Get access

Microvascular head and neck reconstruction in patients with liver cirrhosis

Authors

  • Nai-Chen Cheng MD,

    1. Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
    2. Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan
    Search for more papers by this author
  • Jenq-Yuh Ko MD, PhD,

    1. Department of Otolaryngology, National Taiwan University Hospital, National Tiwan University College of Medicine, Taipei, Taiwan
    Search for more papers by this author
  • Hao-Chi Tai MD,

    1. Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan
    Search for more papers by this author
  • Shyue-Yih Horng MD,

    1. Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan
    Search for more papers by this author
  • Yueh-Bih Tang MD, PhD

    Corresponding author
    1. Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan
    • Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan
    Search for more papers by this author

Abstract

Background

The aim of this retrospective case series was to review the safety, complications, and outcomes of free-tissue transfer in head and neck cancer reconstruction in patients with liver cirrhosis.

Methods

A retrospective review of all microvascular head and neck reconstruction cases with concomitant liver cirrhosis treated in our institution from 1994 to 2005 was performed. Data collected included patient demographics, etiology, and severity of liver cirrhosis, defect site, choice of free flap, complications, and clinical follow-up.

Results

Seven patients were identified. They were all males and underwent microvascular head and neck reconstruction due to ablative cancer surgery. Their Child-Pugh classification of liver cirrhosis was graded as follows: Child A (n = 3); Child B (n = 3); and Child C (n = 1). Eight free flaps were transferred (1 patient received 2), including anterolateral thigh (n = 4); radial forearm (n = 3); and fibula (n = 1). All flaps survived without the need for any microvascular revision procedures. Two patients died within postoperative 30 days due to hepatic decompensation. Other complications included neck hematoma (n = 1), neck wound infection (n = 2), and donor site dehiscence (n = 1). Only 2 patients with Child A cirrhosis remained free from complications and survived more than 1 year after the surgery.

Conclusion

Microvascular head and neck reconstruction may be performed in patients with liver cirrhosis with a certain degree of technical success. However, the procedure is associated with significant mortality and morbidity in Child class B and C patients. Therefore, we recommend avoiding free-tissue transfer in patients with head and neck cancer with advanced liver cirrhosis. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Ancillary