A Prospective Study of Free Flap Reconstruction in Head and Neck Malignancy

Background: Microvascular free flaps have become a preferred method of reconstruction, however rare complications may occur.

Aims & Objectives: The aim of the study was to assess the incidence and causes of complications in patients undergoing microvascular free flap reconstruction in the head and neck region.

Methods: The study was conducted on patients undergoing free flap procedures for reconstruction of defects in the oral and maxillofacial malignancy. The surgeries will be performed at the Department of Surgical Oncology, BMCHRC, Jaipur. The data was collected according to the proforma to assess the incidence and causes of complications in patients undergoing microvascular free flap reconstruction in the head and neck region.

Results: The overall flap success rate was 99%. There were 35 cases of postoperative vascular thrombosis (20 venous and 15 arterial), constituting 3.3% of the entire series. Five flaps were salvaged, representing a 71.4% successful salvage rate in cases of vascular complications. Most of the successful salvage attempts were made within 24 hours of the end of the initial operation, and the successful salvage rate for re-exploration was 100%. Finally, the total flap loss rate was 0.9% and the partial flap loss rate was 2.3%. We conclude that early re- exploration should be the first choice for management of vascular compromised flaps. Complications at the donor site occurred in 17 cases (8.0%), the most common complication of which was partial skin graft loss after harvesting a radial forearm flap (n=10; 9.0%). Recipient and donor site morbidity was limited and considered acceptable.

Conclusion: The success rate of microvascular free flap reconstruction at our centre was 99%. The most common complication was venous thrombosis. The most common donor site complication was graft loss. Radial artery free flap showed least complications. However when complications occur, they must be identified early and managed efficiently because there is a narrow window of opportunity to salvage potential flap failure.