A Ten-Year Experience of Multiple Flaps in Head and Neck Surgery: How Successful Are They?
Gary RossErik Ang S.W.Declan A. LannonPatrick AddisonAlex GolgerChristine B. NovakJoan E. LipaPatrick GullanePeter C. Neligan
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Abstract:
Ablative surgery in the head and neck often results in defects that require free flap reconstruction. With improved ablation/reconstructive and adjuvant techniques, improved survival has led to an increase in the number of patients undergoing multiple free flap reconstruction. We retrospectively analyzed a single institution’s 10-year experience (August 1993 to August 2003) in free flap reconstruction for malignant tumors of the head and neck. Five hundred eighty-two flaps in 534 patients were identified with full details regarding ablation and reconstruction with a minimum of 6-month follow-up. Of these 584 flaps, 506 were for primary reconstruction, 50 for secondary reconstruction, 12 for tertiary reconstruction, and 8 patients underwent two flaps simultaneously for extensive defects. Overall flap success was 550/584 (94%). For primary free flap surgery, success was 481/506 (95%), compared with 44/50 (88%) for a second free flap reconstruction and 9/12 (75%) for a third free flap reconstruction (p < 0.05). Eight extensive defects were reconstructed with 16 flaps, all of which were successful. More than one free flap may be required for reconstruction of head and neck defects, although success decreases as the number of reconstructive procedures increases.Keywords:
Free flap reconstruction
Reconstructive Surgery
Free flap reconstruction
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Microvascular surgery
Free flap reconstruction
Reconstructive Surgeon
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Free flap reconstruction
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Free-flap microvascular surgery of the head and neck is now an accepted reconstructive technique. Optimal reconstruction of both function and form are achieved in selected patients by this method. We describe our experience with free-flap reconstruction of head and neck defects in 13 patients. In 5 oncologic patients reconstruction was immediate, while in 8 other oncologic and trauma patients it was delayed. The free rectus abdominis myocutaneous flap was used most often. 3 flaps required revision, but only 1 failed.
Free flap reconstruction
Form and function
Oncologic surgery
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Purpose: Free tissue transfer, pioneered in late 1970s, revolutionized reconstruction of defects created by surgical extirpation of head and neck cancers. Over the subsequent decades an enormous experience with these techniques has been gained. We report our experience of head and neck free flap reconstruction at Auckland Head and Neck unit. Methodology: Operative and clinical notes of all head and neck free flap reconstructions from Jan 1999 to 2008 were reviewed. The techniques, flap survival and complications are discussed. Results: During the ten year period, total of 320 free flap reconstructions were performed for 294 patients. Of these, 16 patients had two flaps, five patients had three flaps, and these were performed for recurrence of disease, flap losses, and complex defects. Radial forearm flaps were most commonly performed to reconstruct soft tissue defects, particularly in oral cavity defects; whereas bony defects were most commonly reconstructed with fibular flaps. Postoperatively 19 patients (5.9%) were explored for vascular compromise with 84% salvage rate. 14 flap (4.4%) loss was reported, total loss in 8 flaps, the overall flap survival rate was 95.6%. Conclusion: Free flap reconstruction have been performed with high standard at Auckland Head and Neck unit, our results are comparable to other international units.
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The purpose of this study was to determine the causes of head and neck free flap loss and to evaluate outcomes after subsequent microvascular and non-microvascular reconstruction.Patients who experienced free flap loss between 2000 and 2012 were reviewed.There were 40 flap losses out of 3090 free flaps (1.3%). Twenty-eight patients underwent subsequent free flap reconstruction of which 27 free flaps were successful (96.4%), which was not significantly different from our initial flap success rate (p = .81). Of patients who underwent subsequent free flap reconstruction for oral/pharyngeal defects, 100% had >80% speech intelligibility and 87.5% were tube feed independent. By comparison, 42.9% of patients who underwent subsequent pectoralis major flap reconstruction had intelligible speech (p = .01) and 25.0% were independent of tube feeds (p = 0.02).Subsequent free flaps after initial free flap losses can be successful in selected patients. Functional outcomes after subsequent free flap reconstruction are favorable compared to pedicled flap reconstruction.
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Microvascular surgery
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Abstract The lateral arm free flap (LAFF) has been chosen by some head and neck reconstructive microsurgeons to be their fasciocutaneous free flap of choice. The qualities of this flap have been suggested to include its consistent vascular anatomy, its thin and pliable nature, and its reinnervation capabilities, as well as its low donor site morbidity and ease of closure. During the past year we have performed 14 head and neck reconstructions using the extended LAFF (ELAFF). We present our indications for its use and review its shortcomings. Although the ELAFF does have its limitations, including variability in its flap thickness and donor vessel size, it unquestionably is an important flap in head and neck reconstruction and is our flap of choice for soft tissue reconstruction.
Reinnervation
Free flap reconstruction
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