Arch Craniofac Surg.  2021 Feb;22(1):38-44. 10.7181/acfs.2020.00745.

Head and neck reconstruction using free flaps: a 30-year medical record review

• Suh JM
• Chung CH
• Chang YJ

• KMID: 2513728
• DOI: http://doi.org/10.7181/acfs.2020.00745

Abstract

Background
The free flap surgical method is useful for the reconstruction of head and neck defects. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 30 years.
Methods
Between 1989 and 2018, a total of 866 free flap procedures were performed on 859 patients with head and neck defects, including 7 double free flaps. The causes of vascular crisis and salvage rate were analyzed, and the total flap survival rate calculated among these patients. Additionally, the survival and complication rates for each flap type were compared.
Results
The 866 cases included 557 radial forearm flaps, 200 anterolateral thigh flaps, 39 fibular osteocutaneous flaps, and 70 of various other flaps. The incidence of the vascular crisis was 5.1%; its most common cause was venous thrombosis (52.3%). Salvage surgery was successful in 52.3% of patients, and the total flap survival rate was 97.6%. The success rate of the radial forearm flap was higher than of the anterolateral flap (p< 0.01), and the primary sites of malignancy were the tongue, tonsils, and hypopharynx, respectively.
Conclusion
The free flap technique is the most reliable method for head and neck reconstruction; however, the radial forearm free flap showed the highest success rate (98.9%). In patients with malignancy, flap failure was more common in the anterolateral thigh (5.5%) and fibular (5.1%) flaps.

Keyword

Free flaps; Head; Microsurgery; Neck; Reconstructive surgery