Free flap reconstructions in the management of oral and pharyngeal cancer

Fifty patients who had undergone microvascular free flap reconstruction of the oral cavity or pharynx for malignancy between 1989 and 1995 were retros pectively analysed to find factors predicting postoperative complications a nd outcomes. The mean follow-up time was 2.6 years. More than half (26/50) of the patients had a stage IV malignancy and 10 patients had a recurrent t umour. The overall flap success rate, with 2 flap losses, was 96%. Postoper ative medical complications occurred in 29/50 (58%) cases. The recipient si te of 10/50 (20%) flaps required re-exploration. Mortality was 2%, with 1 d eath occuring within 30 days. The mean survival rate after the microvascula r operation was 1.6 years, and the 3- and 5-year survival rates were 42% an d 23%, respectively. Patients with an oropharyngeal tumour seemed to have t he best prognosis and those with a hypopharyngeal tumour the poorest. Men h ad a threefold greater risk of dying within < 1 year postoperatively compar ed with women. Tumour stage was the strongest attribute influencing surviva l. The risk of death after the microvascular procedure increased 2.8-fold w hen the stage advanced from II to III or from III to IV. None of the tested variables alone could predict complications.