Free flaps: Outcomes and complications in head and neck reconstructions

• Published in: Journal of cranio-maxillo-facial surgery 2009-12, Vol.37 (8), p.438-442
• Main Authors: Bianchi, Bernardo, MD, Copelli, Chiara, MD, Ferrari, Silvano, Ferri, Andrea, MD, Sesenna, Enrico
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ameloblastoma - surgery; Biological and medical sciences; Child; Dentistry; Diabetes Complications; Facial Paralysis - surgery; Female; free flaps; Graft Survival; Head - surgery; head and neck; Head and Neck Neoplasms - surgery; Humans; major and minor complications; Male; Medical sciences; Middle Aged; Neck - surgery; Osteonecrosis - surgery; Otorhinolaryngology. Stomatology; Postoperative Complications; Radiotherapy, Adjuvant - adverse effects; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Risk Factors; Smoking - adverse effects; Surgery; Surgical Flaps - adverse effects; Surgical Flaps - pathology; Surgical Wound Dehiscence - etiology; Thrombosis - etiology; Tissue and Organ Harvesting - adverse effects; Tissue and Organ Harvesting - methods; Treatment Outcome; Young Adult
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2009.05.003

Summary Between 2000 and 2007, 376 free-flap transfers were performed in 352 patients at the Department of Maxillofacial Surgery, University of Parma, Italy. They included 303 reconstructions after cancer surgery (80.6%), 28 secondary reconstructions (7.4%), 32 transfers for facial paralysis (8.5%) and 13 reconstructions for other pathology (3.5%) such as osteonecrosis and ameloblastoma. We determined the rates of major and minor flap, donor-site and systemic complications and analysed their relationships with factors such as aetiology, patient age, smoking history and the presence of comorbid conditions. For the free flaps examined in this study, the overall complication rate was 47%. Major complications occurred in 20.7% of the cases and minor complications in 26.3%. The major flap, donor-site and systemic complication rates were 11.9, 3.2 and 5.6%, respectively. Total flap loss occurred in 15 cases (4%). The minor flap, donor-site and systemic complication rates were 19.1, 4 and 3.2% respectively. Aetiology, patient age, smoking history and the presence of comorbid conditions were related to higher rates of major and minor complications, although these were not statistically significant.