title: Elective free flap revision in the head and neck cancer patient: Indications and outcomes.
abstract: Elective free flap revision among head and neck cancer patients remains poorly characterized. This study evaluates patients who underwent flap revision and their surgical outcomes. Patients who underwent tumor extirpation with free flap reconstruction were identified over a 5-year period. Elective flap revision was defined as debulking or redraping of the original free flap for functional or cosmetic reasons. Patient demographics, surgical indications, and outcomes were reviewed. One hundred and eighty-six patients were identified, and 19 (10.2%) underwent flap revision. Revision of oral cavity flaps (n = 9, 47.4%) was performed to address excessive flap bulk compromising lip competence, speech, swallowing, mastication, or placement of a dental prosthesis. Revision of flaps resurfacing the face or neck (n = 10, 52.6%) was performed to address facial ptosis after facial nerve sacrifice, facial asymmetry, or soft tissue redundancy. Revisions were performed at an average of 7.3 months postoperatively and there was no age or gender bias toward undergoing flap revision. Patients whose flap skin paddles were used to resurface the facial or neck skin were significantly more likely to undergo elective revision than patients with an external paddle designed for flap monitoring (p < 0.01). We identified a 10% elective revision rate for head and neck free flaps in cancer patients, approximately half of which were performed to improve oral cavity function and half of which were performed to address facial ptosis or asymmetry. While there was no age or gender preference for flap revision, extensive facial or neck resurfacing was significantly associated with eventual flap revision.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Garg
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Poore
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Wieland
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Mcculloch
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Hartig
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000379:methods*; D005153:Facial Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome