Functional outcomes following secondary free flap reconstruction of the head and neck.
OBJECTIVE
To evaluate head and neck patients undergoing secondary (delayed) free flap reconstructions.


METHODS
Retrospective chart review.


METHODS
Of the 523 free flaps between October 2004 and May 2008, 70 patients underwent 71 secondary free flaps. Outcomes include: hospital stay, complications, flap operative time, enterogastric tube, and tracheostomy requirement. Variables assessed include donor site, indication, prior radiation, and extra-cervical vascular anastomosis.


RESULTS
Radial forearm (40.8%) and fibula free flaps (29.6%) were most commonly used. Mean hospital stay was 7.9 days, follow-up 23.5 months, and operative time 323 minutes. Complications occurred in 39.4% in hospital (early) and 31.4% after discharge (late). Many required further surgery (33.8%), tracheostomy at discharge (26.8%), and prolonged enterogastric tube feeding (31%). In-hospital mortality was 1.4%, total flap failure 1.4%, and partial failure 5.6%. The radial forearm required the least operative time (P = .002), and had least tracheostomies at discharge (P = .040). Osteocutaneous fibula took longest (P = .0001), and had the highest tracheostomy rate (P = .047). Early complications were highest with anterolateral thigh flaps (P = .001). Osteoradionecrosis resulted in higher tracheostomy rates at discharge (P = .0001). Osteocutaneous flaps took 111 minutes longer (P = .001), and required more tracheostomies on discharge (P = .031), but with lower fistula rates (P = .046). Previous irradiation and extra-cervical vessels did not significantly impact outcomes.


CONCLUSIONS
Secondary free flaps are technically feasible for head and neck reconstruction with low mortality and flap failure rates. The extra-cervical and external carotid vessels were equally effective. Patients considering semi-elective free flap reconstruction for osteoradionecrosis should be cautioned about complication rates and tracheostomy retention.
Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Tim A
TA
Iseli
Joshua C
JC
Yelverton
Claire E
CE
Iseli
William R
WR
Carroll
J Scott
JS
Magnuson
Eben L
EL
Rosenthal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005360:Fibula / Q000098:blood supply; D005542:Forearm / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007440:Intubation; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply; D013997:Time Factors; D014139:Tracheostomy / Q000706:statistics & numerical data; D016896:Treatment Outcome