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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
› Institutsangaben 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


Publikationsverlauf

Eingereicht: 11. Mai 2022

Angenommen: 31. Oktober 2022

Accepted Manuscript online:
28. Dezember 2022

Artikel online veröffentlicht:
21. Februar 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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  • References

  • 1 Jones NF, Johnson JT, Shestak KC, Myers EN, Swartz WM. Microsurgical reconstruction of the head and neck: interdisciplinary collaboration between head and neck surgeons and plastic surgeons in 305 cases. Ann Plast Surg 1996; 36 (01) 37-43
    CrossrefPubMedGoogle Scholar
  • 2 Mäkitie A, Aitasalo K, Pukander J. et al. Microvascular free flaps in head and neck cancer surgery in Finland 1986-1995. Acta Otolaryngol Suppl 1997; 529 (529) 245-246
    CrossrefPubMedGoogle Scholar
  • 3 Disa JJ, Cordeiro PG, Hidalgo DA. Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases. Plast Reconstr Surg 1999; 104 (01) 97-101
    CrossrefPubMedGoogle Scholar
  • 4 Ross GL, Ang ES, Lannon D. et al. Ten-year experience of free flaps in head and neck surgery. How necessary is a second venous anastomosis?. Head Neck 2008; 30 (08) 1086-1089
    CrossrefPubMedGoogle Scholar
  • 5 Ichinose A, Terashi H, Nakahara M. et al. Do multiple venous anastomoses reduce risk of thrombosis in free-flap transfer? Efficacy of dual anastomoses of separate venous systems. Ann Plast Surg 2004; 52 (01) 61-63
    CrossrefPubMedGoogle Scholar
  • 6 Nuara MJ, Sauder CL, Alam DS. Prospective analysis of outcomes and complications of 300 consecutive microvascular reconstructions. Arch Facial Plast Surg 2009; 11 (04) 235-239
    CrossrefPubMedGoogle Scholar
  • 7 Shanker MK, Rajan A, Hemant B, Kumar DA. Outcome of 1000 free flap head and neck reconstructions at a tertiary cancer care institute in India. Eur J Plast Surg 2020; 44 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 8 Corbitt C, Skoracki RJ, Yu P, Hanasono MM. Free flap failure in head and neck reconstruction. Head Neck 2014; 36 (10) 1440-1445
    CrossrefPubMedGoogle Scholar
  • 9 Kuuskeri M, O'Neill AC, Hofer SO. Unfavorable results after free tissue transfer to head and neck: lessons based on experience from the University of Toronto. Clin Plast Surg 2016; 43 (04) 639-651
    CrossrefPubMedGoogle Scholar
  • 10 Neligan PC. Head and neck reconstruction. Plast Reconstr Surg 2013; 131 (02) 260e-269e
    CrossrefPubMedGoogle Scholar
  • 11 Ma CY, Ji T, Ow A. et al. Surgical site infection in elderly oral cancer patients: is the evaluation of comorbid conditions helpful in the identification of high-risk ones?. J Oral Maxillofac Surg 2012; 70 (10) 2445-2452
    CrossrefPubMedGoogle Scholar
  • 12 Ferrari S, Copelli C, Bianchi B. et al. Free flaps in elderly patients: outcomes and complications in head and neck reconstruction after oncological resection. J Craniomaxillofac Surg 2013; 41 (02) 167-171
    CrossrefPubMedGoogle Scholar
  • 13 Tarsitano A, Pizzigallo A, Sgarzani R, Oranges CM, Cipriani R, Marchetti C. Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure?. Acta Otorhinolaryngol Ital 2012; 32 (06) 371-375
    PubMedGoogle Scholar
  • 14 Bridger AG, O'Brien CJ, Lee KK. Advanced patient age should not preclude the use of free-flap reconstruction for head and neck cancer. Am J Surg 1994; 168 (05) 425-428
    CrossrefPubMedGoogle Scholar
  • 15 Shestak KC, Jones NF. Microsurgical free-tissue transfer in the elderly patient. Plast Reconstr Surg 1991; 88 (02) 259-263
    CrossrefPubMedGoogle Scholar
  • 16 Macnamara M, Pope S, Sadler A, Grant H, Brough M. Microvascular free flaps in head and neck surgery. J Laryngol Otol 1994; 108 (11) 962-968
    CrossrefPubMedGoogle Scholar
  • 17 Kroll SS, Schusterman MA, Reece GP. et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg 1996; 98 (03) 459-463
