Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection

Area of Science:

• Plastic Surgery
• Head and Neck Oncology
• Reconstructive Surgery

Background:

• Head and neck cancer often requires extensive surgical resection, leading to complex defects.
• Reconstruction of these defects is crucial for restoring function and aesthetics.
• Free tissue transfer offers a versatile solution for large and complex reconstructions.

Purpose of the Study:

• To evaluate the efficacy and outcomes of free tissue transfer in head and neck oncology over a 13-year period.
• To analyze the success rates, complications, and common donor sites used in this patient cohort.

Main Methods:

• Retrospective review of 728 free flaps performed in 698 patients undergoing head and neck cancer surgery.
• Categorization of recipient sites by anatomical region (mandible, midface/orbit, hypopharynx, oral cavity, skull base, scalp).
• Analysis of flap success rates, reexploration for vascular compromise, flap loss, and overall complication rates.

Main Results:

• An overall free flap success rate of 98.6% was achieved.
• The overall complication rate was 17.5%, with 10.9% of flaps requiring reexploration for vascular compromise and 1.4% being lost.
• The forearm, fibula, rectus, and jejunum flaps were utilized in 92% of cases, serving as the primary donor sites.

Conclusions:

• Free tissue transfer is a highly effective and reliable method for reconstructing oncological defects in the head and neck.
• The forearm, fibula, rectus, and jejunum flaps are established as the preferred donor sites for the majority of head and neck reconstructions.
• The study confirms the long-term efficacy of free tissue transfer in managing complex head and neck oncologic defects.