Free flap reconstruction of the head and neck: Analysis of 241 cases

OBJECTIVE: We undertook this study of free flap reconstruction of the head and neck to stratify patients and procedures, to determine how donor site p reference changed over time, to assess medical and surgical outcomes, and t o identify variables associated with complications. METHODS: We analyzed computerized medical records from 236 patients who und erwent a total of 241 reconstructions at a tertiary academic medical center in St. Louis between 1989 and 1998. We created a more detailed retrospecti ve database of 141 of those patients by using 48 perioperative variables an d 7 adverse outcome measures. Multivariate statistical models were used to analyze associations between variables and outcomes. RESULTS: The fibula became the preferred donor site for mandibular reconstr uction, and the radial forearm became the preferred donor site for pharyngo esophageal reconstruction. For the 241 procedures, the mortality rate was 2 ,146, the median length of stay was 11 days, and the flap survival rate was 95%. Administration of more than 7 L of crystalloid during surgery and age over 55 were associated with major medical complications. Blood transfusio n, prognostic comorbidity, and number of surgeons correlated with length of stay. Cigarette smoking and receipt of more than 7 L of crystalloid during surgery were associated with overall flap complications, and weight loss o f more than 10% before surgery, more than one operating surgeon, and cigare tte smoking were associated with major flap complications. CONCLUSIONS: Risk to patients and transferred tissue is low in free flap he ad and neck reconstruction. Age, smoking history, and weight loss should be considered during patient selection. Fluid balance should be considered du ring and after surgery. Division of labor for patient care should be carefu lly delineated among surgeons in a teaching setting.