A Longitudinal Assessment of Patient Satisfaction Following Head and Neck Free Flap Reconstruction

Long-term aesthetic outcomes following head and neck (HNC) microvascular free flap reconstruction are poorly understood. As patient survival improves for HNC, it is critical to understand the impact of surgical treatment upon aesthetic outcomes over the patient's life course.

Four hundred and fifty-six web-based surveys were prospectively collected at a tertiary care center (June 2018-July 2024). Three FACE-Q scales were used to evaluate patient-reported outcomes: Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress, and Social Function scales. A retrospective chart review was conducted to collect demographic and comorbidity data.

Two hundred and forty-seven subjects (age: 64.65 ± 14.46) were divided into 3 cancer subsite groups: oral cavity (n = 146), cutaneous (n = 42), and other (n = 59). FACE-Q scores remained largely stable across postoperative time points, with no statistically significant difference between time intervals across subsites. Significant differences were found across subsites for facial satisfaction (p = 0.010): cutaneous, 30.1 ± 8.5, oral cavity, 27.5 ± 8.8, and other subsites, 25.7 ± 9.0; social function (p < 0.001): cutaneous 25.5 ± 6.1, oral cavity 21.6 ± 7.1, and other subsite 20.9 ± 6.9; and stress (p = 0.001): cutaneous, 13.6 ± 6.0, oral cavity, 16.3 ± 7.4, and other subsites, 17.7 ± 7.3.

The findings suggest that patients who undergo head and neck microvascular reconstruction may be more resilient to aesthetic outcomes than previously anticipated, as they return to pre-operative baselines. Findings also reveal that reconstructive site is significantly related to postoperative aesthetic satisfaction.