Use Of Microvascular Free Flaps Research Articles

Impacts of vascular comorbidities on free flap perfusion in microvascular head and neck reconstruction

PurposeArterial hypertension (AHTN), type 2 diabetes mellitus (DM), and atherosclerotic vascular disease (ASVD) are common vascular comorbidities in patients undergoing reconstruction of the head and neck region with a microvascular free flap. These conditions may affect flap perfusion (microvascular blood flow and tissue oxygenation), which is a prerequisite for flap survival and thus reconstruction success. This study aimed to investigate the impacts of AHTN, DM, and ASVD on flap perfusion.MethodsData from 308 patients who underwent successful reconstruction of the head and neck region with radial free forearm flaps, anterolateral thigh flaps, or fibula free flaps between 2011 and 2020 were retrospectively analyzed. Flap perfusion was measured intraoperatively and postoperatively with the O2C tissue oxygen analysis system. Flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation were compared between patients with and without AHTN, DM, and ASVD.ResultsIntraoperative hemoglobin oxygen saturation and postoperative blood flow were lower in patients with ASVD than in patients without ASVD (63.3% vs. 69.5%, p = 0.046; 67.5 arbitrary units [AU] vs. 85.0 AU, p = 0.036; respectively). These differences did not persist in the multivariable analysis (all p > 0.05). No difference was found in intraoperative or postoperative blood flow or hemoglobin oxygen saturation between patients with and without AHTN or DM (all p > 0.05).ConclusionPerfusion of microvascular free flaps used for head and neck reconstruction is not impaired in patients with AHTN, DM, or ASVD. Unrestricted flap perfusion may contribute to the observed successful use of microvascular free flaps in patients with these comorbidities.

Microvascular reconstructions in oral and maxillofacial surgery — Results of a survey among oral and maxillofacial surgeons in Germany, Austria, and Switzerland

This study aimed to evaluate the use of microvascular free flaps (MFF) in oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland.A dynamic online questionnaire, using 42–46 questions, was sent to OMF surgeons based in hospitals in Germany, Austria, and Switzerland. The questionnaire was evaluated internally and externally. Aside from general information, data were collected on organizational aspects, approaches, MFF types and frequency, presurgical planning, intraoperative procedures, perioperative medications, flap monitoring, and patient management.Participants mostly performed 30–40 MFF each year (11/53). Most stated that the COVID-19 pandemic did influence MFF frequency (25/53) to varying extents. Radial forearm flap was most frequently used (37/53), followed by ALT (5/53), and fibula flap (5/53). Primary reconstruction was performed by most participants (35/48). Irradiated bony transplants were mostly used for implant placement after 12 months (23/48). Most participants (38/48) used reconstruction plates, followed by miniplates (36/48), PSI reconstruction (31/48), and PSI miniplates (10/48). Regarding the postoperative use of anticoagulants, low-molecular-weight (37/48) and unfractioned heparins (15/48) were widely used, most often for 3–7 days (26/48). Clinical evaluation was mostly preferred for flap monitoring (47/48), usually every 2 h (34/48), for at least 48 h (19/48).Strong heterogeneity in MFF reconstructions in OMFS was found, especially regarding the timepoints of reconstruction, types of osteosynthesis, and postoperative MFF management. These findings provide the chance to further compare the different treatment algorithms regarding relevant MFF aspects, such as postoperative management. This could create evidence-based treatment algorithms that will further improve the clinical outcomes in MFF reconstructions.

Free-Flap Reconstruction for Diabetic Lower Extremity Limb Salvage

BackgroundMicrosurgical free tissue transfer is an important treatment option for nonhealing lower extremity diabetic wounds. The purpose of this study was to identify factors that affect flap survival and wound complications. MethodsA retrospective review was conducted of 806 lower extremity free-flap reconstructions performed from 1979 to 2016. A total of 33 free flaps were used for coverage of nonhealing lower-extremity diabetic ulcers. Primary outcome measures were perioperative complications and long-term wound breakdown. ResultsThe average age was 54 ± 12.3 y. 15.2% of patients were smokers, 12.1% had coronary artery disease and 12.1% had end-stage renal disease. Muscle flaps predominated (75.8%) compared to fasciocutaneous flaps (24.2%). There were 7 patients (21.2%) that underwent a revascularization procedure before (71.4%) or at the same time (28.6%) as the free flap. Immediate complications occurred in 7 flaps (21.2%) with 4 partial losses (12.1%) and 3 total flap failures (9.1%). Major wound complications occurred in 18.2% of patients. An end-to-side (E-S) anastomosis for the artery was used in 63.6% (n = 22) of flaps compared with an end-to-end (E-E) anastomosis. E-S anastomosis was associated with a significantly lower risk of wound complications compared with an arterial E-E anastomosis (0% versus 45.5%, P = 0.001). ConclusionsThe use of microvascular free flaps can be used successfully to cover lower-extremity diabetic wounds. E-E arterial anastomosis should be avoided if possible as it is associated with higher rates of wound breakdown, likely by impairing perfusion to a distal limb with an already compromised vasculature. Level of evidenceLevel III.

