Free flap failure in head and neck reconstruction

Area of Science:

• Head and Neck Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Free flap reconstruction is a common method for head and neck defects.
• Flap loss can occur, necessitating further surgical intervention.
• Understanding causes and outcomes of flap loss is crucial for improving patient care.

Purpose of the Study:

• To identify the causes of head and neck free flap loss.
• To evaluate the success and functional outcomes of subsequent microvascular and non-microvascular reconstructions following free flap failure.

Main Methods:

• Retrospective review of patients who experienced free flap loss between 2000 and 2012.
• Analysis of initial flap loss rates and outcomes of secondary reconstructions (free flap vs. pedicled flap).

Main Results:

• The study identified 40 free flap losses out of 3090 cases (1.3% incidence).
• Subsequent free flap reconstruction in 28 patients achieved a high success rate (96.4%), comparable to initial rates.
• Patients undergoing subsequent free flap reconstruction for oral/pharyngeal defects showed superior speech intelligibility (>80%) and tube feed independence (87.5%) compared to those receiving pectoralis major flaps (42.9% speech, 25.0% tube feed independence).

Conclusions:

• Successful outcomes can be achieved with subsequent free flap reconstruction in selected patients following initial free flap loss.
• Functional results, including speech and swallowing, are significantly better with secondary free flaps compared to pedicled flaps like the pectoralis major flap.