title: Review of 346 patients with free-flap reconstruction following head and neck surgery for neoplasm.
abstract: We present our 14-year experience of free tissue transfer following surgery for head and neck neoplasm. We evaluated 346 patients mean age 57 years, 65% had squamous cell carcinoma; the most frequent sites were oral cavity and mandible (168) craniomaxillo facial region (94) pharynx +/- cervical oesophagus and oropharyngostomes (84). In 327 (95%) cases the reconstruction was a success. Flap revision was necessary in 29 (8.4% of total) and recovery was successful in 10/29. Nine patients (2.6%) died perioperatively. Poor preoperative condition, previous treatment, and requirement for vein graft were significantly associated with increased risk of major complications after surgery. Cosmetic and functional outcomes were assessed on 1-10 scales: 69 and 77% of patients, respectively, had cosmetic and functional results in the 7-10 range, indicating successful outcome. Overall survival probabilities, estimated on 338 patients with malignant disease, were 53% at 2 years and 32% at 5 years. Most patients, but not all, had advanced disease stage, and 188 (54%) had recurrent disease. Hence, overall survival rates are acceptable and justify the use of complex reconstruction procedures in such patients.
authors.affiliation: Otorhinolaryngology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133 Milano, Italy. spodrecca@yahoo.it
authors.forename: S
authors.initials: S
authors.lastname: Podrecca
authors.forename: P
authors.initials: P
authors.lastname: Salvatori
authors.forename: M
authors.initials: M
authors.lastname: Squadrelli Saraceno
authors.forename: D
authors.initials: D
authors.lastname: Fallahdar
authors.forename: L
authors.initials: L
authors.lastname: Calabrese
authors.forename: G
authors.initials: G
authors.lastname: Cantù
authors.forename: R
authors.initials: R
authors.lastname: Molinari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002648:Child; D004954:Esthetics; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome