed. The 5 patients who developed complications following reconstructive surgery and the course of recovery were examined.Patients and Methods: Thirty four microvascular free-flap transfer operations were performed, which included patients with cutaneous radial forearm (17; 50%), myocutaneous rectus abdominis (13; 38%), osteocutaneous scapula composite (2; 6%), osteocutaneous scapula composite with forearm chimera (1; 3%), and myocutaneous rectus abdominis with forearm chimera (1; 3%).Results: Complications were seen in the forearm (n = 2), osteocutaneous scapula composite (n = 2), and chimeric (scapula composite + forearm) [n = 1] microvascular free flaps. The facial artery showed the most complications when used as a recipient artery, presenting 2 complications in 4 inosculation cases; only 2 complications (7%) were observed for the superior thyroid artery (n = 28). The most frequently used recipient vein, the internal jugular vein (n = 27), showed 3 complications (11%). The presenting complications were first observed at 0.5, 4, 36, and 58 hours (mean ± standard deviation, 19.8 ± 26.1 hours) in the 5 patients with complication. Thrombosis was related to the cause of all complications, including bending of the anastomosis (n = 1), distorted pedicle (n = 1), oppression of the pedicle (n = 1), oppression due to coagulation in the surrounding scar (n = 1), and unknown factors (n = 1). Complete recovery was achieved in all patients.Conclusion: Early detection of complications, with diligent and meticulous postsurgical follow-up, is key to achieving complete recovery rates following free-flap transfer surgeries.