title: Free flap failure in head and neck reconstruction.
abstract: BACKGROUND
  The purpose of this study was to determine the causes of head and neck free flap loss and to evaluate outcomes after subsequent microvascular and non-microvascular reconstruction.
  
  
  METHODS
  Patients who experienced free flap loss between 2000 and 2012 were reviewed.
  
  
  RESULTS
  There were 40 flap losses out of 3090 free flaps (1.3%). Twenty-eight patients underwent subsequent free flap reconstruction of which 27 free flaps were successful (96.4%), which was not significantly different from our initial flap success rate (p = .81). Of patients who underwent subsequent free flap reconstruction for oral/pharyngeal defects, 100% had >80% speech intelligibility and 87.5% were tube feed independent. By comparison, 42.9% of patients who underwent subsequent pectoralis major flap reconstruction had intelligible speech (p = .01) and 25.0% were independent of tube feeds (p = 0.02).
  
  
  CONCLUSIONS
  Subsequent free flaps after initial free flap losses can be successful in selected patients. Functional outcomes after subsequent free flap reconstruction are favorable compared to pedicled flap reconstruction.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Christian
authors.initials: C
authors.lastname: Corbitt
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
mesh_terms: D003679:Deglutition; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D013065:Speech Intelligibility; D017211:Treatment Failure
keywords: free flap failure; free flap loss; head and neck reconstruction; microvascular free flap; surgical complications