Free flaps in the reconstruction of postoperative ENT defects: a retrospective study 2000– 2022

Czech version

Authors: B. Gál ^1,2; I. Stupka ^2,3; Z. Dvořák ^2,3; D. Slouka ^4,5; J. Hložek ¹; M. Veselý ^1,2; K. Sádovská ¹; J. Kanděra ^1,2; V. Vejmelka ^1,2; R. Lamoš ^1,2; P. Urbánková ^1,2
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku FN u sv. Anny v Brně ¹; LF MU, Brno ²; Klinika plastické a estetické chirurgie FN U sv. Anny v Brně ³; Othorinolaryngologická klinika FN Plzeň ⁴; LF UK v Plzni ⁵
Published in: Otorinolaryngol Foniatr, 74, 2025, No. 2, pp. 89-98.
Category: Original Article
doi: https://doi.org/10.48095/ccorl202589

Overview

Introduction: Free flaps are considered as the gold standard in reconstructive surgery for anatomically and functionally complex defects in the head and neck region. These surgeries are time-consuming and technically demanding, requiring interdisciplinary cooperation. Materials and methods: The retrospective clinical study included patients who underwent free flap reconstruction of oncological defects in the head and neck region at the Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne’s University Hospital in Brno, between 2000 and 2022. Results: A total of 158 patients underwent 162 free flap reconstructive surgeries. Flap types: radial forearm fasciocutaneous flap 62 (38.3%); lateral arm fasciocutaneous flap 16 (9.9%); latissimus dorsi musculocutaneous flap 79 (48.8%); and other 5 (3.1%). Complications: Revision for vascular compromise: 30 (18.5%); partial flap necrosis: 5 (3.12%); total flap necrosis: 2 (1.2%); and flap survival rate 98.8%. Conclusion: The flap survival rate is comparable to leading international centers for head and surgery. Key factors for a successful program include high-quality interdisciplinary cooperation, appropriate patient selection, high level of surgical skills, and standardized postoperative care protocols.

Keywords:

reconstruction – head and neck cancer – free flap – microsurgery

Sources

1. Binková H, Hložek J, Kostřica R et al. Volné laloky v rekonstrukci rozsáhlých defektů po onkochirurgických výkonech v oblasti hlavy a krku. Otorinolaryngol Foniatr 2014; 63 (2): 75–81.

2. Mortensen K, Nilsson M, Slim K et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg 2014; 101 (10): 1209–1229. Doi: 10.1002/bjs.9582.

3. Modrall JG, Minter RM, Minhajuddin A et al. The surgeon volume-outcome relationship: not yet ready for policy. Ann Surg 2018; 267 (5): 863–867.

4. González-García JA, Chiesa-Estomba CM, Sistiaga JA et al. Utility and versatility of the supraclavicular artery island flap in head and neck reconstruction. Acta Otorrinolaringol Esp 2018; 69 (1): 8–17. Doi: 10.1016/j.otorri.2017.03.004.

5. Molitor M. Radikální operace a rekonstrukce lalokovými přenosy u zhoubných nádorů hlavy a krku a optimalizace vztahu k chemoterapii a radioterapii [dissertation]. Brno: Masarykova univerzita, Lékařská fakulta. 2006 [online]. Available from: https: //is.muni.cz/th/47143/lf_d/aaa_ DP3.pdf.

6. Ban MJ, Na G, Ko S et al. Externally monitored versus conventional buried flaps in laryngopharyngeal reconstruction. Clin Exp Otorhinolaryngol 2021; 14 (4): 407–413. Doi: 10.21053/ceo.2020.02074.

7. Chiu YH, Chang DH, Perng CK et al. Vascular complications and free flap salvage in head and neck reconstructive surgery: analysis of 150 cases of reexploration. Ann Plast Surg 2017; 78 (3 Suppl 2): S83–S88. Doi: 10.1097/SAP.0000000000001011.

8. Brennan M, Wong S, Faringer PD et al. Head and neck tumor resection and free flap reconstruction in low-volume center. Ear Nose Throat J 2021; 100 (9): 647–650. Doi: 10.1177/01455 61320923835.

9. Han SH, Kim YC, Kwon TK et al. Cumulative sum analysis of the learning curve of free flap reconstruction in head and neck cancer patients. Clin Exp Otorhinolaryngol 2022; 15 (2): 177–182. Doi: 10.21053/ceo.2021.01053.

10. Chovanec M, