Experiences with Free-Tissue Transfer in Head and Neck Cancer Patients Having Coronary Artery Disease

Abstract

Background:Microvascular free tissue transfer to head and neck defect after tumor ablation is the main method in current practice. Although the safety and reliability was proven in high risk patients such as elderly or patients with concomitant medical comorbidities, the outcome of performing such major operation in patients with coronary artery disease is rarely reported.Aim and Objectives:To share our experience in treating head and neck cancer patients who had coronary artery disease and received tumor resection as well as free flap reconstruction regarding the management and the outcome.Materials and methods:Retrospective review of 952 patients undergoing extensive surgical resections and free flap reconstruction in a 5-year period was performed from 2006 to 2010. Patients with coronary artery disease were identified and their demographic, medications, surgery and tumor related data as well as postoperative surgical and medical complications were recorded and analyzed from prospective maintained database.Results:14 patients with coronary artery disease were identified. 15 free flap procedures (12 anterolateral thigh flaps, 3 fibula flaps) were performed. All flaps survived. Partial skin paddle loss was observed in a fibula flap. There were 2 patients died because acute myocardial infarction and pneumonia respectively. The mortality rate was 14.3%. Conclusion:To perform microvascular free tissue transfer for head and neck reconstruction in patients with coronary artery disease is feasible. However, postoperative cardiac or pulmonary complications may result in mortality despite strict preoperative and postoperative management. A thorough discussion to patient and family with emphasis on unexpectable postoperative death before operation is strongly advised.