Factors affecting success of reconstruction of extremity injuries with microvascular free flaps

Objective One of the most challenging aspects of restoring form and function to an extremity affected by a traumatic event is repairing the extensive soft tissue defect. Some methods of repair are use of microvascular free flaps, pedicled perforator flaps, and skin grafting.1 The choice of reconstruction depends on many factors, including location/size, patient's comorbidities, and donor site limitations. The aim of this study was to review extremity soft tissue reconstructions that were performed by pedicled and free flap methods and to determine if any factors played a role in the outcome of treatment. Methods With institutional review board approval, a retrospective chart review was performed for cases in the Department of Oral and Maxillofacial Surgery involving extremity reconstruction procedures in the years 2010–2015. A data set was created in REDCap to record patient demographic characteristics, social habits, cause/site of injury, procedures performed, postoperative/post-discharge complications, and healing outcome. Statistical analysis was performed by using SPSS, SAS, and Excel software. A comparative analysis, by using Fisher's exact test, Pearson's χ2 test, and independentt tests, was performed. Results We identified 71 patients, 20 of whom were excluded because of repetition and/or other reconstruction. Of the 51 patients identified, 38 (74.5%) were males and 13 (25.5%) were females (mean age 41 years). Accident-related injuries included motorcycle, 13 (26.5%); car, 14 (28.6%); falls, 8 (15.7%); pedestrian–automobile collision, 8 (15.7%); and other causes. Lower extremities were affected in 49 of 51 cases. Reconstructions included radial forearm free flap (17), anterior lateral thigh flap (7), latissimus dorsi free flap (3), gastrocnemius pedicled flap (9), and other rotational flaps (15). Of 51 patients, 15 required readmissions—9 for wound dehiscence and 11 for infection (6 had both). Of the patients with poor wound care, 60% developed an infection, 72% of whom required readmission. No significant correlation between patient comorbidities and the rate of flap failure/readmission was noted. Conclusions Extensive extremity injuries caused by traumatic events often lead to soft tissue defects that require tissue rearrangement/free tissue transfer for repair. In evaluating patients with free flap/rotational flap reconstruction of these defects, we determined that readmissions mainly resulted from infection, most of which were correlated with poor wound care. To further address our hypothesis, we plan to review patients from 2016 to 2019 to evaluate if any other factors (i.e., orthopedic hardware) may play a role in the rate of infections.

The use of microsurgical reconstruction in treatment of craniofacial defects in paediatric patients

Background: Reconstruction of craniofacial defects with the use of microvascular free flaps is currently a golden standard of reconstructive surgery in subjects with post-resection, post-traumatic and congenital tissue defects. Although microsurgical techniques are quite common in adult treatment, they are much less frequently used in paediatric patients. In juvenile patients, defects of skeleton and soft facial tissues are most frequently related to congenital defects (facial clefts, congenital applasias), resection of neoplastic tumours. The most serious include disorders in craniofacial growth and development resulting from damage to growth centres and loss of the main tissue mass. This leads to impaired ratio of facial to cerebral skull and to the remaining structures, which causes big difficulties during secondary reconstruction procedures and has a negative effect on the final functional and aesthetic effect. Additionally, defects of craniofacial tissue are very often related to impaired anatomy of the stomatognathic system (teeth, maxillary alveolar bones and bones of the alveolar part of the mandible, muscles of mastication and temporomandibular joints). The use of microsurgical techniques in craniofacial reconstruction procedures allows reconstruction of the oral cavity tissue base, which in turn enables rehabilitation of the stomatognathic system structure at the earliest possible time, also with the use of implantoprosthetic techniques. This creates proper growth impulses for further craniofacial development following a reconstruction procedure.

