Head and neck free flaps: Are they safe in the irradiated or pediatric patient?

Abstract

Forty‐three tissue transfers were performed in 41 patients for severe head and neck defects, no two of which were identical. Two thirds of the patients were in the pediatric age group (18 years or less), and 16 presented with severe radiation‐related defects. No bowel transfers are included in this group. The majority of the defects were complex, three‐dimensional defects in the cheek secondary to radiotherapy, surgery, or congenital defect. Free flaps were chosen to give the optimal aesthetic result and because they gave the best solution to the problem rather than the only solution. Total flap loss occurred in one patient, and partial loss occurred in two of the 43 flaps. No significant problems were encountered with either the radiotherapy or pediatric age group, although the complexity of the reconstruction was often greater. There were more flap‐related complications in the radiotherapy group, although these were all minor.

Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

“…However, systemic diseases that affect vessel condition, such as diabetes, hypertension, and arteriosclerosis, are very rare in children, creating a more favorable recipient environment for free flaps. 25 Additionally, benign tumor resection and trauma are dominant causes of head and neck defects in pediatric patients; thus, fewer patients have received radiotherapy preoperatively. This is also a factor that contributes to flap success because a history of irradiation is a potential risk factor for poor free flap survival in adults.…”

“…Recently, the use of microsurgery for free flap transfer is commonly used in head and neck reconstructions at many centers . Although free flap transfer in pediatric patients presents many challenges, there have been many series published in the past 20 years demonstrating the safety and reliability of free flap transfer in such patients and its increasing use in head and neck reconstruction …”

“…Although high success rates (range 90%–99%) have been reported for free flap transfers in pediatric head and neck reconstruction, few studies have investigated factors affecting free flap survival. So what factors influence pediatric free flap survival?…”

“…[1][2][3] Although free flap transfer in pediatric patients presents many challenges, there have been many series published in the past 20 years demonstrating the safety and reliability of free flap transfer in such patients [4][5][6][7][8][9][10][11][12][13][14][15][16][17] and its increasing use in head and neck reconstruction. 4,5,8,9,[17][18][19][20][21][22][23][24][25] Although high success rates (range 90%-99%) 4,5,8,9,[17][18][19][20][21][22][23][24][25] have been reported for free flap transfers in pediatric head and neck reconstruction, few studies have investigated factors affecting free flap survival. So what factors influence pediatric free flap survival?…”