Abstract
IntroductionReconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates.ObjectiveTo evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions.MethodsThis was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients’ demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed.ResultsThe patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up.ConclusionMicrosurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.
Highlights
Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates
The free flap technique represented a revolution in reconstructive surgery as it enabled the harvesting of a large amount of revascularized tissue, and it could be tailored to the defect and allowed for more complex reconstructive procedures, while simultaneously permitting more extensive head and neck resections.3---5
We investigated 93 consecutive patients undergoing microsurgical reconstructions, which were conducted in the Department of Head and Neck Surgery in our hospital between January 2007 and June 2015
Summary
Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates. Head and neck cancer is the sixth common cause of cancer with an estimated worldwide incidence of over 600,000 new cases annually.[1] Surgery for tumors of head and neck can cause significant soft tissue, bony and skin defects. This may result in functional impairment such as speech and swallowing deficits. The free flap technique represented a revolution in reconstructive surgery as it enabled the harvesting of a large amount of revascularized tissue, and it could be tailored to the defect and allowed for more complex reconstructive procedures, while simultaneously permitting more extensive head and neck resections.3---5 Today, microvascular surgery is an essential part of the treatment of head and neck defects
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