Analysis of flap failures in microvascular head and neck reconstructions : 11-year single-center results

Background Free flap reconstruction is the gold standard in head and neck reconstructions. The current paper analyses failed free flaps in the head and neck region during an eleven-year period in a single center aiming to discover factors that could be influenced in order to reduce the risk for flap failure. Methods During the study period, 336 patients underwent free flap reconstruction at Tampere University Hospital, Finland. The patients’ average age was 62 years (range 14-92 years). 201 (61.5%) of the patients were women. Medical records were reviewed and statistical analyses performed. Results Ten (3%) of free flaps failed. Patients‘ age, comorbidities, smoking, dosage of anticoagulation, flap type or the location of the defect did not influence the risk of flap failure. All lost flaps were postoperatively followed by clinical monitoring only. In contrast, 89% of all flaps had both Licox ® and clinical follow-up postoperatively. In six (60%) of the failed cases, a second free flap surgery was performed as a salvage, with a survival rate of 83.3%. Conclusion Our free flap success rate of 97% is in accordance with other head and neck centers. According to our findings, free flap reconstructions can be successfully performed on elderly patients and patients with comorbidities. Smoking did not increase the flap loss rate. We encourage the use of other methods in addition to clinical monitoring to follow the flaps postoperatively. All flap types used have high success rates, and reconstruction can be conducted with the most suitable flap for the defect.Peer reviewe