[Donor site choice for free flaps in head and neck reconstruction after tumor surgery]

To choose suitable free flaps for reconstructing head and neck defects caused by tumor resection.

A retrospective analyses was made in 86 cases of head and neck defects treated with four kinds of free flaps between January 1999 and January 2002. The head and neck defects were caused by tumor resection. The locations were oral cavity (n=32), hypopharynx (n=27), mandible (n=12), skull base (n=5), scalp and skin (n=6) and midface (n=4). The donor sites of free flaps included the rectus abdominis (n=32), anterolateral thigh (n=10), jejunum (n=25), fibula (n=11), latissimus dorsi (n=4), forearm (n=3) and scapula (n=1). The sizes of the cutaneous/musculocutaneous flaps ranged from 4 cm x 5 cm to 14 cm x 24 cm. The lengths of the fibula were 4-16 cm, of jejunum 9-20 cm.

The overall free flap success rate was 92% (79/86). Of 32 oral cavity defects, 22 were reconstructed by rectus abdominis (69%) and 10 by anterolateral thigh flaps (31%). Of 27 hypopharyngeal defects, 25 were restored by jejunum flaps (93%). Eleven of 12 mandibular defects were reconstructed by fibula flaps (92%). Four of 5 defects of skull base were reconstructed by rectus abdominis flaps (80%). The free flaps of rectus abdominis, anterolateral thigh, jejunum and fibula were most frequently used, accounting for 91% (78/86) of all flaps in head and neck defect reconstruction.

Although head and neck defects represent a complicated spectrum of subsites and loss, these four free flaps can manage most reconstruction problems.