Analysis of 59 cases with free flap thrombosis after reconstructive surgery for head and neck cancer.
OBJECTIVE
There have been few reports addressing methods of dealing with free flap thrombosis after reconstructive surgery for head and neck cancer. The present study, through a detailed analysis of the subsequent course of patients who developed postoperative flap thrombosis, aims to clarify possible methods of salvage surgery in the event of vascular occlusion despite rigorous postoperative follow-up.


METHODS
We analyzed 59 cases of postoperative thrombosis in 1031 patients who underwent free flap transfer and considered the most appropriate salvage surgery in the event of total flap necrosis.


RESULTS
The flap salvage rate through vascular reanastomosis was highest for radial forearm flaps, with salvage of jejunal flaps being problematic if postoperative thrombosis occurred. For cases of postoperative thrombosis among patients who underwent reconstruction using a jejunal flap, the period of hospitalization was significantly extended for those patients in whom a second jejunal flap grafting was impossible. For cases of postoperative thrombosis among patients who underwent reconstruction using a radial forearm flap (FA), rectus abdominis flap (RA), or anterior lateral thigh flap (ALT), no significant difference was observed between those undergoing re-grafting with a free flap and those with a pedicled flap.


CONCLUSIONS
We concluded that, among patients who undergo reconstruction using a jejunal flap, thrombosis should be discovered at an early stage to enable another jejunal flap re-grafting. For patients who undergo reconstruction using a FA, RA, or ALT, if thrombosis can be discovered at an early stage, there is a possibility of salvaging the flap by means of vascular reanastomosis. If it should prove impossible to salvage the flap, however, primary suture of the defect or reconstruction with a pedicled flap may also be considered.
Yoshimoto
Seiichi
S
Department of Head and Neck, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, Japan. seyoshim@ncc.go.jp
Kawabata
Kazuyoshi
K
Mitani
Hiroki
H
D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage; D001510:Bed Rest; D001783:Blood Flow Velocity / Q000502:physiology; D003422:Critical Care / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000601:surgery; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009336:Necrosis; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology; D013927:Thrombosis / Q000175:diagnosis* / Q000601:surgery; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000517:prevention & control
D006493:Heparin; D000527:Alprostadil