Reconstructive Head and Neck Surgery in Spanish Otorhinolaryngology—Head and Neck Surgery Departments: Current State of the Art

Advances in oncological head and neck surgery evidenced in the last decades have been linked to the progression in the reconstruction capacity of the defects resulting from resection of advanced tumors, allowing the improvement of both esthetic and functional results, as well as decrease the rate of postoperative complications in rescue surgery. To understand the situation of head and neck reconstruction across the country. a questionnaire about the current state of head and neck reconstructive surgery in Spain in otorhinolaryngology and head and neck surgery departments was distributed via email. Eighty (25.5%) of 313 ENT departments in Spain carry out some type of reconstruction in oncological surgery of the head and neck. Forty-four (55%) departments use regional pedicled flaps as a single reconstruction strategy, while 36 (45%) departments also employed the use of microvascular free flaps. Fifty-six (70%) departments perform 10 or less regional pedicled flaps per year, while 21 (29.6%) perform 10 or more flaps per year, with an average of 9.91 ± 11.73 flaps/year (min. 2, max. 40). Seven (8.75%) departments perform 10 or more free flaps a year, while the other 29 (36.25%) perform 10 or less, with an average of 4.96 ± 5.1 free flaps microvascular year (min. 2, max 20). In our country, head and neck cancer surgeries are performed in a tertiary level hospital and patients benefit from the reconstruction of post-surgical defects, through the use of regional pedicled or microvascular free flaps.

The use of microvascular free flaps in head and neck reconstruction performed by the otorhinolaryngologists: a series of 65 flaps

This study aims to assess the success rate of surgery and postoperative morbidity in patients who underwent major head and neck surgery with reconstruction by microvascular free flaps performed by otolaryngologists. We retrospectively analyzed the medical records of 63 patients (31 males, 32 females; mean age 47.9±12.5 years; range 20-71 years) operated in our clinic between September 2012 - August 2016. The indications of reconstruction by free flap, success rates, need for revision and re-exploration, reasons of flap failure, morbidity and mortality were evaluated. Thirty-seven (56.9%) of the 65 microvascular free flaps were radial forearm; 23 flaps (35.4%) were fibula and five flaps (7.7%) were rectus abdominis. Three of the total 65 flaps ended up in failure; accordingly the success rate was 95.4%. Except for these three failure cases, an urgent re-exploration was performed on 13 patients in the first postoperative 48 hours (n=16, %24.6). No permanent major sequel was observed in any of the patients. From the otolaryngologists' point of view, we observed that performing microvascular surgery and the successful surgical results not only gives the flexibility in reconstruction but also provides safer resection during ablative surgery.

The use of free flaps in skull base reconstruction

Skull base tumours are rare, comprising less than 1% of all tumours of the head and neck. Surgical treatment of these tumours involves the approach, the resection, and the reconstruction of the defect, which present a challenge due to the technical difficulty and anatomical complexity. A retrospective study of 17 patients with tumours involving the skull base, treated by resection and immediate reconstruction using microsurgical free flaps, is presented; 11 were men and six were women. The following types of flap were used: osteocutaneous fibula flaps, fasciocutaneous anterolateral thigh flaps, and myocutaneous latissimus dorsi flaps. The most common histology of the tumours was squamous cell carcinoma. The most frequent point of origin was the paranasal sinuses (58.8%). All of the free flaps used for reconstruction were viable. A cerebrospinal fluid fistula occurred in two patients, and in one of these cases, meningoencephalitis led to death. In conclusion, the reconstruction of large defects of the skull base after ablation requires a viable tissue that in many cases can be obtained only through the use of microvascular free flaps. The type of flap to be selected depends on the anatomical structures and size of the defect to be restored.

Free Flap Reconstruction in the Head and Neck. Indications, Technical Aspects and Outcomes

Introduction and objectivesThe use of microvascular free flaps (MFF) has become a common method of head and neck reconstruction because of its high success rates and better functional results. We report our experience in reconstructing complex defects with MFF. MethodsWe analysed a series of 246 patients who underwent reconstruction using MFF in our Department from 1991 to 2013. ResultsA total of 259 interventions were performed in 246 patients. The most common reason for surgery was tumour recurrence (46%), followed by primary tumour resection (25%). The hypopharynx (52%) and the craniofacial region (22%) were the most frequently reconstructed sites. The free flaps most commonly used were the radial forearm free flap (41%) and the anterolateral thigh free flap (35%). Overall success and complication rates of 92% and 20% respectively were reported. ConclusionsThe microvascular free flap is a reliable and useful tool for reconstructing complex head and neck defects and continues to be the reconstructive modality of choice for these defects.

Reconstrucción de cabeza y cuello mediante colgajos libres microvascularizados. Indicaciones, aspectos técnicos y resultados

Introduction and objectivesThe use of microvascular free flaps (MFF) has become a common method of head and neck reconstruction because of its high success rates and better functional results. We report our experience in reconstructing complex defects with MFF. MethodsWe analysed a series of 246 patients that underwent reconstruction using MFF in our Department from 1991 to 2013. ResultsThere were 259 interventions performed in 246 patients. The most common reason for surgery was tumour recurrence (46%), followed by primary tumour resection (25%). The hypopharynx (52%) and the craniofacial region (22%) were the most frequently reconstructed sites. The free flaps most commonly used were the radial forearm free flap (41%) and the anterolateral thigh free flap (35%). Overall success and complication rates of 92% and 20% respectively were reported. ConclusionsThe microvascular free flap is a reliable and useful tool for reconstructing complex head and neck defects and continues to be the reconstructive modality of choice for these defects.

OP211: Microvascular tissue transfer in the management of advanced osteoradionecrosis

The purpose of this study is to evaluate the outcomes of the use of microvascular free flaps (MVFF’s) in the management of advanced stage III osteoradionecrosis (ORN) that fails conservative management. This is a retrospective review of all patients treated for ORN with radical resection and microvascular reconstruction at the University of Maryland department of oral & maxillofacial surgery between July of 2010 and October of 2012. Outcomes measured included the resolution rate (resolution of pain, infection, and exposed bone) as well as perioperative complications. There were 12 patients (10 men and two women) (eight caucasians, three blacks, and one hispanic). The mean age at time of treatment was 62 years. Mean follow up was 15 months. All had Marx stage III ORN. Six patients had radiation therapy alone, and 6 had combined chemoradiation. The presenting features included pain (10 patients), orocutaneous fistulas (4), exposed bone (11), and pathologic fracture (8). Eight patients had hyperbaric oxygen (HBO) as part of their conservative treatment. The mean latency period between completion of adjuvant therapy and development of symptoms was 6.7 years (10–312 months). Seven patients were reconstructed with a fibula flap, four with a scapula flap, and one with a deep circumflex iliac artery flap. The resolution rate was a 100% with resolution of pain, drainage, and exposed bone. The perioperative complication rate was 50%. One flap developed vascular compromise, and was successfully salvaged. Four patients had postoperative infections which required a washout and drainage, one had a hematoma evacuation. Three patients have chronic dysphagia and are partially PEG tube dependent. Resection and microvascular reconstruction is a highly predictable mode of treatment for advanced ORN. The increased postoperative complication rate is consistent with the literature, and is expected given the poor quality fibrotic tissue in radiated patients.

Reconstruction of chest wall chondrosarcoma with an anterolateral thigh free flap: An illustration of decision-making in chest wall reconstruction

INTRODUCTIONChondrosarcomas are the most common primary chest wall malignancy. The mainstay of treatment is radical resection, which often requires chest wall reconstruction. This presents numerous challenges and more extensive defects mandate the use of microvascular free flaps. Selecting the most appropriate flap is important to the outcome of the surgery. PRESENTATION OF CASEA 71-year-old male presented with a large chondrocarcoma of the chest wall. The planned resection excluded use of the ipsilateral and contralateral pectoralis major flap because of size and reach limitations. The latissimus dorsi flap was deemed inappropriate on logistical grounds as well as potential vascular compromise. The patient was too thin for reconstruction using an abdominal flap. Therefore, following radical tumour resection, the defect was reconstructed with a methyl methacrylate polypropylene mesh plate for chest wall stability and an anterolateral thigh free flap in a single-stage joint cardiothoracic and plastic surgical procedure. The flap was anastomosed to the contralateral internal mammary vessels as the ipsilateral mammary vessels had been resected. DISCUSSIONThe outcome was complete resection of the tumour, no significant impact on ventilation and acceptable cosmesis. CONCLUSIONThis case demonstrates the complex decision making process required in chest wall reconstruction and the versatility of the ALT free flap. The ALT free flap ensured adequate skin cover, subsequent bulk, provided an excellent operative position, produced little loss of donor site function, and provided an acceptable cosmetic result.

Practical Approach to Microvascular Reconstruction of Significant Skull Base Defects

Background: Complex defects of the lateral and anterior skull base present challenges for the reconstructive surgeon. With the increasing use of microvascular free flaps and improved medical modeling technology, reconstruction of large complex defects can be approached with a practical algorithm. However, surgeons must be experienced with the full reconstructive ladder to balance the reconstruction with patient-oriented factors.

