Published: 2021-11-25

Microvascular free flap for head and neck reconstruction: our experiences with 218 free flaps for head and neck reconstructions

N. Brian Shunyu, Suvamoy Chakraborty, Lomtu Ronrang, Zareen Lynrah, Hanifa Aktar, Jayanta Medhi, Deepanava J. Das, Chanmiki Sayoo, Clement Momin


Background: Defect following radical resection for advance head and neck cancers are complex and without doubt microvascular free flap offer the best reconstructive option. The purpose of this study is to investigate the flap survival rate and review each vascular compromised flaps.

Methods: This is a reviewed of 218 microvascular free flaps done for reconstruction of 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.  

Results: There were 16 complete flap loss and 3 partial flap loss, giving an overall flap survival rate 91.8% (19/218) and flap survival in turn of complete loss 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). In FF, there were 6 complete flap loss, giving a flap survival rate 92.7% (6/82). In ALT flap, there were 3 complete and 2 partial flaps loss, giving an overall flap survival rate 79.2% (5/24) and flap survival in turn of flap complete loss 87.5% (3/24). In our series vascular flaps complications rate was 12.3% (27/218), with a salvageable rate of 29.6% (8/27). The most salvageable flap was RFF 46.6% (7/15).

Conclusions: The study re-enforce the learning curve in microvascular free flap and RFF is a good flap for a beginner. 


Free flaps, Flap survival, Flap vascular complications

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