Free tissue transfers in head and neck reconstruction: Complications, outcomes and strategies for management of flap failure: Analysis of 2019 flaps in single institute

Abstract

Background: Free tissue transfer has become the preferred option for complex reconstructions in head and neck cancer ablation. This study reviewed the surgical outcome and analyzed the evolution of microsurgical head and neck reconstruction over 20 years in single institute. Patients and Methods: A total of 1,918 patients underwent microsurgical head and neck reconstructions in 20-year period. The surgical outcome and complications among these 2,019 flaps (1,223 anterolateral thigh flaps, 372 fibula flaps, 353 radial forearm flaps, 12 jejunal flaps, and 59 others) were retrospectively reviewed and analyzed. Results: A total of 201 cases required emergent surgical reexploration and the overall flap success rate was 96.2%. Venous insufficiency was the most common cause for re-exploration. Other major complications included fistula formation (5.4%), partial flap necrosis (7.5%), and infection (17.8%). The fibula flap had frequent complications compared with soft tissue flaps. The familiarity to the ALT flap had minimized complications and allowed for widely versatile uses. Conclusion: Free tissue transfer is shown to be highly reliable option for head and neck reconstruction. For soft tissue defect, ALT flap is the first choice. Fibula flap is ideal for bone defect reconstruction. In case of complex composite defects, double flaps, which include ALT and fibula flaps could reconstruct bone and soft tissue defects simultaneously with high success rate. V C 2013 Wiley Periodicals, Inc. Microsurgery 34:339-344, 2014.

Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer

“…Consistent with our findings, Weber et al 6 demonstrated that negative performance indicators, including blood product transfusion, 30-day surgical site infection, return to the operating room, and death, were dependent on procedure acuity, individual surgeon skill, and comorbidity. Other studies have also found that greater procedure complexity increased a patient’s risk of developing complications, including neck dissection, 17,20,21 reconstruction, 20,22,23 and tracheotomy. 24,25 Surrogate operative markers of procedure complexity also increased this risk, including anesthesia time, 26–28 volume of intraoperative fluid administered, 26,29 and estimated blood loss.…”

A Novel Tube-Drainage Technique of Negative Pressure Wound Therapy for Fistulae after Reconstructive Surgery

“…12,13 However, if a fistula does develop and flap surgery is performed again to repair it, the risk of complications increases: these complications include infection, donor-site mobility, and flap necrosis, as well as formation of another fistula or relapse of the original fistula. 14 Indeed, McLean et al 15 reported that reconstruction surgery for fistula formation associates with high rates (35.3%) of fistula relapse.…”

Intraoperative Hemifacial Composite Flap Perfusion Assessment Using Spatial Frequency Domain Imaging

“…The risk of flap failure in head and neck free autologous tissue transfer has been reported at 3.8% and represents significant clinical morbidity. 8 Emergent surgical re-exploration is indicated for post-operative flap compromise, and is most often performed for venous or arterial insufficiency. 8,9 A majority of salvage procedures performed for vascular compromise in a recent series of autologous head and neck flaps were reported to be successful in preventing complete flap loss.…”

“…8 Emergent surgical re-exploration is indicated for post-operative flap compromise, and is most often performed for venous or arterial insufficiency. 8,9 A majority of salvage procedures performed for vascular compromise in a recent series of autologous head and neck flaps were reported to be successful in preventing complete flap loss. 8 Earlier identification of flap compromise and prompt re-exploration have led to improvement in rates of successful flap salvage.…”

“…8,9 A majority of salvage procedures performed for vascular compromise in a recent series of autologous head and neck flaps were reported to be successful in preventing complete flap loss. 8 Earlier identification of flap compromise and prompt re-exploration have led to improvement in rates of successful flap salvage. 10 The importance of early detection and salvage of facial allografts cannot be understated, as loss of the graft mandates removal, and may leave patients in a worse functional and aesthetic state than prior to transplantation.…”