title: Management of complications and compromised free flaps following major head and neck surgery.
abstract: Microvascular free flaps are preferred for most major head and neck reconstruction surgeries because of better functional outcomes, improved esthetics, and generally higher success rates. Numerous studies have investigated measures to prevent flap loss, but few have evaluated the optimal treatment for free flap complications. This study aimed to determine the complication rate after free flap reconstructions and discusses our management strategies. Medical records of 260 consecutive patients who underwent free flap reconstructions for head and neck defects between July 2006 and June 2010 were retrospectively reviewed for patient and surgical characteristics and postoperative complications. The results revealed that microvascular free flaps were extremely reliable, with a 3.5 % incidence of flap failure. There were 78 surgical site complications. The most common complication was neck wound infection, followed by dehiscence, vascular congestion, abscess, flap necrosis, hematoma, osteoradionecrosis, and brisk bleeding. Twenty patients with poor wound healing received hyperbaric oxygen therapy, which was ineffective in three patients who eventually experienced complete flap loss. Eleven patients with vascular congestion underwent medicinal leech therapy, which was effective. Among the 78 patients with complications, 44 required repeat surgery, which was performed for postoperative brisk bleeding in three. Eventually, ten patients experienced partial flap loss and nine experienced complete flap loss, with the latter requiring subsequent pectoralis major flap reconstruction. Microvascular free flap reconstruction represents an essential and reliable technique for head and neck defects and allows surgeons to perform radical resection with satisfactory functional results and acceptable complication rates.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA. ckucur@mynet.com.|Department of Otolaryngology Head and Neck Surgery, University of Dumlupinar, Kutahya, Turkey. ckucur@mynet.com.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kucur
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA.
authors.forename: Kasim
authors.initials: K
authors.lastname: Durmus
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA.|Department of Otolaryngology Head and Neck Surgery, University of Cumhuriyet, Sivas, Turkey.
authors.forename: Ismail O
authors.initials: IO
authors.lastname: Uysal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Old
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Arshad
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA.
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Teknos
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA. enver.ozer@osumc.edu.
authors.forename: Enver
authors.initials: E
authors.lastname: Ozer
mesh_terms: D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000098:blood supply / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000295:instrumentation / Q000379:methods; D009820:Ohio; D010025:Osteoradionecrosis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology / Q000628:therapy; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies
keywords: Dehiscence; Flap failure; Head and neck reconstruction; Hyperbaric oxygen therapy; Microvascular free flaps; Radical resection; Vascular congestion