Outcomes in head and neck reconstruction by surgical site and donor site

Authors

  • John W. Frederick MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Larissa Sweeny MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • William R. Carroll MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Glenn E. Peters MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Eben L. Rosenthal MD

    Corresponding author
    • Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • This work was supported by grants from the National Institutes of Health (R01 CA142637-01 and 2T32 CA091078-09).

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Eben L. Rosenthal, MD, Division of Otolaryngology, BDB Suite 563, 1808 7th Avenue South, Birmingham, AL 35294-0012. E-mail: oto@uab.edu

Abstract

Objectives/Hypothesis

Define surgical outcomes of specific donor sites for free tissue transfer in head and neck reconstruction.

Study Design

Retrospective cohort review at an academic tertiary care center.

Methods

A review was made of free tissue transfer procedures performed at a university-based tertiary care facility from October 2004 to April 2011. A total of 1,051 patients underwent six types of free flaps: fasciocutaneous radial forearm (53%), osteocutaneous radial forearm (16%), rectus abdominis (11%), fibula (10%), anterior lateral thigh (7%), and latissimus dorsi (2%). Demographic data were collected, and outcomes measured were: length of hospital stay, flap viability, and major complications (infection, fistula, and hematoma).

Results

Of the 1,051 flaps performed, the most common operative site was oral cavity (40%, n = 414) followed by hypopharynx/larynx (22%, n = 234), cutaneous (20%, n = 206), oropharynx (9%, n = 98), midface (7%, n = 76), and skull base (2%, n = 23). The median hospital stay was 7.9 days (range, 1–76), and the overall failure rate was 2.8%. Cutaneous defects required the shortest length of hospitalization (5.8 days, P < .0001), a low free flap failure rate (1.5%, n = 3), and limited major complications (6%, n = 12). Conversely, oropharynx defects were associated with the longest hospitalization (8.9 days). Midface defects had a high incidence of complications (15%, n = 11, P = .10). Defects above the angle of the mandible had higher overall complications when compared to below. Similarly, reconstruction for primary or recurrent cancer had a total failure rate of 2.5%, whereas secondary reconstruction and radionecrosis had a failure rate of 4.0% (P = .29). Additionally, there was no statistical difference between outcomes based on donor site.

Conclusions

This review demonstrates that certain subsets of patients are at higher risk for complications after free tissue transfer. Patients undergoing free flap reconstruction for cutaneous defects have substantially shorter hospital stays and are at lower risk of flap complications, whereas reconstruction for radionecrosis and secondary reconstruction tend to have higher overall flap failure rates.

Level of Evidence

2c. Laryngoscope, 2013

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