Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T07:19:10.490Z Has data issue: false hasContentIssue false
  • English
  • Français

Microvascular free flaps in head and neck surgery

Published online by Cambridge University Press:  29 June 2007

Marcelle Macnamara ,
Sarah Pope ,
A. Sadler ,
H. Grant  and
M. Brough
Marcelle Macnamara
Affiliation:
Ferens Institute of Otolaryngology. the Department of Plastic Surgery and the Department of Maxillofacial Surgery, The Middlesex Hospital, Mortimer Street, London WIN 8AA.
Sarah Pope
Affiliation:
Ferens Institute of Otolaryngology. the Department of Plastic Surgery and the Department of Maxillofacial Surgery, The Middlesex Hospital, Mortimer Street, London WIN 8AA.
A. Sadler
Affiliation:
Ferens Institute of Otolaryngology. the Department of Plastic Surgery and the Department of Maxillofacial Surgery, The Middlesex Hospital, Mortimer Street, London WIN 8AA.
H. Grant
Affiliation:
Ferens Institute of Otolaryngology. the Department of Plastic Surgery and the Department of Maxillofacial Surgery, The Middlesex Hospital, Mortimer Street, London WIN 8AA.
M. Brough*
Affiliation:
Ferens Institute of Otolaryngology. the Department of Plastic Surgery and the Department of Maxillofacial Surgery, The Middlesex Hospital, Mortimer Street, London WIN 8AA.
*
M. Brough, M.A., F.R.C.S., Department of Plastic Surgery, The Middlesex Hospital, Mortimer Street, London WIN 8AA.
Get access Rights & Permissions [Opens in a new window]

Abstract

This study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.

Keywords

Surgical flaps, microvascularHead and neck, surgerycomplications
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 108 , Issue 11 , November 1994 , pp. 962 - 968
Copyright
Copyright © JLO (1984) Limited 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Acland, R. D., Flynn, M. B. (1978) Immediate reconstruction of oral cavity and oropharyngeal defects using microvascular free flaps. American Journal of Surgery 136: 419–423.CrossRefGoogle ScholarPubMed
Ariyan, S. (1979) The pectoralis major mycutaneous flap. Plastic and Reconstructive Surgery 63: 73–81.CrossRefGoogle Scholar
Aviv, J. E., Urken, M. L., Vickery, C., Weinberg, H., Buchbinder, D., Biller, H. F. (1991) The combined lattissimus dorsi scapular free flap in head and neck reconstruction. Archives of Otolaryngologx, Head and Neck Surgery 117: 1242–1250.CrossRefGoogle Scholar
Bakamjian, V. Y. (1965) A two-stage method for pharyngooesophageal reconstruction with a primary pectoral skin flap. Plastic and Reconstructive Surgery 36: 173–183.CrossRefGoogle Scholar
Baker, S. R. (1986) Microvascular free flaps in soft tissue augmentation of the head and neck. Archives of Otolaryngology: Head and Neck Surgery 112: 733–737.CrossRefGoogle ScholarPubMed
Barton, F. E., Thomas, E. S., Byrd, H. S. (1983) Head and neck reconstruction with the latissimus dorsi myocutaneous flap: anatomic observations and report of 60 cases. Plastic and Reconstructive Surgery 71: 201–205.CrossRefGoogle ScholarPubMed
Buckspan, G. S., Newton, E. D., Franklin, J. D., Lynch, J. B. (1985) Split jejunal free tissue transfer in oropharyngeal reconstruction. Plastic and Reconstructive Surgery 77 (5): 717–726.CrossRefGoogle Scholar
Carlson, G. W., Coleman, J. J. (1989) Microvascular free tissue transfer. Archives of Surgery 124: 438–440.CrossRefGoogle ScholarPubMed
Carrel, A. (1908) Results of the transplantation of blood vessels organs and limbs. Journal of the American Medical Association 51: 1662–1667.CrossRefGoogle Scholar
Coleman, J. J., Searles, J. M., Hester, T. R., Nahai, F., Zubowicz, V., McConnell, F. M. S., Jurkiewicz, M. J. (1987) Ten years experience with the free jejunal autograft. American Journal of Surgery 154: 394–398.CrossRefGoogle ScholarPubMed
Evans, H. B., Lampe, H. B. (1987) The radial forearm flap in head and neck reconstruction. Journal of Otolarynyoloyx 16 (6): 382–386.Google ScholarPubMed
Fearon, J. A., Cuadros, C. L., May, J. W. (1990) Flap failure after microvascular free tissue transfer: the fate of a second attempt. Plastic and Reconstructive Surgery 86 (4): 746–751.CrossRefGoogle ScholarPubMed
Fleming, A. F. S., Brough, M. D., Evans, N. D., Grant, H. R., Harris, M., James, D., Lawlor, M., Laws, I. M. (1990) Mandibular reconstruction using vascularized fibula. British Journal of Plastic Surgery 43: 403–409.CrossRefGoogle Scholar
Frampton, M. C, Breach, N. M., Archer, D. J., Shaw, H. J. (1986) The use of free tissue transfer in reconstruction following head and neck tumour resection. Journal of Laryngology and Otology 100: 97–103.CrossRefGoogle ScholarPubMed
Furnas, H., Rosen, J. M. (1991) Monitoring in microvascular surgery. Annals of Plastic Surgery 26 (3): 265–272.CrossRefGoogle ScholarPubMed
Goodacre, T. E. E., Walker, C. J., Jawad, A. S., Brough, M. D. (1990) Donor site morbidity following osseocutaneous free fibula transfer. British Journal of Plastic Surgery 43: 410–412.CrossRefGoogle Scholar
Harii, K., Ohmori, K., Sekegushi, J. (1976) The free musculocutaneous flap. Plastic and Reconstructive Surgery 57: 294–303.CrossRefGoogle ScholarPubMed
Harii, K., Ohmori, K., Ohmori, S. (1974) Successful clinical transfer of 10 free flaps by microvascular anastamosis. Plastic and Reconstructive Surgery 53 (3): 259–270.CrossRefGoogle Scholar
Harishina, T. (1988) Analysis of 200 free flaps. British Journal of Plastic Surgery 41: 33–36.CrossRefGoogle Scholar
Hester, T. R., Mcconnell, F. M. S., Nahai, E., Jurkiewicz, M. J., Brown, R. G. (1980) Reconstruction of the cervical oesophagus, hypopharynx and oral cavity using free jejunal transfer. American Journal of Surgery 140: 487–491.CrossRefGoogle ScholarPubMed
Hidalgo, D. A., Jones, C. S. (1970) The role of emergent free tissue transfer: a review of 150 consecutive cases. Plastic and Reconstructive Surgery 86 (3): 492–501.CrossRefGoogle Scholar
