Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction.
BACKGROUND
The purpose of this study was to analyze the causes of flap compromise and failure in head and neck free flap reconstruction.


METHODS
We retrospectively reviewed 1310 free flap reconstructions for head and neck defects performed between July 1995 and June 2006.


RESULTS
Forty-nine cases of flap compromise due to vascular obstruction (3.7%) were identified, and 27 flaps were lost (2%). Arterial occlusions occurred in 12 flaps, with a salvage rate of 33%. Eight flaps failed within the first 24 hours, and only 1 of these was salvageable. Five of the 8 flaps had intraoperative thrombosis due to technical difficulties. Venous occlusions occurred in 31 flaps, with a salvage rate of 58%. Twenty-two venous occlusions occurred within the first 72 hours. The main reason for venous failure was mechanical obstruction due to compression, twisting, kinking, or stretching of the vein. The most common cause of late failures (after 7 days) was unrecognized failure of a buried flap owing to the lack of reliable monitoring. Overall, there was no correlation between surgeon experience and flap failure, but the flap failure rate was lower in surgeons who had performed more than 70 free flap procedures.


CONCLUSIONS
Precise surgical techniques, avoidance of mechanical obstruction, and better monitoring of buried flaps may further improve the success rate of free tissue transfer in complex head and neck reconstruction.
Yu
Peirong
P
Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. peirongyu@mdanderson.org
Chang
David W
DW
Miller
Michael J
MJ
Reece
Gregory
G
Robb
Geoffrey L
GL
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply; D013927:Thrombosis / Q000209:etiology; D017211:Treatment Failure; D014652:Vascular Diseases / Q000453:epidemiology; D055815:Young Adult