title: Analysis of salvage treatments following the failure of free flap transfer caused by vascular thrombosis in reconstruction for head and neck cancer.
abstract: BACKGROUND
  Few authors have reported the subsequent treatment for patients in whom free tissue transfers in the head and neck have failed as a result of vascular thrombosis.
  
  
  METHODS
  Between 1993 and May of 2005, 502 free flaps were transferred after head and neck cancer ablation in the authors' hospital, 19 of which resulted in total necrosis caused by vascular thrombosis. The authors categorized these 19 cases into four groups and analyzed the salvage treatment.
  
  
  RESULTS
  For failed free jejunal transfer, early initiation of oral intake was obtained when another free jejunum was transferred. For failed free soft-tissue transfer for intraoral defects, reconstruction with common free (first choice) or pedicled flaps was used: a voluminous musculocutaneous flap for extensive defects, forearm flap or pedicled pectoralis major flap for intermediate defects, and direct closure for small defects of the oral floor. For failed secondary soft-tissue transfer to improve a certain function, salvage flap transfer was not chosen in the acute setting. For failed secondary maxillary reconstruction, simple reconstruction using the rectus abdominis musculocutaneous flap combined with costal cartilage achieved stable results. The overall success rate of the repeated free flap was 89 percent (eight of nine patients).
  
  
  CONCLUSIONS
  When a free flap is judged unsalvageable, surgeons should determine subsequent treatments, considering the success rate as one of the most important factors. The authors believe that simple reconstruction using a common free flap is the first choice in most cases. When regional or general conditions do not permit further free flap transfer or when defects are comparatively small, reconstruction with a pedicled flap or direct closure of the defect may be considered.
authors.affiliation: Tokyo, Mitaka, Moroyama, and Sendai, Japan From the Departments of Plastic and Reconstructive Surgery of Graduate School of Medicine, University of Tokyo; Kyorin University; Saitama Medical School; and Tohoku University.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Okazaki
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Asato
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takushima
authors.forename: Shunji
authors.initials: S
authors.lastname: Sarukawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakatsuka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamada
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D017211:Treatment Failure