Head and neck reconstruction surgery with microvascular free tissue transfer performed by head and neck surgeons

Abstract

Reconstruction with microvascular free tissue transfer is useful for healing, appearance, and the preservation of function after head and neck cancer resection. Flap elevation, suturing, and vascular anastomosis are generally performed under microscopy by plastic surgeons. Since April 2017, however, this has been performed in our department by head and neck surgeons, except for the elevation of free jejunum. Here, we retrospectively evaluate this practice in 40 patients(41 flaps)undergoing treatment up to September 2019, focusing mainly on the perioperative period. There were 16 cases of primary tumors in the tongue and 12 cases in the hypopharynx, and almost all were advanced cancer. Pharyngolaryngoesophagectomy was performed in 13 cases, followed by subtotal tongue removal in 7 cases. Reconstruction materials consisted mainly of free jejunum in 12 cases and anterolateral thigh flap in 11 cases. Anastomosis with the pedicle was mainly done using the superior thyroid artery and internal jugular vein. Median operation time and blood loss were 603.5 minutes and 517.5ml, respectively. Intraoperative complications arose in 5 cases. Further, 17 cases had postoperative complications and reoperation was performed in 3 cases. No vascular thrombosis or leakage due to suture failure occurred. Although some points warrant improvement, performance was not significantly inferior to that in previous large studies.