Abstract
Background Free flap reconstruction is the gold standard in head and neck reconstructions. The
current article analyzes failed free flaps in the head and neck region during an 11-year
period in a single center aiming to discover factors that could be influenced in order
to reduce the risk for flap failure.
Methods During the 11-year study period, 336 patients underwent free flap reconstruction
at Tampere University Hospital, Tampere, Finland. The patients' average age was 62
years (range 14–92 years). Note that 201 (61.5%) of the patients were women and 135
(38.5%) men. Medical records were reviewed for demographics, comorbidities, neoadjuvant
and adjuvant therapies, free flap type, area of reconstruction, and intraoperative
and postoperative complications. Statistical analyses were performed.
Results Ten (3%) of the 336 free flaps failed. Patients' age, comorbidities, smoking, dosage
of anticoagulation, free flap type, or the location of the defect did not influence
the risk of flap failure. All lost flaps were postoperatively followed by clinical
monitoring only. In contrast, 89% of all flaps had both Licox (Integra LifeSciences
Corp, NJ) and clinical follow-up postoperatively. In six (60%) of the failed cases,
a second free flap surgery was performed as a salvage procedure, with a survival rate
of 83.3%.
Conclusion Our free flap success rate of 97% is in accordance with that of other centers that
perform head and neck reconstructions. According to our findings, free flap reconstructions
can be successfully performed on elderly patients and patients with comorbidities.
Smoking did not increase the flap loss rate. We encourage the use of other methods
in addition to clinical monitoring to follow the flaps after head and neck free flap
reconstructions. All flap types used have high success rates, and reconstruction can
be conducted with the most suitable flaps for the demands of the defect.
Keywords
head and neck reconstruction - free flap - flap loss - complications - flap monitoring
