title: Microsurgical free flap reconstructions of head and neck region in 406 cases: a 13-year experience.
abstract: OBJECTIVE
  The reconstruction of extended soft tissue and bony defects in the maxillofacial region with microsurgical flaps is considered to be the therapy of first choice. The aim of this retrospective study was to detect different influencing factors concerning flap survival.
  
  
  METHODS
  We examined the data of 406 patient cases (121 female and 285 male cases; mean age, 57 years) undergoing reconstruction with a microsurgical flap in our facility between 1998 and 2010. In these cases 326 soft tissue flaps (radial forearm flap, scapula flap, latissimus dorsi flap, anterolateral thigh flap, lateral arm flap, and jejunum flap) and 80 bony flaps (fibula flap and deep circumflex iliac artery flap) were examined. Evaluated parameters were, among others, the timing of reconstruction, defect localization, and recipient vessels used (external vs internal jugular system), as well as anticoagulative management. We statistically analyzed data by means of a χ(2) test, taking account of the odds ratio with P < .05, which was deemed significant.
  
  
  RESULTS
  The overall flap survival rate was approximately 92%, without any gender- or age-specific differences. Primary reconstructions proceeded distinctly more successfully than secondary reconstructions (P < .01). Likewise, the defect localization exerted a significant effect on the survival rate (P = .01), with a more caudal localization affecting flap survival positively. Finally, neither the anticoagulation regimen nor the choice of recipient vein system exercised an influence on the survival rate.
  
  
  CONCLUSIONS
  Microsurgical tissue transfer is a convenient and reliable method in maxillofacial surgery, provided that one is aware of the determining factors for success.
authors.affiliation: Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of the Aachen University, Aachen, Germany. mgerressen@ukaachen.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Gerressen
authors.forename: Claudia Inge
authors.initials: CI
authors.lastname: Pastaschek
authors.forename: Dieter
authors.initials: D
authors.lastname: Riediger
authors.forename: Ralf-Dieter
authors.initials: RD
authors.lastname: Hilgers
authors.forename: Frank
authors.initials: F
authors.lastname: Hölzle
authors.forename: Nelson
authors.initials: N
authors.lastname: Noroozi
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghassemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011884:Radius / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants