Management of free flap failure in head and neck surgery

C Copelli, K Tewfik, L Cassano, N Pederneschi, S Catanzaro, A Manfuso, R Cocchi, C Copelli, K Tewfik, L Cassano, N Pederneschi, S Catanzaro, A Manfuso, R Cocchi

Abstract

Free flap surgery is overall considered the gold standard in head and neck reconstruction, with a success rate of 95%. The management of a total flap necrosis and which solution, between a pedicled or a second free flap, is safer for a salvage procedure is still controversial. Object of this study is to describe the authors' management of total free flap loss in head and neck reconstruction and compare the choices and results to those reported in the literature. From January 2012 to January 2016, 149 consecutive free flaps were performed at the Maxillo- Facial Operative Unit of the Hospital Casa Sollievo della Sofferenza in San Giovanni Rotondo (Italy) for reconstruction of head and neck defects. Of these, 6 flaps were lost due to a total necrosis. In 5 cases it was decided to harvest a second free flap, and in the remaining patient a temporalis muscle flap was used. All the free salvage flaps were successful, without complications and with a good aesthetic and functional recovery. Analysing the data obtained, and comparing them with those reported in the literature, it can be concluded that a second subsequent free flap can be considered an ideal and safe procedure in salvage surgery.

Keywords: Flap loss management; Free flap failure; Head and neck reconstruction; Salvage free flap.

© Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

References

    1. Gusenoff JA, Vega SJ, Jiang S, et al. Free tissue transfer: comparison of outcomes between university hospitals and community hospitals. Plast Reconstr Surg. 2006;118:671–675.
    1. Almadori G, Rigante M, Bussu F, et al. Impact of microvascular free flap reconstruction in oral cavity cancer: our experience in 130 cases. Acta Otorhinolaryngol Ital. 2015;35:386–393.
    1. Tarsitano A, Ciocca L, Cipriani R, et al. Mandibular reconstruction using fibula free flap harvested using a customised cutting guide: how we do it. Acta Otorhinolaryngol Ital. 2015;35:198–201.
    1. Okazaki M, Asato H, Takushima A, et al. Analysis of salvage treatments following the failure of free flap transfer caused by vascular thrombosis in reconstruction for head and neck cancer. Plast Reconstr Surg. 2007;119:1223–1232.
    1. Colletti G, Autelitano L, Tewfik K, et al. Autonomized flaps in secondary head and neck reconstructions. Acta Otorhinolaryngol Ital. 2012;32:329–335.
    1. Bianchi B, Copelli C, Ferrari S, et al. Free flaps: outcomes and complications in head and neck reconstructions. J Craniomaxillofac Surg. 2009;37:438–442.
    1. Herle P, Shukla L, Morrison WA, et al. Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis. ANZ J Surg. 2015;85:121–127.
    1. Cheng SW, Wu LL, Ting AC, et al. Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies. Am J Surg. 1999;178:323–328.
    1. Benatar MJ, Dassonville O, Chamorey E. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J. Plast. Reconstr Aesthet Surg. 2013;66:478–482.
    1. Yoshimoto S, Kawabata K, Mitani H. Factors involved in free flap thrombosis after reconstructive surgery for head and neck cancer. Auris Nasus Larynx. 2010;37:212–216.
    1. Nahabedian MY, Singh N, Deune EG, et al. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg. 2004;52:148–155.
    1. Ferrari S, Copelli C, Bianchi B, et al. Free flaps in elderly patients: outcomes and complications in head and neck reconstruction after oncological resection. J Craniomaxillofac Surg. 2013;41:167–171.
    1. Tarsitano A, Pizzigallo A, Sgarzani R, et al. Head and neck cancer in elderly patients: is microsurgical freetissue transfer a safe procedure? Acta Otorhinolaryngol. 2012;32:371–375.
    1. Corbitt C, Skoracki RJ, Yu P, et al. Free flap failure in head and neck reconstruction. Head Neck. 2014;36:1440–1445.
    1. Kadota H, Sakuraba M, Kimata Y, et al. Analysis of thrombosis on postoperative day 5 or later after microvascular reconstruction for head and neck cancers. Head Neck. 2009;31:635–641.
    1. Wax MK, Rosenthal E. Etiology of late free flap failures occurring after hospital discharge. Laryngoscope. 2007;117:1961–1963.
    1. Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2006;59:737–742.
    1. Ross G, Yla-Kotola TM, Goldstein D, et al. Second free flaps in head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2015;65:1165–1168.
    1. Wei F-C, Demirkan F, Chen HC. The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder? Plast Reconstr Surg. 2001;108:1154–1160.
    1. Alam DS, Khariwala SS. Technical considerations in patients requiring a second microvascular free flap in the head and neck. Arch Otolaryngol Head Neck Surg. 2009;135:268–273.
    1. Chepeha DB, Annich G, Pynnonen MA. Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg. 2004;130:181–186.
    1. Tsue TT, Desyatnikova SS, Deleyiannis FW. Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer. Arch Otolaryngol Head Neck Surg. 1997;123:731–737.

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