EVALUATION OF 250 FREE-FLAP RECONSTRUCTIONS AFTER RESECTION OF TUMORSOF THE HEAD AND NECK

Background: Microvascular free-tissue transfer is now the primary meth od of reconstruction in many centres. The aim of this study was to eva luate the applications, complications and limitations of free-flap rec onstruction in a series of patients with tumours of the head and neck. Methods: This study reviewed prospectively accessioned computerized r ecords in a dedicated head and neck database. Patients treated between 1987 and 1995 with a minimum of a 1-year follow-up were reviewed. The re were 242 patients with a mean age of 58 years (172 men and 70 women ). The most common tumour sites were oral cavity (42%), oropharynx (32 %) and hypopharynx (11%). Mucosal squamous carcinoma accounted for 87% of primary cancers. Results: Among the 250 free flaps, the radial for earm flap (205) and free jejunum (25) predominated. There were 21 epis odes of vascular occlusion (8%), failure of 10 flaps (4%) and two pati ents died peri-operatively (0.8%). A second free flap was used in five of 10 cases of flap failure. The fistula rate was 4.4% among 203 pati ents at risk for this complication, which comprised four of 178 forear m flaps and five of 25 free jejunal grafts. Four of 16 jaw reconstruct ions failed. Conclusions: A 96% success rate was achieved using free-t issue transfer for head and neck reconstruction. The overall complicat ion rate was low but jaw reconstruction and free jejunal grafts posed the greatest problems because of failure of radial bone and fistulas, respectively. The radial forearm septocutaneous flap was very reliable and remains our mainstay for oral reconstruction.