Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions: A Systematic Review

Area of Science:

• Head and Neck Surgery
• Reconstructive Surgery
• Oncology

Background:

• Complex head and neck cancer defects often necessitate multiflap reconstructions.
• The patient outcomes and morbidity associated with these extensive surgical procedures require systematic review.

Purpose of the Study:

• To systematically review the literature on outcomes for patients undergoing large-scale head and neck resections requiring multiple-flap reconstructions.
• To characterize functional, aesthetic, survival, and cost-related outcomes.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane Review databases.
• Inclusion of studies reporting functional, aesthetic, survival, or cost outcomes for patients requiring >1 flap reconstruction.
• Assessment of study quality using MINORS criteria and modified Oxford Centre for Evidence-Based Medicine recommendations.

Main Results:

• Analysis of 24 studies (487 patients) revealed significant functional deficits (feeding tube dependence 24.8%, poor oral competence 29.3%, unintelligible speech 17.6%).
• Aesthetic dissatisfaction was reported by 14.1% of patients, with a mean survival of 2.36 years.
• High complication rates (88 minor, 185 major) and long hospital stays (mean 24.5 days) indicate substantial costs.

Conclusions:

• Multiflap reconstructions for complex head and neck defects present considerable morbidity, modest functional/aesthetic outcomes, and significant costs.
• Surgeons should carefully balance curative and palliative benefits against these outcomes.
• Preoperative patient counseling must emphasize realistic expectations regarding functional recovery and overall results.