Microvascular Free Flap Reconstruction for Head and Neck Defects

Abstract

\s=b\In a three-year period, 53 microvascular free-tissue grafts were performed on 51 patients to repair defects following major head and neck ablative surgery or trauma. The vast majority were done at the time of tumor resection. The remainder were done as secondary operations after resection or injury. The choice of free flap was dictated by the reconstructive needs of the patient and donor site availability. Fifty-two (98%) of 53 free\x=req-\ tissue transfers were successful with one failure resulting from venous thrombosis. Complications were noted in 16 of 53 flaps. The majority of these complications were in flaps used to replace bony defects or oropharyngeal resections. Although free flaps may appear to be more risky than traditional forms of reconstruction, they offer the surgeon a greater spectrum of reconstructive options. Limitations of the use of free flaps result only from lack of technical skills and specialized equipment.

Length of Stay After Free Flap Reconstruction of the Head and Neck

“…A combined medical and surgical complication rate of 30% to 35% has been reported by many authors. 9,13,14,18,19 Our overall complication rate of 31% is comparable. This high rate is related to the generally unhealthy population who develop head and neck cancer and the tremendous physiological stress of a 6‐ to 18‐hour surgical procedure.…”

Effect of operative time on complications associated with free flap reconstruction of the head and neck

“…Some of these factors cannot be modulated, however, head and neck microvascular reconstructions are typically long operations, where many components can be made more efficient. These include anaesthetic preparation time, surgical planning, equipment preparation, team communication and multi‐tasking, and concurrent flap harvest with tumour ablation, as well as innovations in harvest and anastomotic techniques, such as advanced sealing technology and venous coupler use 8,11,12,17 . In our institution we routinely performing concurrent flap harvest where possible and is likely to have the greatest impact on the duration of surgery.…”

“…These include anaesthetic preparation time, surgical planning, equipment preparation, team communication and multi-tasking, and concurrent flap harvest with tumour ablation, as well as innovations in harvest and anastomotic techniques, such as advanced sealing technology and venous coupler use. 8,11,12,17 In our institution we routinely performing concurrent flap harvest where possible and is likely to have the greatest impact on the duration of surgery. Several approaches make this option viable in a greater proportion of cases.…”

Risk of Microvascular Anastomosis Performed in Previous Treated Neck

“…11,12) Previous studies have shown that several factors are associated with reoperation and free flap failure, such as previous treatment at the anastomosis site, cardiovascular diseases such as hypertension, angina pectoris, arteriosclerosis, and diabetes. 8,10,13,15) However, in the head and neck, few authors have confirmed that the previous treatment is a risk factor for re-exploration after free flap reconstruction. 11,14) The identification of the risk of performing microvascular anastomosis in previously treated neck can help surgeons better consult with patients and make such risks predictable.…”