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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2023; 08(01): e18-e22
DOI: 10.1055/a-2003-9976
Original Article

Analysis of Flap Failures in Microvascular Head and Neck Reconstructions: 11-Year Single-Center Results

Daria Jokinen
1   Department of Plastic Surgery, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
,
Marika Kuuskeri
1   Department of Plastic Surgery, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
,
Mika Helminen
2   Tays Research Services, Tampere University Hospital and Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
,
Minna Kääriäinen
1   Department of Plastic Surgery, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
› Author Affiliations
Funding This study was funded by Tampere University Hospital Support Foundation.
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Abstract

Background Free flap reconstruction is the gold standard in head and neck reconstructions. The current article analyzes failed free flaps in the head and neck region during an 11-year period in a single center aiming to discover factors that could be influenced in order to reduce the risk for flap failure.

Methods During the 11-year study period, 336 patients underwent free flap reconstruction at Tampere University Hospital, Tampere, Finland. The patients' average age was 62 years (range 14–92 years). Note that 201 (61.5%) of the patients were women and 135 (38.5%) men. Medical records were reviewed for demographics, comorbidities, neoadjuvant and adjuvant therapies, free flap type, area of reconstruction, and intraoperative and postoperative complications. Statistical analyses were performed.

Results Ten (3%) of the 336 free flaps failed. Patients' age, comorbidities, smoking, dosage of anticoagulation, free flap type, or the location of the defect did not influence the risk of flap failure. All lost flaps were postoperatively followed by clinical monitoring only. In contrast, 89% of all flaps had both Licox (Integra LifeSciences Corp, NJ) and clinical follow-up postoperatively. In six (60%) of the failed cases, a second free flap surgery was performed as a salvage procedure, with a survival rate of 83.3%.

Conclusion Our free flap success rate of 97% is in accordance with that of other centers that perform head and neck reconstructions. According to our findings, free flap reconstructions can be successfully performed on elderly patients and patients with comorbidities. Smoking did not increase the flap loss rate. We encourage the use of other methods in addition to clinical monitoring to follow the flaps after head and neck free flap reconstructions. All flap types used have high success rates, and reconstruction can be conducted with the most suitable flaps for the demands of the defect.

Keywords

head and neck reconstruction - free flap - flap loss - complications - flap monitoring


Publication History

Received: 11 May 2022

Accepted: 31 October 2022

Accepted Manuscript online:
28 December 2022

Article published online:
21 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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