Secondary Free Tissue Transfer in Head and Neck Reconstruction

Secondary Free Tissue Transfer in Head and Neck Reconstruction:

Publication date: Available online 9 March 2019

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Sarita V. Vamadeva, Francis P. Henry, Alasdair Mace, Peter M. Clarke, Simon H. Wood, Navid Jallali

Summary

Background

The incidence of head and neck cancer continues to rise and with it the need for reconstructive surgery. Head and Neck microsurgeons are likely to encounter challenging secondary free flap surgery on the background of failed primary flaps, radiotherapy treatment or recurrence. The aim of this study was to review our experience of treating such cases in a tertiary referral centre in the United Kingdom.

Methods

We performed a retrospective analysis of all patients undergoing sequential free flap surgery for head and neck defects in our unit between 2010–2017. Parameters recorded included indication for surgery, type and sequence of reconstruction, recipient vessel use and postoperative complications.

Results

We identified 17 patients who underwent 39 free tissue transfers for reconstruction of head and neck defects (five transfers were performed at other units). The radial forearm and anterolateral thigh flaps were most commonly used. Almost a quarter of patients underwent three or more free flap reconstructive procedures. In over a third the same vein and artery were used for subsequent anastomoses and we used five vein grafts over 68 anastomoses. There were no flap failures recorded.

Conclusions

Secondary free flaps in the head and neck are required for a variety of aetiologies and can have success rates similar to primary free tissue transfers with minimal morbidity and mortality. Free tissue transfer is the best reconstructive option in H&N patients and should still be considered the first choice option in salvage cases until the patient's donor sites have been depleted.