Polymorphous Low Grade Adenocarcinoma: Case Series and Review of Surgical Management

The aim of the present study was to review the published data regarding the management of polymorphous low-grade adenocarcinoma (PLGA) and present our experience in the treatment of patients diagnosed with PLGA. We performed a review of the published data of the treatment possibilities for PLGA, and report on a case series of 4 patients diagnosed with palatal PLGA. The mean age at diagnosis was 61.75 years. All cases were localized on the hard palate. The male/female ratio was 1:3. One patient had an ulcerative painful lump. In correlation with the published data, most of our patients presented initially with a diagnosis that was not conclusive for the presence of PLGA. The most common initial diagnostic findings were adenoid cystic carcinoma and pleomorphic adenoma. The treatment of choice was surgical excision of the tumor with safe margins of 1.5 cm. One patient had a positive cervical lymph node metastasis and underwent an elective neck dissection followed by radiotherapy. Local recurrence was diagnosed in 1 patient 6 years after the surgical management. Most cases were reconstructed using an obturator, except for 1 patient who underwent reconstruction using the temporalis myofascial flap. PLGA is a slow-growing, distinct, uncommon neoplasm of the minor salivary glands. Because it is characterized by a diverse morphologic pattern that resembles adenoid cystic carcinoma or pleomorphic adenoma, the initial diagnosis is usually inconclusive. Until a final diagnosis has been made, we believe that the reconstruction possibilities should be mainly obturators to allow a good visualization of the surgical site. The use of microvascular free flaps or rotational flaps should be reserved to patients with clearer pathologic diagnosis.

Optimal Use of Microvascular Free Flaps, Cartilage Grafts, and a Paramedian Forehead Flap for Aesthetic Reconstruction of the Nose and Adjacent Facial Units

Optimal Use of Microvascular Free Flaps, Cartilage Grafts, and a Paramedian Forehead Flap for Aesthetic Reconstruction of the Nose and Adjacent Facial Units

Optimal Use of Microvascular Free Flaps, Cartilage Grafts, and a Paramedian Forehead Flap for Aesthetic Reconstruction of the Nose and Adjacent Facial Units

Facial reconstruction with only free microvascular flaps has rarely produced an aesthetic result. Menick stated, "Distant skin always appears as a mismatched patch within residual normal facial skin." In addition, earlier techniques using a single large nasal lining flap or bilateral nasal lining vaults incurred a high incidence of airway obstruction. The authors describe 10 consecutive patients requiring reconstruction of the nasal vestibule and columella lining from October of 1997 through May of 2005. Most of them also required reconstruction of the floor of the nose, the platform on which the alar bases and columella rest, and defects of the facial units adjacent to the nose. Aesthetic nasal reconstruction used two separate skin paddles to reconstruct the lining for the nasal vestibule and columella, an artistically constructed nasal framework made of cartilage, a forehead flap for cover, and other flaps and grafts to reconstruct adjacent facial unit defects. The average patient age was 41.8 years (range, 10.4 to 65.3 years). Follow-up (from the time of the first operative stage) averaged 26.4 months (range, 4 to 49 months). Nine patients had functional airways, and one required nasal airway support with internal silicone tubes. At the time of publication, eight patients had normal-appearing noses, and two were awaiting secondary surgery to correct persistent deformity. Microvascular free flaps have proved to be highly reliable and efficacious for restoration of missing elements of the nasal lining and adjacent facial soft-tissue defects in total and subtotal nasal reconstruction. Combined with a forehead flap, this aesthetic approach allows for reconstruction of the center of the face layer by layer and facial unit by facial unit. Specific attention is paid to the artistic creation of normal nasal dimensions, proportion, and form using carved and assembled cartilage grafts and by secondary subcutaneous contouring. In addition, this technique produces a patent airway.

Infrahyoid fascio‐myocutaneous flap as an alternative to free radial forearm flap in head and neck reconstruction

The use of microvascular free flaps is currently the favored method for the reconstruction of defects after resection of head and neck cancer. The flap most commonly used for head and neck reconstruction is the free radial forearm flap, but the less popular infrahyoid flap represents a good alternative in selected cases. This flap has proven to be helpful in the reconstruction of a wide range of moderate-sized head and neck defects. We reviewed a series of 13 patients with defects resulting from cancer of the head and neck, who underwent infrahyoid flap reconstruction as an alternative to free radial forearm flap. The series includes 12 squamous cell carcinomas arising from the oral cavity and oropharynx, and 1 Merkel cell carcinoma of the submental skin. In the harvesting of the flap, the technical modifications recently suggested by Dolivet et al were used in all cases. Furthermore, another technical change has been introduced so creating a new infrahyoid facio-myocutaneous flap (IHFMCF). The surgical technique is described in detail. No total or partial flap necrosis was experienced. All reconstructions healed quickly without wound complications and with good functional results. The healing process in the donor site was excellent in every case with good aesthetic results. The IHFMCF is a versatile, reliable, and convenient flap suitable for repairing small and medium-sized defects of the oral cavity and oropharynx and obviates the need for a microvascular reconstruction.

