Long-Term Experience with Multiple Free Tissue Transfer for Head and Neck Reconstruction
Lawrence O. Lin, BSME, Edward I. Chang, MD, FACS, Matthew M. Hanasono, MD, FACS.
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE: The use of multiple simultaneous free flaps is often necessary for optimal reconstruction of extensive head and neck defects. This study aims to evaluate the indications, complications, and outcomes in multiple simultaneous head and neck free flaps.
METHODS: A retrospective review of all multiple free flaps for head and neck reconstruction from 2001-2015 was performed.
RESULTS: 217 patients (220 cases, average age: 57.5 years) underwent reconstruction with 440 free flaps. The majority of patients were male (73.7%) with significant co-morbidities such as active smoking (30.0%), prior radiation (44.24%), and chemotherapy (36.87%). Multiple free flaps were most commonly performed following primary resection (n=113, 51.4%), recurrent disease (n=54, 24.5%), and osteoradionecrosis (n=38, 17.3%). The most common defects encountered were mandibular (n=136; 61.8%), external skin and mucosal lining (n=131; 59.5%), and floor of mouth (n=102; 46.4%). Twenty flaps (4.5%) experienced vascular compromise requiring reoperation on median postoperative day 2 (average = 2.2 days), resulting in 7 total flap losses (1.6%). Multivariate analysis demonstrated preoperative radiotherapy (p=0.050) and use of interpositional vein grafts (p=0.009) were associated with flap compromise. Active smoking (p=0.016) and use of interpositional vein grafting (p=0.001) were significantly associated with flap loss. With an average follow-up of 12.8 months, 78.6% of patients were alive without evidence of disease. There was an all-cause mortality rate of 9.4%.
CONCLUSION: In the modern era, utilizing multiple distant tissue flaps for single-stage complex head and neck reconstruction can be done safely and reliably with low complication rates.
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