Outcomes of free flap reconstructive surgery in cancer patients-institutional experience

Pravenkumar R. R.; Lankaram J. J.; Nellaiyappar P.

doi:10.18203/2349-2902.isj20243986

Authors

Pravenkumar R. R. Department of Surgical Oncology, Tamil Nadu Government Multi Superspeciality Hospital, Omandurar Estate, Anna Salai, Chennai, Tamil Nadu, India https://orcid.org/0000-0002-6032-183X
Lankaram J. J. Department of Surgical Oncology, Tamil Nadu Government Multi Superspeciality Hospital, Omandurar Estate, Anna Salai, Chennai, Tamil Nadu, India
Nellaiyappar P. Department of Plastic Surgery, Kilpauk Medical College, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20243986

Keywords:

Free flap, Reconstructive surgery, Free tissue transfer, Radial forearm flap, Outcomes of free flap, Complications of free flap, Microsurgery

Abstract

Background: The success rate of free flap reconstruction following cancer surgery has steadily improved over past decades and has achieved a success rate of 91–99%, but occasional failures still occur. The aim of this study was to identify the outcomes of free flap reconstructions in our institution. The primary objective was to assess the success rates of free tissue transfer. The second objective was to assess independent preoperative, intra-operative, and postoperative risk factors for flap loss after microvascular reconstruction.

Methods: All consecutive cancer patients who received a free flap for head and neck, appendicular bone, perineal, and extremity reconstruction between October 2020 and September 2023 in our institute were included. Patient characteristics, surgical data, postoperative complications, and reoperations were collected.

Results: A total of 37 patients who underwent reconstruction by free flaps were analysed. The overall flap success rate was 73%. Among 37 patients, 12 (32.4%) had flap complications and 10 (27%) had flap loss. Smoking, comorbidity, and operating time did not show significant association with flap failure whereas the choice of flap, reconstruction post radiation, and reconstruction for recurrent cancers showed significant association with flap loss.

Conclusion: The overall success rate of 73% in free flap reconstructive surgery in our study mandates us to modify our treatment policy by careful patient selection, better choice of free flap, improved treatment algorithm in terms of flap monitoring and timing of re-exploration, which will help in reduction of free flap failure rates.

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References

Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg. 2007;119(7):2092-100. DOI: https://doi.org/10.1097/01.prs.0000260598.24376.e1

Nobel GJ, Higgins KM, Enepekides DJ. Predictors of complications of free flap reconstruction in head and neck surgery: Analysis of 304 free flap reconstruction procedures. Laryngo. 2012;122(5):1014-9. DOI: https://doi.org/10.1002/lary.22454

Eckardt A, Meyer A, Laas U, Hausamen JE. Reconstruction of defects in the head and neck with free flaps: 20 years’ experience. British J Oral and Maxillo Surg. 2007;45(1):11-5. DOI: https://doi.org/10.1016/j.bjoms.2005.12.012

Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction. J Plas, Reconstruc and Aesth Surg. 2006;59(7):737-42. DOI: https://doi.org/10.1016/j.bjps.2005.11.013

Mücke T, Ritschl LM, Roth M, Güll FD, Rau A, Grill S, et al. Predictors of free flap loss in the head and neck region: a four-year retrospective study with 451 microvascular transplants at a single centre. J Cranio-Maxillofacial Surg. 2016;44(9):1292-8. DOI: https://doi.org/10.1016/j.jcms.2016.04.029

Marttila E, Thorén H, Törnwall J, Viitikko A, Wilkman T. Complications and loss of free flaps after reconstructions for oral cancer. Brit J Oral and Maxillofac Surg. 2018;56(9):835-40. DOI: https://doi.org/10.1016/j.bjoms.2018.09.005

Chaine A, Pitak-Arnnop P, Hivelin M, Dhanuthai K, Bertrand JC, Bertolus C. Postoperative complications of fibular free flaps in mandibular reconstruction: an analysis of 25 consecutive cases. Oral Surgery, Oral Med, Oral Pathol, Oral Radiol, Endodontol. 2009;108(4):488-95. DOI: https://doi.org/10.1016/j.tripleo.2009.05.043

