Simplifying head and neck microvascular reconstruction.
BACKGROUND
Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources.


METHODS
This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital.


RESULTS
Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet.


CONCLUSIONS
This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results.
Rosenthal
Eben
E
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, 1501 5th Avenue South, Birmingham, AL 35249, USA. oto@uab.edu
Carroll
William
W
Dobbs
Mathew
M
Scott Magnuson
J
J
Wax
Mark
M
Peters
Glenn
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016025:Bone Transplantation; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation; D005542:Forearm / Q000098:blood supply / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011884:Radius / Q000098:blood supply / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome