Controversies in free tissue transfer for head and neck cancer: A review of the literature

Abstract

Background Microvascular free tissue transfer provides superior functional outcomes when reconstructing head and neck cancer defects. Careful patient selection and surgical planning is necessary to ensure success, as many preoperative, intraoperative, and postoperative patient and technical factors may affect outcome. Aims To provide a concise, yet thorough, review of the current literature regarding free flap patient selection and management for the patient with head and neck. Materials and Methods PubMed and Cochrane databases were queried for publications pertaining to free tissue transfer management and outcomes. Results Malnutrition and tobacco use are modifiable patient factors that negatively impact surgical outcomes. The use of postoperative antiplatelet medications and perioperative antibiotics for greater than 24 hours have not been shown to improve outcomes, although the use of clindamycin alone has been shown to have a higher risk of flap failure. Liberal blood transfusion should be avoided due to higher risk of wound infection and medical complications. Discussion There is a wide range of beliefs regarding proper management of patients undergoing free tissue transfer. While there is some data to support these practices, much of the data is conflicting and common practices are often continued out of habit or dogma. Conclusion Free flap reconstruction remains a highly successful surgery overall despite as many different approaches to patient care as there are free flap surgeons. Close patient monitoring remains a cornerstone of surgical success.

Efficacy of Negative Pressure Wound Therapy (NPWT) Monitoring System for Postoperative Flap Management in Diabetic Foot Patients

“…The rst 24 h after free ap procedures are crucial for monitoring, detecting, and (planning for) managing complications [38,39]. Frequent ap monitoring is regarded as ideal for ap salvage [40], but the requisite short monitoring intervals and time-consuming steps involved in conventional postoperative ap monitoring are burdensome. Moreover, aps are susceptible to infection and vascular injury, which can lead to hematoma and seroma formation [41].…”

Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap

“…Oral surgical reconstructive procedures have always been both fascinating and challenging for reconstructive surgeons. Extensive complex defects involving the mucosa, muscle, and bone often require radical approaches, including the use of composite revascularized flaps [ 2 , 3 ]. Small-to-medium defects are best covered with local flaps, such as temporalis muscle or temporalis fascia flaps.…”

“…Facial contours and tissues have been corrected using a variety of surgical reconstructive procedures, including autogenous bone and cartilage grafts, fat, muscle, alloplastic materials, and microvascular free flaps [ 1 , 2 , 3 , 4 ]. The gold standard for both soft tissue and bony reconstruction of large head and neck surgical defects is the microvascular free flap [ 2 , 3 ]. Although head and neck reconstructive surgery has achieved excellent results, the shortcomings of such methods have prompted a search for improvements.…”

The Early Effects of Coronavirus Disease-2019 on Head and Neck Oncology and Microvascular Reconstruction Practice: A National Survey of Oral and Maxillofacial Surgeons Enrolled in the Head and Neck Special Interest Group

“…The superiority of free microvascular tissue transfer (FMTT) to pedicled regional flaps and local flaps has been debated in the literature but is considered the gold standard for reconstructing head and neck defects arising from complex oncologic ablative procedures. 2 , 3 , 4 , 5 Abouyrad et al 2 conducted a literature review of free tissue transfer management and outcomes and concluded that FMTT remains highly successful despite the lack of consensus regarding the care of patients receiving FMTT.There are many reasons FMTT is considered the gold standard for head and neck reconstruction; first, these defects arising from head and neck ablation are complex, and they tend to involve multiple anatomic subunits and have proximity to vital structures, and the ultimate goal is to restore preablative form and function. Success rates of FMTT vary in the literature, reaching 95 to 97% irrespective of the setting of FMTT being performed at, such as academic institutions or a community hospital.…”