A Review of the Past 30 Years of Head and Neck Flap Reconstruction at Yale-New Haven Hospital
Haosi Sun, BS1, Katherine Ip, BS2, Xiaolu Xu, BS, PhD1, Raysa Cabrejo, BA1, Yunsoo Kim, AB1, Clarence Sasaki, MD1, Stephan Ariyan, MD1, Derek Steinbacher, MD, DMD1.
1Yale School of Medicine, New Haven, CT, USA, 2Yale School of Public Health, New Haven, CT, USA.
PURPOSE: Head and neck reconstruction is challenging. Since the introduction of free tissue transfer, we hypothesize a shift in flap procedures for head and neck reconstruction following tumor extirpation. The purpose of this paper is to evaluate the trends in pedicled versus free flaps for head and neck reconstruction over a 30-year period.
METHODS: This is an HIC approved retrospective analysis. All patients undergoing head and neck cancer resection with flap reconstruction, at a single institution, were included from 1983-2012. Records were obtained and those receiving flap reconstruction by Plastic Surgery were included. Demographic, perioperative, and post-operative data were documented.
RESULTS: Over 3000 records were queried and 930 fulfilled criteria. The early decades were predominated by pedicled reconstruction (96%), while recent time points demonstrated free flap reconstruction (>70%). The flap type was independent of tumor staging, patient age, and number of comorbidities. In this cohort, free flaps were associated with a significantly longer postoperative hospital and ICU stays when compared to pedicled flaps (p < 0.01). Additionally, free flaps were associated with higher rates of emergency reoperation, hematoma, total flap loss and donor site morbidity (p < 0.01). Prior radiation was associated with more complications in the free flap group, although a greater proportion of pedicled flap patients were previously irradiated.
CONCLUSION: Recent patients are more complex, concurrent with free flap reconstructive preference, contributing to potential for greater complications and longer hospital stays. Radiation was an independent predictor of complication rate.
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