title: Use of free flaps for reconstruction in head and neck surgery: a retrospective study of 182 cases.
abstract: OBJECTIVE
  In order to clarify the factors affecting the survival of flaps, we performed a retrospective study on free flaps (187) used for reconstruction in head and neck surgery in 182 patients.
  
  
  METHODS
  Free jejunum flaps were used on 68 occasions, rectus abdominus myocutaneous flaps on 67, radial forearm flaps on 49, scapular osteocutaneous flaps on 2 and latissimus dorsi myocutaneous flap on ones occasion, during the period from May 1996 to April 2003. Post-operative circulatory complications at the recipient site were analyzed mainly in relation to a history of previous surgery, radiotherapy and chemotherapy.
  
  
  RESULTS
  Circulatory crisis was observed in seven cases and circulation was restored in two of them after emergency exploration, whereas the other five flaps failed to survive. The overall failure rate of free flaps was 2.7%. Wound infection at the recipient site was frequent in patients with a history of previous local cervical surgery. Flap failure was significantly more frequent in patients with a history of previous surgery and infection, except for 2 patients in whose case the microsurgical technique was inadequate. Flap failure was not observed in those patients whose irradiation field could be analyzed, or in the patients who received chemotherapy. Although the incidence of circulatory crisis as a consequence of inadequate microsurgical technique was observed in the early period of this retrospective study, their frequency has diminished in the last 2 years.
  
  
  CONCLUSIONS
  The survival of flaps was affected by a history of previous surgery following wound infection, although a history of irradiation and chemotherapy would have no effects on flap failure. The appropriate choice of vessels and surgical skill are crucial for the success of free flaps from our experience. Emergency exploration was also crucial for the survival of the flap in the case of circulatory crisis.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo 113-8603, Japan. nakamizo@nms.ac.jp
authors.forename: Munenaga
authors.initials: M
authors.lastname: Nakamizo
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yokoshima
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply