These results indicate that head and neck reconstruction with free flaps is reliable. However, the high 30-day post-operative mortality rate among patients 80 years or older should be considered when deciding whether to operate. To decrease the operative mortality rate, careful perioperative management is needed to prevent complications and shorten the hospital stay.
Anteriorly based PCF had significantly better vascularity compared to laterally based PCF and seemed safer to harvest regardless of flap pedicle type. Also, the feasibility of harvesting muscle sparing laterally based PCF was indicated. Finally, being older than 45 years, a body mass index more than 25, or being a smoker might increase the risk of reducing flap vascularity.
Owing to changes in the treatment of skull-base tumors, such as perioperative radiotherapy and advances in approaching the skull base, the use of pericranial flaps should be reconsidered. Therefore, we reviewed the reliability of and indications for pericranial flaps in 26 cases in terms of patient background, the effects of preoperative and postoperative treatment, and the pattern of blood circulation. Flaps were harvested as 25 anteriorly based and 4 laterally based. As a result, postoperative complications were observed in 4 patients. No other risk factors, except for heavy smoking, were observed relative to patient background. Sixteen patients had perioperative radiotherapy, and complication rate was significantly higher in patients with preoperative radiotherapy than patients without preoperative radiotherapy (P=0.014). However, no complications, such as cerebral spinal fluid leakage and intracranial infection, were observed in patients receiving postoperative radiotherapy. Laterally based pericranial flaps had a high complication rate (25%), but it was not significantly higher than anteriorly based flaps (P=0.467). Five anteriorly based flaps were harvested with less feeding vessels as usual because of applying dismasking flap approach, but it did not lead to increasing in complication rate. We conclude that a pericranial flap can be used for skull base reconstruction even if postoperative radiotherapy is planned but might be avoided for patients who have received preoperative radiotherapy. In addition, particular care and flap design should be taken to preserve sufficient vascularity when pericranial flaps are raised as laterally based and less feeding vessels as usual.
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