Second Free Flaps in Head and Neck Reconstruction
Ayman AminBonnie J. BaldwinAli GürlekMichael J. MillerSteven KrollGregory P. ReeceGregory R. D. EvansGeoffrey L. RobbMark A. Schusterman
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Abstract:
Over the past decade, free-tissue transfer has greatly improved the quality of oncology-related head and neck reconstruction. As this technique has developed, second free flaps have been performed for aesthetic improvement of the reconstructed site. This study evaluated the indications for and the success of second free flaps. Medical files for patients who underwent second free flaps for head and neck reconstruction at the University of Texas M.D. Anderson Cancer Center, from May 1, 1988 to November 30, 1996, were reviewed. The flaps were classified as being either immediate (done within 72 hr) or delayed (done within 2 years) reconstructions. Indications, risk factors, recipient vessels, outcome, and complications were analyzed. Of the 28 patients included in this study, 12 had immediate (nine as salvage after primary free flap failure, and three for reconstruction of a soft-tissue defect), and 16 had delayed second free flaps (two for reconstruction of a defect resulting from excision of recurrent tumors, and 14 for aesthetic improvement). Reconstruction sites included the oral cavity in 18 patients; the midface in six; the skull base in two; and the scalp in two. The success rate for the second free flaps was 96 percent. Five patients had significant wound complications. In a substantial number of cases, identical recipient vessels were used for both the first and second free flaps. The authors conclude that second free flaps can play an important role in salvaging or improving head and neck reconstruction in selected patients. In many cases, the same recipient vessels can be used for both the first and second flaps.Keywords:
Free flap reconstruction
Objective: To demonstrate the feasibility of double free flap surgery in head and neck reconstruction. Design: Descriptive case series.Setting: A university-affiliated hospital in Hong Kong
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Objective To review 100 consecutive free tissue transfers for head and neck reconstruction in a new microsurgery unit.Methods One hundred consecutive free tissue transfers performed in 96 patients from May 26,1999 to June 8,2000 were reviewed.Data concerning the operation included date of surgery,defect description and site,stage,flap type,recipient vessel and type of anastomosis used and complications.Results The free radial forearm flap was most commonly used,followed by free fibula flap,rectus abdominis flap,illiac crest flap,scapular flap,and latissumus dorsi flap.The overall success rate was 97%.The overall complication rate was 32%.The vessel thrombosis rate was 6 percent,and the flap salvage rate was 50 percent.Conclusion Free tissue fransfer in oral and maxillofacial region is safe and reliable.It is superior to the conventional pedicaled flap technique.
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Abstract Background The purpose of this clinical review was to assess the feasibility of reconstructing complex head and neck defects with 2 or more free flaps simultaneously. Methods A total of 38 articles were reviewed. The patient population included those who received 2 or more free flaps or a single free flap plus a locoregional flap. The primary outcome assessed was rate of complications. Results Among double flaps, the minor complication rate was 6.96% and the major complication rate was 20.0%. In comparison, the free flap plus locoregional flap group had higher rates of minor and major complications of 30.4% and 29.5%, respectively. The median operating time was 660 minutes for double flaps and 602 minutes for free flap plus locoregional flap ( P = .828). Conclusion Compared to the single free flap plus locoregional flap, double free flaps are relatively reliable without increasing surgical complications or decreasing flap survival, while only modestly increasing operating times.
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To analyze the value of free flap transfers in head and neck reconstruction.Five hundred and forty-five consecutive free flap transfers performed in 507 patients from May 1999 to September 2002 were reviewed. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel and complications.The free fibula flap was most commonly used, followed by free radial forearm flap, rectus abdominis flap, jejunum flap, scapular flap, illiac crest flap, latissimus dorsi flap, and anterolateral thigh flap. The overall success rate of flap was 98.2% (535/545). The overall complication rate was 25.2% (128/507). The vessel thrombosis rate was 4.8% (26/545), and the flap salvage rate was 61.5%(16/26).Free flap transfer in head and neck region is safe and reliable. It is superior to the conventional pedicled flap technique.
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Objective To analysis the results of different free flaps for reconstruction of head and neck defects.Methods From January,2010 to December,2013,243 free flaps were performed in 244 patients in this retrospective study.Evaluated parameters were defect localization,histology of tumor,free flap type,recipient vessels and complications.Results Total 243 free flaps were transplanted successfully except 6 flaps failured.The overall flap survival rate was approximately 97.6％.Thirty-three cases were encountered vascular complication,which rate was 5.2％.There were arterial crisis in 2 cases and venous crisis in 11 cases.Seven cases survived by explorative operation.The flap salvage rate was 54％.Seventy-three cases suffered local or systemic complications,and overall complication rate was 29.9％.The anterolateral thigh flap was most commonly used,followed by free fibula flap and free radial forearm flap.Conclusion Free flap is a reliable method for reconstruction of head and neck defect.
Key words:
Head and neck defect; Free flap; Reconstruction; Microsurgical operation
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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.
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PURPOSE: To analyze the reliability and safety of free flap transfers in head and neck reconstruction. METHODS: Two hundred consecutive free flap transfers performed in 194 patients from January of 2004 to December of 2004 were reviewed. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel and complications. RESULTS: Seven kinds of free flap were used in this series, they were free fibular flap, free radial forearm flap, free anterolateral thigh flap, free jejunal flap, free rectus abdominis flap, free scapular flap, and free latissimus dorsi flap. The overall success rate of free flap was 99.5%. The overall complication rate was 24.2%. The vessel thrombosis rate was 2%, and the flap salvage rate was 75%. CONCLUSIONS: Free flap in head and neck reconstruction is very safe and reliable. The success rate can reach nearly 100% if every precaution is taken before, during, and after operation.
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In Brief A retrospective analysis of 12 patients with a head and neck tumor recurrence within a previous free flap treated with extirpation and a second free flap is reported. A 15-year experience at Mayo Clinic, Rochester, from 1988 to 2003 of 12 patients (5 men, 7 women) who underwent 25 free flaps is reviewed. The overall flap survival rate was 92%, with a 100% survival rate in the first free-tissue transfer and 85% survival rate in the second free-tissue transfer. There was 1 minor complication (8%) and there were 2 major complications (15%) among the second free flaps. Overall, 10 of 13 (77%) second free flaps were anastomosed to ipsilateral neck vessels. Moreover, in 5 of 13 cases (38%) the same artery and in 7 of 13 cases (54%) the same vein were used for both the first and second free flaps. Reconstruction of the head and neck with a second free flap in patients with a recurrent tumor is safe and effective. The original recipient vessels can often be used for the second reconstruction. A retrospective analysis of 12 patients whose head and neck tumors required placement of a second freeflap into a local recurrence showed an 85% survival rate for the second flaps. The same recipient artery wasreused in 38% of the flaps and the same vein in 54%.
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