MICROVASCULAR FREE FLAPS IN HEAD AND NECK RECONSTRUCTION - REPORT OF 200 CASES AND REVIEW OF COMPLICATIONS

Objective: Microvascular free-tissue transfer to the head and neck has become an accepted method of reconstruction owing to increased succes s rates and superior aesthetic and functional results. Although the la rge number of arteries and veins in the neck make free-flap revascular ization easier than in other recipient sites of the body, there are al so unique problems that pose significant risks to the success of the p rocedure. We report our experience with 200 microvascular free flaps p erformed between 1987 and 1992. Setting: This study was conducted at a tertiary referral center. Patients: The majority of patients in this series underwent surgery for squamous cell cancer. Approximately 75% o f the reconstructions were performed for defects of the oral cavity. T here were 120 vascularized bone-containing free flaps for mandibular a nd midface reconstruction. The remaining 80 soft-tissue flaps were use d for a variety of defects ranging from the scalp to the pharyngoesoph agus. Results: An overall success rate of 93.5% for free-tissue transf ers is reported. Greater experience with this technique has resulted i n a reduction and a change in the nature of the complications encounte red compared with those seen in the early part of our series. Donor an d recipient site complications, including flap failures and anastomoti c revisions, are analyzed in detail with respect to age, radiation sta tus, donor site, and whether the ablative procedure was done for a pri mary or recurrent neoplasm.