Use of Microvascular Free Flaps in the Reconstruction of the Anterior and Middle Skull Base

Different reconstruction techniques of the anterior and middle skull base as consequence of a defect after surgical treatment of neoplastic pathologies are described in the literature. The aim of the present study is to present our experience regarding the use of microvascular free flaps for reconstruction of the anterior or middle skull base after large defects caused by removal of malignant neoplasms. From 2000 to 2004, in the Department of Maxillo-Facial Surgery of the University of Rome "La Sapienza" and "Tor Vergata," 13 surgical procedures for reconstruction of anterior and middle skull base defects by free flaps were performed in 11 patients. Data on patient demographics, histopathology, location and size of defect, type of reconstruction, and postoperative complications were obtained from medical record charts. A safe soft tissue closure of the intracranial space was achieved in all patients. Defect repair was accomplished by revascularized transfer of rectus abdominis flaps in seven cases, latissimus dorsi muscle flaps in two patients, radial forearm flap in one case, and fibula flap in one case. There were two total flap losses; the secondary defect repair was accomplished in both cases by revascularized transfer of latissimus dorsi muscle flap. No donor site complications were observed in all the flaps. The mean operation time was 85 hours; patients were hospitalized for a mean period of 14 days. The method of choice for the reconstruction of anterior or middle skull base defect should be based upon careful evaluation of the single case and, particularly, the localization and entity of the residual defect. For defects that require large amounts of soft tissue, the latissimus dorsi free flap and the rectus abdominis free flap are the best appropriate choices for reconstructive procedures for anterior and middle skull base tumors.

Pectoralis major myocutaneous flap for hypopharyngeal reconstruction.

The reconstruction of total or subtotal defects after surgical treatment for hypopharyngeal cancer is a challenging problem in head and neck surgery. The authors discuss reconstructive surgery performed in 37 patients affected by advanced hypopharyngeal cancer using the pectoralis major myocutaneous flap. In 22 cases of total pharyngolaryngectomy, the reconstructive procedure originally proposed by the authors was based on the use of a pectoralis major myocutaneous flap directly sutured to the pharyngeal and esophageal stumps and the prevertebral fascia, which eventually represented the posterior wall of the neohypopharynx. In 15 cases of subtotal pharyngolaryngectomy, the posterior wall of the neohypopharynx consisted of a residual strip of pharyngeal mucosa. In each patient, removal of the tumor and reconstruction were performed during the same operation, with only a few complications. Neither flap necrosis nor strictures were encountered; five patients had pharyngeal fistula and one patient died because of massive pneumonia. Although the use of microvascular free flaps is a reliable procedure, the pectoralis major myocutaneous flap is still applicable for hypopharyngeal reconstruction, thanks to its feasibility and low complication rate. The other reconstructive options require surgical transgression of the abdomen and/or thorax in patients affected by malnutrition and other chronic systemic disorders.

Microvascular Free Tissue Transfers after Preoperative Irradiation in Head and Neck Reconstructions

Surgical reconstruction of large head and neck tumors involves great problems. Preoperative irradiation increases the risk of postoperative complications. The use of microvascular free flaps has definitive advantages over conventional reconstruction techniques and permits immediate preoperative high-dose radiation therapy. Eighty-eight patients, 55 (62%) men and 33 (38%) women, with head and neck tumors underwent microvascular reconstruction at the Turku University Central Hospital in 1985–1995; 77 of them were irradiated before surgery. All irradiated patients underwent primary reconstruction. The preoperative radiation dose was 50–65 Gy. The free tissue transfer was successful in 77 (88%) of the 88 patients. The success rate was 87% in irradiated patients and 91% in nonirradiated patients. Free tissue transfers are suitable for one-stage reconstruction in selected patients such as those receiving high-dose preoperative irradiation. The transfer of microvascular free flaps to the head and neck has become the most common reconstruction method owing to its increasing success rates as well as its excellent esthetic and functional results.