Factors affecting survival in head and neck reconstruction with free flaps in oncologic patients: a single surgeon's experience

Free tissue transfer has become the standard of care for reconstruction of head and neck complex defects, with success rates ranging to 91 to 99 percent. There are significant factors associated with the development of complications following free tissue transfer. The aims of this retrospective study is to evaluate relantionships between free flaps failure and pre- and intraoperative risk factors in oncologic patients in which surgery was performed by a single expert surgeon. We analyze a series of 91 consecutive free flap reconstruction performed from January 2002 to November 2008 at our Department identified variables influencing reconstructive complications. Success rate was 94.4% (6/91 free flaps were lost). All studied factors were similarly related to flap loss (complications rate of 9-10%); only in patients who previously received radiotherapy a complication rate of 12% was observed. Neverthless, microvascular surgery is a highly successful and relatively safe method for the reconstruction of large head and neck defects also in irradiated patients.