title: A Thirty-Year Experience With Head and Neck Flap Reconstruction.
abstract: BACKGROUND
  Head and neck (HN) defects after tumor extirpation can be challenging to repair. Historically, pedicled flaps were the mainstay for reconstruction, but recently, free tissue transfer has been preferred. This study compares patient characteristics and flap outcomes for HN defects over a 30-year period at the authors' institution.
  
  
  METHODS
  Head and neck cancer patients receiving flap reconstruction from 1983 to 2013 were included. Records were reviewed for demographic and perioperative data. Flap complications were compared and statistical tests were 2-tailed with a significance level of 0.05.
  
  
  RESULTS
  Eight hundred sixty-one patients fulfilled inclusion and exclusion criteria. Pedicled reconstruction predominated during early time-points (96.3% pedicled), compared with later years (69.5% free-tissue). Free flaps were associated with significantly longer operative times (643.5 versus 429.7 minutes, P<0.0001) and postoperative stays (16.89 versus 14.01 nights, P = 0.0005) and had higher rates of emergent reoperation, total flap loss, hematoma, and donor site morbidity. Previous irradiation did not affect major complication rate for either flap type.
  
  
  CONCLUSIONS
  A shift from pedicled to free flaps for HN reconstruction occurred over the last 30 years. Free flaps had a higher complication profile in this cohort, which was largely accounted for by a higher return rate to the operating room compared with pedicled flaps (17.31% versus 5.46%, P<0.0001). Additionally, this complication profile may reflect the increasingly common use of free tissue flaps for more complex reconstructions. Several of these differences in complication rates between flap types were no longer significant in the last 5 years of this study.
authors.affiliation: *Section of Plastic and Reconstructive Surgery †Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT.
authors.forename: Alexander Haosi
authors.initials: AH
authors.lastname: Sun
authors.forename: Xiaolu
authors.initials: X
authors.lastname: Xu
authors.forename: Clarence Takashi
authors.initials: CT
authors.lastname: Sasaki
authors.forename: Stephan
authors.initials: S
authors.lastname: Ariyan
authors.forename: Derek Matthew
authors.initials: DM
authors.lastname: Steinbacher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult