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Predictive Factors of Free Flap Volume Evolution in Head and Neck Reconstruction
Quentin Hennocq1,2, Jean-Baptiste Caruhel3, Mourad Benassarou2
1Sorbonne University, Paris, France.
Summary
Free flap volume changes in head and neck reconstruction can be predicted. Vein choice and microsurgical technique significantly impact flap volume evolution, guiding overcorrection strategies for better outcomes.
Area of Science:
- Plastic Surgery
- Head and Neck Reconstruction
- Microsurgery
Background:
- Free flaps are crucial for head and neck reconstruction.
- Predicting and managing volumetric changes in free flaps is essential for successful long-term outcomes.
- Understanding factors influencing flap volume evolution aids in surgical planning.
Purpose of the Study:
- To determine factors influencing total and bone volume changes in free flaps used for head and neck surgery.
- To establish volume change predictions over 30 months.
- To propose appropriate overcorrection percentages for different flap types.
Main Methods:
- Prospective study including 166 free flaps from August 2021 to January 2024.
- Collected data on patient, surgical, and treatment factors.
- Measured flap and bone volumes using CT and MRI; analyzed with multivariate mixed models.
Main Results:
- Volume loss was observed, with bone volume decreasing by 19-38% at 30 months depending on flap type (Fibula Free Flap, Deep Circumflex Iliac Artery, Scapular System Free Flap).
- Venous anastomosis using superior thyroid or lingual veins and small couplers correlated with negative volume changes.
- Patient characteristics and adjuvant treatments had less impact than surgical technique on volume evolution.
Conclusions:
- Recommended overcorrection of approximately 60% for fasciocutaneous/osteocutaneous flaps and 75% for muscle/osteomuscular flaps.
- Vein selection and microsurgical technique are critical determinants of free flap volume stability.
- Findings support tailored overcorrection strategies based on flap type and surgical approach.
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