Evolution of Head and Neck Microvascular Reconstructive Strategy at an Academic Centre: An 18-Year Review

Abstract

Background A remarkable development through the evolution of free flap techniques has led to the modern reconstructive head and neck surgery. This study aimed to review experiences from head and neck free-flap reconstructions performed at our institution over an 18-year period. Methods Between 1995 and 2012, 594 free-flap operations were performed on 541 head and neck patients at the Department of Plastic Surgery, Helsinki University Hospital, Finland. We retrospectively recorded hospital chart data regarding patient demographics, tumor characteristics, surgical treatment, and outcome. Results The mean age of patients increased from 53 years (1995-2000) to 56 (2007-2012), while the gender distribution remained constant (60% males). The most commonly used flap type between 1995 and 2000 was radial forearm flap (50%), while during the periods of 2001 through 2006 and 2007 through 2012 the anterolateral thigh flap was the most common method (42 and 36%, respectively). The number of different flap types and flap combinations increased during these periods (15 flap types during 1995 through 2000; 17 flap types during 2001 through 2006; and 24 flap types during 2007 through 2012). Despite a wider range of flap options used during the period 2001 through 2012, the overall flap survival rate (97%) remained constant. The prevalence of surgical complications decreased from 26% (2001 through 2006) to 21% (2007 through 2012). Conclusions During the study period, the number of flap types increased and reconstructions became more individualized. The overall surgical complication rate decreased although the mean age of patients increased.

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

“…When a lesion also involves the tongue, the optimal reconstructive method should combine satisfactory structural cosmesis with good restoration of function of speech and swallowing. Opinions around optimal flap choice continues to be divided a study by Husso et al (2) demonstrated that the number of different flap types and flap combinations increased between 1995 and 2012 from 15 to 24 in the 5 year periods analyzed.…”

NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

“…Of these, 2 flaps were nonviable, which is consistent with current national data. 5 , 7 , 24 , 25 Nine patients required feeding tube insertion during the course of admission. This highlights the importance of preoperative assessment of postoperative swallowing function and wound status to avoid unnecessary second surgeries and prolonged LOS.…”

“…However, our free flap results are consistent with the published experiences from other centers. 24 , 25 , 29 …”

Risk Factors for and Cost Implications of Free Flap Take‐backs: A Single Institution Review

“…With recent advances in microsurgical techniques, MFTT is now performed with success rates at major centers consistently in excess of 95%, 1 even for elderly patients. 2,3 MFTT offers improved functional recovery 4 and greater improvement in postoperative quality of life when compared to locoregional flaps. 5 Due to these improvements, flaps with limited donor site morbidity, such as the anterior lateral thigh (ALT) flap, have been used with increasing frequency using less stringent indications.…”