Clin Exp Otorhinolaryngol.  2015 Jun;8(2):167-173. 10.3342/ceo.2015.8.2.167.

Results of Free Flap Reconstruction After Ablative Surgery in the Head and Neck

• Kim H
• Jeong WJ
• Ahn SH

• KMID: 2360789
• DOI: http://doi.org/10.3342/ceo.2015.8.2.167

Abstract

OBJECTIVES
Due to the complex anatomy and function of the head and neck region, the reconstruction of ablative defects in this area is challenging. In addition, an increasing interest in improving the quality of life of patients and achieving good functional results has highlighted the importance of free flaps. The aim of this study was to summarize the results of free flap reconstruction and salvage of free flaps in a single institute, and to analyze differences in the results by the flap donor site, recipient site, and learning curve.
METHODS
The medical records of patients who underwent free flap reconstruction from 2004-2012 were reviewed retrospectively. One hundred and fifty free flaps were used in 134 patients, who had an average age of 57.7 years. The types of flaps applied, primary defect sites, success rates, results of salvage operations for compromised flap, and the learning curve were analyzed.
RESULTS
The anterolateral thigh flap was preferred for the reconstruction of head and neck defects. The overall success rate was 90.7%, with 14 cases of failure. A total of 19 salvage operations (12.7%) for compromised flap were performed, and 12 flaps (63.2%) were salvaged successfully. Dependency on the facial vessels as recipient vessels was statistically different when oral and oropharyngeal defects were compared to hypopharyngeal and laryngeal defects. The learning curve for microvascular surgery showed decrease in the failure rate after 50 cases.
CONCLUSION
The free flap technique is safe but involves a significant learning period and requires careful postoperative monitoring of the patient. Early intervention is important for the salvage of free flaps and for lowering the failure rate.

Keyword

Free Tissue Flaps; Head and Neck Neoplasms; Reoperation

MeSH Terms

Early Intervention (Education)
Free Tissue Flaps*
Head and Neck Neoplasms
Head*
Humans
Learning
Learning Curve
Medical Records
Neck*
Quality of Life
Reoperation
Retrospective Studies
Thigh
Tissue Donors

Figure

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  Fig. 1 Flaps selected in soft tissue or bony tissue defect reconstruction. (A) The anterolateral thigh flap was most commonly used among various fascio or musclocutaneous flap. (B) The fibular flap was chosen most frequently for the reconstruction of bony defect.

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  Fig. 2 Cases of failure and salvage according to the time of revision

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  Fig. 3 Cases of salvage and failure according to experience. (A) Failure and salvage rates for each 50 cases. (B) Cases of anterolateral thigh free flap (ALTFF) failure and salvage during the same period. (C) Cases of radial forearm free flap (RFFF) failure and salvage during the same period.

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