The fate of free flaps used to reconstruct defects in recurrent head and neck cancers

The purpose of this study was to assess free-flap viability in patients tre ated for recurrent head and neck cancers. A 10-year retrospective review id entified 121 patients who had had prior head and neck cancers extirpated fo r cure, who subsequently presented with documented recurrent cancers that w ere removed, and who then underwent reconstruction with free flaps. The cha rts of these patients were reviewed for patient demographics, tumor types, location, flaps used for reconstruction, size of area requiring reconstruct ion, length of operation, previous radiation, and all postoperative morbidi ty and mortality. The time to recurrence ranged from 21/2 months to 21 year s. The majority of tumors treated were squamous cell carcinomas (n = 82). M ost of them were located intraorally (n = 75). Radiation therapy had been d elivered to 88 patients before their free-flap reconstructions. In this ser ies, 31 percent of all patients required additional surgery for complicatio ns, 14 percent of free flaps were lost, and 4 percent of patients died with in 30 days of their operation. The significant findings were that a flap th at was >4 cm in diameter was related to flap loss (P = 0.03 by the chi (2) method) and that flap loss was related to operative times greater than 11 h ours (p = 0.03 by the chi (2) method). It was concluded that recurrent head and neck cancers with large postextirpation defects that required prolonge d operative times yielded a significantly high tendency toward flap failure .