title: Microvascular head and neck reconstruction in patients with liver cirrhosis.
abstract: 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.
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
authors.forename: Nai-Chen
authors.initials: NC
authors.lastname: Cheng
authors.forename: Jenq-Yuh
authors.initials: JY
authors.lastname: Ko
authors.forename: Hao-Chi
authors.initials: HC
authors.lastname: Tai
authors.forename: Shyue-Yih
authors.initials: SY
authors.lastname: Horng
authors.forename: Yueh-Bih
authors.initials: YB
authors.lastname: Tang
mesh_terms: 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