Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure

Abstract

ree tissue transfer is considered the standard treatment for oncologic reconstruction of head and neck defects, as it has been shown to offer equivalent success rates of flap survival in comparison to regional flaps, with the advantage of optimizing function. [1][2][3][4] The overall rate of a successful free flap for head and neck reconstruction in large centers has been reported to be approximately 95%. 5 Nonetheless, outcomes are generally suboptimal if flaps present vascular complications requiring reexploration after primary Background: Finite options exist to address free flap failure. There is a lack of consensus on the standard treatment for secondary reconstruction in such cases. Herein, the authors determined the survival rate of a second flap following a total loss of an initial free flap during head and neck reconstructions and evaluated whether there was a difference in the rate of secondary flap necrosis depending on the timing of reconstruction salvage. Methods: The authors retrospectively reviewed 1572 free flaps for head and neck reconstruction from 2010 to 2022. Patients who underwent secondary surgery with flaps after failure of a primary free flap were included. Patients were divided into three groups based on the time for secondary flap reconstruction from the time of primary reconstruction (group A, 0 to 5 days; group B, 6 to 30 days; and group C, >30 days). Results: The authors identified 64 cases of complete flap loss after primary reconstruction requiring secondary reconstruction. Pedicled flaps were used in 34.4% of the cases, whereas a second free flap was used in 65.6% of the cases. Overall, the flap failure rate for secondary reconstructions was 6.7% in group A, 35.3% in group B, and 6.7% in group C (P = 0.022). For free tissue transfer, the success rate of a secondary reconstruction was 92.3% in group A, 28.57% in group B, and 93.3% in group C. Conclusions: The authors favor an early microsurgical reconstruction (≤5 days) following primary reconstruction in cases of free flap failure. If early reconstruction cannot be performed, a deferred reconstruction with free tissue transfer (>30 days) should be considered.

Intraoral Microvascular Anastomosis in Immediate Free Flap Reconstruction for Midfacial Tumor Defects: A Retrospective Multicenter Study

“…Additionally, there were three cases of partial failure, involving the skin of a medial femur, a rectus, and a scapula flap, necessitating revision of the anastomoses. Importantly, it is worth highlighting that these failures were not linked to the anastomosis technique itself, but rather the postoperative complications observed were consistent with those commonly encountered in conventional free flap procedures [32,33]. Furthermore, in line with the findings in the existing literature, it appears that intraoral anastomosis techniques exhibit suitability for a wide range of free flaps, without any distinct preferences among them [10,12].…”

Discussion: Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure

“…Although numerous studies aim to delineate potential risk factors to avoid such complications, the present study aims to provide evidence-based recommendations for managing patients who have experienced a total flap loss. 1 The authors examined 64 of 1572 patients undergoing microvascular reconstruction following squamous cell carcinoma resection, specifically focusing on the timing of secondary reconstruction following the flap failure. The authors demonstrate a significantly higher risk of complications when performing reconstruction between 5 and 30 days following the initial resection and free flap.…”