Microvascular head and neck reconstruction in patients with liver cirrhosis.
BACKGROUND
The aim of this retrospective case series was to review the safety, complications, and outcomes of free-tissue transfer in head and neck cancer reconstruction in patients with liver cirrhosis.


METHODS
A retrospective review of all microvascular head and neck reconstruction cases with concomitant liver cirrhosis treated in our institution from 1994 to 2005 was performed. Data collected included patient demographics, etiology, and severity of liver cirrhosis, defect site, choice of free flap, complications, and clinical follow-up.


RESULTS
Seven patients were identified. They were all males and underwent microvascular head and neck reconstruction due to ablative cancer surgery. Their Child-Pugh classification of liver cirrhosis was graded as follows: Child A (n = 3); Child B (n = 3); and Child C (n = 1). Eight free flaps were transferred (1 patient received 2), including anterolateral thigh (n = 4); radial forearm (n = 3); and fibula (n = 1). All flaps survived without the need for any microvascular revision procedures. Two patients died within postoperative 30 days due to hepatic decompensation. Other complications included neck hematoma (n = 1), neck wound infection (n = 2), and donor site dehiscence (n = 1). Only 2 patients with Child A cirrhosis remained free from complications and survived more than 1 year after the surgery.


CONCLUSIONS
Microvascular head and neck reconstruction may be performed in patients with liver cirrhosis with a certain degree of technical success. However, the procedure is associated with significant mortality and morbidity in Child class B and C patients. Therefore, we recommend avoiding free-tissue transfer in patients with head and neck cancer with advanced liver cirrhosis.
Cheng
Nai-Chen
NC
Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
Ko
Jenq-Yuh
JY
Tai
Hao-Chi
HC
Horng
Shyue-Yih
SY
Tang
Yueh-Bih
YB
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D015996:Survival Rate