    CrossrefPubMedGoogle Scholar
  • 18 Andre K, Schraub S, Mercier M, Bontemps P. Role of alcohol and tobacco in the aetiology of head and neck cancer: a case-control study in the Doubs region of France. Eur J Cancer B Oral Oncol 1995; 31B (05) 301-309
    CrossrefPubMedGoogle Scholar
  • 19 Jethwa AR, Khariwala SS. Tobacco-related carcinogenesis in head and neck cancer. Cancer Metastasis Rev 2017; 36 (03) 411-423
    CrossrefPubMedGoogle Scholar
  • 20 Wyss AB, Hashibe M, Lee YA. et al. Smokeless tobacco use and the risk of head and neck cancer: pooled analysis of US studies in the INHANCE consortium. Am J Epidemiol 2016; 184 (10) 703-716
    CrossrefPubMedGoogle Scholar
  • 21 Lewin F, Norell SE, Johansson H. et al. Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck: a population-based case-referent study in Sweden. Cancer 1998; 82 (07) 1367-1375
    CrossrefPubMedGoogle Scholar
  • 22 Hashibe M, Brennan P, Chuang SC. et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev 2009; 18 (02) 541-550
    CrossrefPubMedGoogle Scholar
  • 23 Schusterman MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994; 93 (03) 472-478 , discussion 479–480
    CrossrefPubMedGoogle Scholar
  • 24 Hatcher JL, Sterba KR, Tooze JA. et al. Tobacco use and surgical outcomes in patients with head and neck cancer. Head Neck 2016; 38 (05) 700-706
    CrossrefPubMedGoogle Scholar
  • 25 Fortin A, Wang CS, Vigneault E. Influence of smoking and alcohol drinking behaviors on treatment outcomes of patients with squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys 2009; 74 (04) 1062-1069
    CrossrefPubMedGoogle Scholar
  • 26 Browman GP, Wong G, Hodson I. et al. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 1993; 328 (03) 159-163
    CrossrefPubMedGoogle Scholar
  • 27 Chen AM, Chen LM, Vaughan A. et al. Tobacco smoking during radiation therapy for head-and-neck cancer is associated with unfavorable outcome. Int J Radiat Oncol Biol Phys 2011; 79 (02) 414-419
    CrossrefPubMedGoogle Scholar
  • 28 Hoff CM, Grau C, Overgaard J. Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma–a prospective study. Radiother Oncol 2012; 103 (01) 38-44
    CrossrefPubMedGoogle Scholar
  • 29 Choi SH, Terrell JE, Bradford CR. et al. Does quitting smoking make a difference among newly diagnosed head and neck cancer patients?. Nicotine Tob Res 2016; 18 (12) 2216-2224
    CrossrefPubMedGoogle Scholar
  • 30 Yoshimoto S, Kawabata K, Mitani H. Factors involved in free flap thrombosis after reconstructive surgery for head and neck cancer. Auris Nasus Larynx 2010; 37 (02) 212-216
    CrossrefPubMedGoogle Scholar
  • 31 Copelli C, Tewfik K, Cassano L. et al. Management of free flap failure in head and neck surgery. Acta Otorhinolaryngol Ital 2017; 37 (05) 387-392
    CrossrefPubMedGoogle Scholar
  • 32 Benatar MJ, Dassonville O, Chamorey E. et al. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg 2013; 66 (04) 478-482
    CrossrefPubMedGoogle Scholar
  • 33 Choi JW, Kim YC, Jeon DN. et al. Impact of recipient vein selection on venous patency and free flap survival in 652 head and neck reconstructions. J Reconstr Microsurg 2020; 36 (02) 73-81
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 34 Raittinen L, Pukander J, Laranne J. Early recognition of ischemia with continuous real-time tissue oxygen monitoring in head and neck microvascular flaps. Eur J Plast Surg 2012; 35 (07) 517-520
    CrossrefPubMedGoogle Scholar
  • 35 Blackwell KE. Unsurpassed reliability of free flaps for head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1999; 125 (03) 295-299
    CrossrefPubMedGoogle Scholar
  • 36 Ch'ng S, Skoracki RJ, Selber JC. et al. Osseointegrated implant-based dental rehabilitation in head and neck reconstruction patients. Head Neck 2016; 38 (Suppl 1): E321-E327
    CrossrefPubMedGoogle Scholar