MICROVASCULAR FREE FLAPS IN HEAD AND NECK RECONSTRUCTION

Abstract

Reconstructive procedures of the head and neck aim to repair soft tissue and bony defects while restoring optimal function and cosmesis. The development of microvascular surgery has offered the possibility of free tissue transfer from distant sites to head and neck area. This allows reconstruction of composite defect in one stage. We would like to review a group of patients with various head and neck defects which were reconstructed with microvascular free flap. Between January 1995 and December 2000, seventy nine patients underwent 82 microvascular free flap reconstruction following major head and neck resection. There were 26 fibular, 25 radial forearm, 20 jejunal, 4 lateral arm, 4 rectus abdominus, 2 latissimus dorsi and 1 groin flaps. The majority (95%) of patients had advanced head and neck cancer. The common tumor sites were oral cavity (55%), hypopharynx (23%) and mandible (9%). Three patients (4%) died perioperatively. There were five total flap failure (6%). The overall major morbidity was 17%, including anastomotic leakage, orocutaneous fistula and major wound infection. The general medical complications rate was 17%. Donor site morbidity rate was 11% and the majority were in form of superficial wound infection. Given the good results observed and versatility of free flaps, we concluded that microvascular grafts should be considered in reconstructing head and neck defects following major ablative surgery.