Hoopes, J. E., Edgerton, M. T. (1966) Immediate forehead flap repair in resection for oropharyngeal cancer. American Journal of Surgery 112: 527–533.CrossRefGoogle ScholarPubMed
Inglis, M. S., Robbie, D. S., Edwards, J. M., Breach, N. M. (1988) The anaesthetic management of patients undergoing free flap reconstructive surgery following resections of head and neck neoplasms - a review of 64 patients. Annals of the Royal College of Surgeons of England 70: 235–238.Google ScholarPubMed
Jacobsen, J. H., Suarez, E. L. (1960) Microsurgery in anastamoses of small vessels. Surgical Forum 11: 243–245.Google Scholar
Jawad, A. S., Zolte, N., Brough, M. D., O'Neill, T. J. (1990) Upper gastrointestinal complications in major head and neck surgery. British Journal of Plastic Surgery 43: 594–595.CrossRefGoogle ScholarPubMed
McGregor, I. A. (1973) Axial and random patterned flaps. British Journal of Plastic Surgery 26: 202–213.CrossRefGoogle ScholarPubMed
Meagher, A. P., Sheridan, B. E, Jansen, M. J., Swift, R., Doust, B. D., Benn, I. V., Nankivell, A. (1991) Venous drainage of free flaps following radical neck dissection. Australian and New Zealand Journal of Surgery 61 (12): 903–908.CrossRefGoogle ScholarPubMed
Panje, W. R., Krause, C. J., Bardach, J. (1977) Microsurgical techniques in free flap reconstruction. Laryngoscope 87 (5): 692–698.CrossRefGoogle ScholarPubMed
Panje, W. R. (1982) Free flaps versus myocutaneous flaps in reconstruction of the head and neck. Otolaryngologic Clinics of North America 15(1): 111–121.Google ScholarPubMed
Schechter, G. L., Baker, J. W., Gilbert, D. A. (1987) Functional evaluation of pharyngooesophageal techniques. Archives of Otolaryngology. Head and Neck Surgery 113 (1): 40–44.CrossRefGoogle Scholar
Seidenberg, B., Rosenak, S., Hurwitt, E. S., Som, M. L. (1959) Immediate reconstruction of the cervical oesophagus by a revascularized isolated jejunal segment. Annals of Surgery 149: 162–171.CrossRefGoogle ScholarPubMed
Serafin, D., Villarreal-Rios, A., Giorgiade, N. G. (1977) A rib containing free flap to reconstruct mandibular defects. British Journal of Plastic Surgery 30: 263–266.CrossRefGoogle ScholarPubMed
Shestak, K. C, Ford Jones, N., Wu, W., Johnson, J. T., Myers, E. N. (1992) The effects of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects. Head and Neck 14: 14–18.CrossRefGoogle ScholarPubMed
Smith, P. J., Foley, B., McGregor, I. A., Jackson, I. T. (1972) The anatomical basis of the groin flap. Plastic and Reconstructive Surgery 49: 41–47.CrossRefGoogle ScholarPubMed
Soutar, D. S., McGregor, I. A. (1986) The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plastic and Reconstructive Surgery 78 (1): 1–8.CrossRefGoogle ScholarPubMed
Soutar, D. S. (1989) Free flaps in reconstructive surgery. Annals of the Royal College of Surgeons of England 71: 169–173.Google ScholarPubMed
Stem, J. R., Keller, A. J., Wenig, B. L. (1989) Evaluation of reconstructive techniques of oropharyngeal defects. Annals of Plastic Surgery 22(4): 332–335.Google Scholar
Tabah, R. J., Flynn, M. B., Acland, R. D., Banis, J. C. (1984) Microvascular free tissue transfer in head and neck oseophageal surgery. American Journal of Surgery 148: 498–504.CrossRefGoogle Scholar
Urken, M. L., Vickery, C., Weinberg, H., Buchbinder, D., Biller, H. F. (1989) Geometry of the vascular pedicle in free tissue transfers to the head and neck. Archives of Otolaryngology, Head and Neck Surgery 115: 954–960.CrossRefGoogle Scholar
Urken, M. L., Buchbinder, D., Weinberg, H., Vickery, C., Sheiner, A., Parker, R., Schaefer, J., Som, P., Shapiro, A., Lawson, W., Biller, H. F. (1991) Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope 101: 935–950.CrossRefGoogle Scholar
Vaughan, E. D., Bainton, R., Martin, I. C. (1992) Improvements in morbidity of mouth cancer using microvascular free flap reconstruction. Journal ofCranioMaxilloFacial Surgery 20: 132–134.CrossRefGoogle Scholar
Watkinson, J. C., Breach, N. B. (1991) Free flaps in head and neck reconstructive surgery: a review of 77 cases. Clinical Otolaryngology 16: 350–353.CrossRefGoogle ScholarPubMed
Yang, G., Chen, B., Gao, W., Liu, X., Li, J., Mei, S., He, S. (1981) Forearm free skin flap transplantation. National Medical Journal of China 61: 139–141.Google Scholar
Zuker, R. M., Manktelow, R. T., Palmer, J. A., Rosen, I. B. (1980) Head and neck reconstruction following resection of carcinoma using microvascular free flaps. Surgery 88(4): 461–466.Google ScholarPubMed