MICROSURGICAL RECONSTRUCTION OF THE HEAD AND NECK - INTERDISCIPLINARYCOLLABORATION BETWEEN HEAD AND NECK SURGEONS AND PLASTIC SURGEONS IN 305 CASES

Three hundred five microsurgical free flaps have been performed for de fects of the head and neck by a team of two head and neck surgeons and two plastic surgeons over a 9-year period, with a success rate of 91. 2%. The most common flaps used were the jejunum (89), radial forearm ( 57), rectus abdominis (48), latissimus dorsi (40), scapular (32), fibu la (15), and iliac crest (11), Thirty-three flaps required reexplorati on for anastomotic thrombosis or hematoma (10.8%), of which 18 flaps w ere salvaged (54.5%). Thirteen flap failures occurred in 113 patients who had received preoperative irradiation (11.5%), but this was not st atistically significant. Seven flaps failed in 20 patients who require d an interposition vein graft (35%) and this was statistically signifi cant. Ninety patients (31.5%) developed a major complication other tha n anastomotic thrombosis or death, Despite postoperative intensive car e nursing and monitoring, 18 patients died postoperatively in the hosp ital (6.3%). The average hospital stay was 21.1 days with a range from 5 to 95 days. During this 9-year time period, various free flaps have evolved as the preferred choice for free flap reconstruction of a spe cific defect of the head and neck, The latissimus dorsi muscle flap su rfaced with a nonmeshed split-thickness skin graft is the optimal free flap for reconstruction of the scalp and skull, whereas a multiple-pa ddle latissimus dorsi musculocutaneous flap is the best flap for recon struction of complex defects of the middle third of the face and maxil la. The radial forearm flap and free jejunal transfer have become the preferred choices for intraoral reconstruction and pharyngo-esophageal reconstruction, respectively. There still remains no universally acce pted flap for mandibular reconstruction, but the fibular osteocutaneou s flap and a reconstruction plate protected by a radial forearm flap h ave largely superseded the iliac crest and scapular osteocutaneous fla ps. Radical resection of tumors of the head and neck with immediate re construction by microsurgical free tissue transfer followed by adjuvan t radiation therapy provides the best possible chance for cure and fun ctional and social rehabilitation of the patient.