ORIGINAL ARTICLE ANALYSIS OF 49 CASES OF FLAP COMPROMISE IN 1310 FREE FLAPS FOR HEAD AND NECK RECONSTRUCTION

Abstract: Background. The purpose of this study was to an-alyze the causes of flap compromise and failure in head and neck free flap reconstruction. Methods. We retrospectively reviewed 1310 free flap recon-structions for head and neck defects performed between July 1995 and June 2006. Results. Forty-nine cases of flap compromise due to vascular obstruction (3.7%) were identified, and 27 flaps were lost (2%). Ar-terial occlusions occurred in 12 flaps, with a salvage rate of 33%. Eight flaps failedwithin the first 24 hours, and only 1 of thesewas sal-vageable. Five of the 8 flaps had intraoperative thrombosis due to technical difficulties. Venous occlusions occurred in 31 flaps, with a salvage rate of 58%. Twenty-two venous occlusions occurred within the first 72 hours. The main reason for venous failure was mechani-cal obstruction due to compression, twisting, kinking, or stretching of the vein. The most common cause of late failures (after 7 days) was unrecognized failure of a buried flap owing to the lack of reliable monitoring. Overall, there was no correlation between surgeon ex-perience and flap failure, but the flap failure rate was lower in sur-geonswho hadperformedmore than 70 free flap procedures. Conclusion. Precise surgical techniques, avoidance of me-chanical obstruction, and better monitoring of buried flaps may further improve the success rate of free tissue transfer in com-plex head and neck reconstruction. VC 2008 Wiley Periodicals