[Free-flap head and neck reconstruction failures: predictive factors and management].
BACKGROUND
Failure after head and neck reconstruction using free flap are rare but their management remains a challenging problem. The purpose of this study was to analyze the causes and the subsequent treatment of free-flap failure in head and neck reconstruction.


METHODS
A retrospective review of patients who had undergone free flap transfer between 2000 and 2007 was performed in our center. Data were collected from computerized medical record to determine patient and tumor characteristics, as well as their treatment. Moreover, a univariate analysis was performed to determine factors associated with free flap failure.


RESULTS
Three hundred and twelve patients had a free flap transfer after head and neck cancer resection. A total of 22 failures (7%) were encountered. Previous surgery for head and neck cancer (p=0.02), surgery after cancer recurrence (p=0.02) and reconstructions after circular pharyngolaryngectomy (p=0.008) were significantly associated with free-flap failure. A second free-flap was performed in 12 patients and the overall success rate of the repeated free flap was 92 percent (11 of 12 patients).


CONCLUSIONS
After a free flap failure, surgeons should determine subsequent treatments after a reconsideration of the need of a second free flap, an analysis of the cause of the first flap failure and an evaluation of local and general conditions. In selected patients, second free flap has a high success rate.
David
S
S
Service de chirurgie plastique, esthétique et reconstructrice et de chirurgie de la main, hôpital Saint-Roch, Nice, France. Sylvdavid@yahoo.fr
Dassonville
O
O
Poissonnet
G
G
Chamorey
E
E
Vallicioni
J
J
Demard
F
F
Médard de Chardon
V
V
Santini
J
J
Bozec
A
A
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010611:Pharyngectomy; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome