Microvascular Free Flap for Head and Neck Reconstruction: A Review

Abstract

This chapter aims to investigate the flap survival rate and review each vascular compromised flaps. Defects after radical resection for advanced head and neck malignancies are difficult, and without a doubt, microvascular free flap reconstruction is the best alternative. This is a reviewed of patients who underwent microvascular free flap for head and neck reconstruction from 2012 to late 2021. Totally, 218 microvascular free flap reconstructions were performed on 204 head and neck patients.  There were 112 (51.3%) radial forearm flaps (RFF), 82 (37.6%) fibula flaps (FF) and 24 (11%) anterior lateral thigh (ALT) flaps. With 16 full flap losses and 3 partial flap losses, the overall flap survival rate was 91.8% (19/218), while the total loss flap survival rate was 92.7% (16/218).  In RFF, there were 7 complete and 1 partial flap loss, giving an overall flap survival rate 92.9% (8/112) and flap survival in turn of complete loss 93.8% (7/112). The rate of vascular flap problems in our series was 12.3% (27/218), with a recoverable rate of 29.6% (8/27). RFF 46.6% (7/15) of the flaps were recoverable. The findings support the learning curve in microvascular free flap surgery, and RFF is a good flap for a beginner. Cancer which was termed as inoperable earlier, has become operable today with the possibility of reconstruction by free flap.