Eckardt A, Fokas K. Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases. J Cranio-Maxillofac Surg. 2003;31(4):197-201. DOI: https://doi.org/10.1016/S1010-5182(03)00039-8

Seo MH, Kim SM, Huan F, Myoung H, Lee JH, Lee SK. Analysis of microvascular free flap failure focusing on the microscopic findings of the anastomosed vessels. Journal of Craniofacial Surgery. 2015;26(7):2047-51. DOI: https://doi.org/10.1097/SCS.0000000000002111

van Gijn DR, D'Souza J, King W, Bater M. Free flap head and neck reconstruction with an emphasis on postoperative care. Facial Plastic Surg. 2018;34(06):597-604. DOI: https://doi.org/10.1055/s-0038-1676076

Las DE, de Jong T, Zuidam JM, Verweij NM, Hovius SE, Mureau MA. Identification of independent risk factors for flap failure: A retrospective analysis of 1530 free flaps for breast, head and neck and extremity reconstruction. J Plas, Reconstr & Aesth Surg. 2016;69(7):894-906. DOI: https://doi.org/10.1016/j.bjps.2016.02.001

Knoedler S, Hoch CC, Huelsboemer L, Knoedler L, Stögner VA, Pomahac B, Kauke-Navarro M, Colen D. Postoperative free flap monitoring in reconstructive surgery—man or machine. Frontiers in Surg. 2023;10:1130566 DOI: https://doi.org/10.3389/fsurg.2023.1130566

Seim NB, Old M, Petrisor D, Thomas W, Naik A, Mowery AJ, et al. Head and neck free flap survival when requiring interposition vein grafting: a multi-instiutional review. Oral Oncol. 2020;101:104482. DOI: https://doi.org/10.1016/j.oraloncology.2019.104482

Futran ND, Stack BC. Single versus dual venous drainage of the radial forearm free flap. Am J Otolaryngol. 1996;17(2):112-7. DOI: https://doi.org/10.1016/S0196-0709(96)90006-X

Chardon VM, Balaguer T, Chignon-Sicard B, Riah Y, Ihrai T, Dannan E, Lebreton E. The radial forearm free flap: a review of microsurgical options. J Plas, Constructive & Aesthetic Surg. 2009;62(1):5-10. DOI: https://doi.org/10.1016/j.bjps.2008.06.053

Klug C, Berzaczy D, Voracek M, Enislidis G, Rath T, Millesi W, Ewers R. Experience with microvascular free flaps in preoperatively irradiated tissue of the oral cavity and oropharynx in 303 patients. Oral oncology. 2005;41(7):738-46. DOI: https://doi.org/10.1016/j.oraloncology.2005.03.015

Lee S, Thiele C. Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in preirradiated soft tissue. J Oral and Maxillofac Surg. 2010;68(9):2169-78. DOI: https://doi.org/10.1016/j.joms.2009.08.026

Rostetter C, Kuster IM, Schenkel JS, Lanzer M, Gander T, Kruse AL. The effects of preoperative radiotherapy on head and neck free flap anastomosis success. JOral and Maxillof Surg. 2016;74(12):2521-5. DOI: https://doi.org/10.1016/j.joms.2016.05.020

Nakamizo M, Yokoshima K, Yagi T. Use of free flaps for reconstruction in head and neck surgery: a retrospective study of 182 cases. Auris Nasus Larynx. 2004;31(3):269-73. DOI: https://doi.org/10.1016/j.anl.2004.03.003

Pohlenz P, Blessmann M, Heiland M, Blake F, Schmelzle R, Lei LI. Postoperative complications in 202 cases of microvascular head and neck reconstruction. J Cranio-Maxillof Surg. 2007;35(6-7):311-5. DOI: https://doi.org/10.1016/j.jcms.2007.05.001