Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases

Microvascular free tissue transfer has become a significant factor in the reconstruction of head and neck cancer patients. Various donor sites are available to enable anatomical and functional repair of a defect.

All free vascularized tissue transfers performed during the period from March 1982 to September 2000 were retrieved from this hospital's database and analysed with regard to the surgical defect, chosen donor site and complications.

During the 18-year period a total of 1,164 patients with head and neck cancer were treated in this institution. A total of 500 free-flap reconstructions were performed for 479 patients. In the majority of patients (n = 451) reconstruction was indicated following ablative tumour surgery. With regard to donor site selection, the first choice of free jejunum was used in 181 patients, followed by the radial forearm flap in 140 patients. Among the 500 free-flap reconstructions, a total flap loss rate of 6% was observed. Patient age (p = 0.004) and tobacco use (p = 0.043) were significant risk factors for complications overall, whereas patient age (p = 0.021) and operating time (p = 0.043) were significantly correlated with local complications.

Immediate repair of head and neck defects using free tissue transfer is a successful and reliable method and is becoming the gold standard at many institutions. The complication rate is low once experience with these techniques has been acquired.