ABSTRACT
Introduction: Microvascular free flap transfers have become a preferred reconstructive technique; however, rare complications may still prove devastating. Objective: The objective of this study was to evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions. Patients and Methods: This study analyzed the surgical outcome and complications of 200 microvascular free flaps head and neck reconstruction. In most cases, reconstruction was undertaken after resection of a malignant tumor. Four types of free flap were performed as follows: Anterolateral thigh (80%), radial forearm (15%), fibula (4%), and jejunum (1%). The superior thyroid artery and the external jugular vein were commonly used as recipient vessels for anastomosis. Patient-related characteristics (age, sex, diagnosis, comorbidity, level, tumor stage, defect site, primary versus secondary reconstruction, and history of surgery, radiation therapy, or chemotherapy) and the incidence of perioperative complications were recorded prospectively. Results: Nine patients required emergency surgical reexploration and the overall flap success rate was 95.3%. Venous thrombosis was the most common cause for reexploration. Other complications included wound infection (12.5%), wound dehiscence (15%), partial flap necrosis (2.5%), fistula formation (9.5%), and bleeding (1.5%). Recipient and donor site morbidity was limited and considered acceptable. Conclusion: Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained. We conclude that early reexploration should be the first choice for the management of vascular compromised flaps.
KEYWORDS:Free flap, Head and neck region, Microvascular.