Free Flap Procedures for Reconstruction After Head and Neck Cancer

Abstract

Patients with head and neck cancer are seeking improved surgical procedures to avoid severe defects that result from head and neck cancer resection. Free flap reconstruction provides vascularized tissue that has been transferred from a distant donor site on a patient's body to a recipient site, markedly improving wound closure and protecting structures of the head and neck. This article discusses free flap procedures for reconstruction after head and neck cancer resection, including the following procedure phases: airway protection and neck dissections, tumor resection, flap harvest, microvascular anastomosis of the flap, and reconstruction and closure. The article also explains specific risk factors for patients undergoing free flap procedures that have been identified in the literature and include procedure length, hypothermia, and pressure injuries. Each of these factors is discussed regarding its specific effect on this patient population, and the nursing interventions to reduce these risks are identified.

Review of surgical resection and reconstruction in head and neck cancer

“… 45 In the late 1950s, the first free flap procedure, which involved the removal of tissue from the donor site and transplantation in another site of the body with anastomosis of the vessels, was performed. 46 , 47 …”

“…Several soft tissue flaps can be harvested from several sites of the patient’s body, like the radial forearm, lateral arm, ulnar forearm, anterolateral or lateral thigh, latissimus, dorsi, jejunum, omentum, rectus abdominis, scapula, and temporal parietal fascia. 47 , 69 , 70 Some axial regional pedicle flap may be preferred because microvascular anastomosis is not necessary and shorter harvesting times are needed for this technique compared with the free flap procedure, such as latissimus dorsi and pectoralis major myocutaneous flaps; however, but the bulkiness and inflexibility of these flaps makes them inferior to the vascularized radial free forearm flap. 71 …”

Optical monitoring of transplanted free flaps using an implantable near-infrared spectroscopy sensor

“…Among these complications, the most devastating ultimate outcome for the patient is total flap failure. [3][4][5] The most common etiology for free flap failure is FTT perfusion disruption, mainly due to venous and arterial thrombosis, with venous thrombosis occurring twice as often. 4,6 Although flap failure occurs in less than 5% of free flap reconstructions, it can be extremely traumatic for the patient and greatly increase patient morbidity due to poor functional and aesthetic results.…”