title: Free tissue transfers in head and neck reconstruction: complications, outcomes and strategies for management of flap failure: analysis of 2019 flaps in single institute.
abstract: BACKGROUND
  Free tissue transfer has become the preferred option for complex reconstructions in head and neck cancer ablation. This study reviewed the surgical outcome and analyzed the evolution of microsurgical head and neck reconstruction over 20 years in single institute.
  
  
  METHODS
  A total of 1,918 patients underwent microsurgical head and neck reconstructions in 20-year period. The surgical outcome and complications among these 2,019 flaps (1,223 anterolateral thigh flaps, 372 fibula flaps, 353 radial forearm flaps, 12 jejunal flaps, and 59 others) were retrospectively reviewed and analyzed.
  
  
  RESULTS
  A total of 201 cases required emergent surgical re-exploration and the overall flap success rate was 96.2%. Venous insufficiency was the most common cause for re-exploration. Other major complications included fistula formation (5.4%), partial flap necrosis (7.5%), and infection (17.8%). The fibula flap had frequent complications compared with soft tissue flaps. The familiarity to the ALT flap had minimized complications and allowed for widely versatile uses.
  
  
  CONCLUSIONS
  Free tissue transfer is shown to be highly reliable option for head and neck reconstruction. For soft tissue defect, ALT flap is the first choice. Fibula flap is ideal for bone defect reconstruction. In case of complex composite defects, double flaps, which include ALT and fibula flaps could reconstruct bone and soft tissue defects simultaneously with high success rate.
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
authors: Cheng-Chun
authors: CC
authors: Wu
authors: Pao-Yuan
authors: PY
authors: Lin
authors: Khong-Yik
authors: KY
authors: Chew
authors: Yur-Ren
authors: YR
authors: Kuo
mesh_terms: D058752:Free Tissue Flaps / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011182:Postoperative Care; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery