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Ten-year Experience of 1064 Head and Neck Free Flap Reconstructions: What Has Changed?
Peirong Yu, M.D., M.S., Geoffrey L. Robb, M.D..
University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA.
PURPOSE: To review our experience of microsurgical reconstruction for oncologic head and neck defects in the last ten years and to identify the significant changes and trends.
METHODS: Retrospective review of 1065 cases of head and neck free flap reconstruction from July 1995 to June 2005.
RESULTS: The types of head and neck defects were divided into 8 groups: scalp (5.3%), auriculotemporal (7.5%), orbitomaxillary (12.5%), tongue (22.8%), mandible (27.3%), pharyngoesophagus (17.1%), trachea (0.5%), and other soft tissue defects (7%). The number of cases per year increased from 82 in 1995 to 164 in 2005. There was a decrease of mandibular cases and an increase of tongue and maxillary cases in recent years. Tracheal reconstruction also started in 2004. Overall, the five most common flaps were rectus abdominis (27.8%), anterolateral thigh (19.7%), fibula (19%), radial forearm (17%), and the jejunum (6.5%). Since the introduction of the anterolateral thigh flap in 2001, it has become the most common flap (38%) while the rectus abdominis flap decreased from 40% to 17% and the jejunum decreased from 11% to 2%. The overall thrombosis rate was 4.3% and flap failure rate was 2.3%, which have not changed over time. The highest flap loss occurred in orbitomaxillary reconstruction (6%) whereas no flaps were lost in auriculotemporal and tracheal reconstructions. Mortality and morbidities have decreased and functional outcomes have improved in recent years.
CONCLUSION: High free flap success has been achieved. Notable changes in recent years include innovative techniques to improve function while reducing donor site morbidities.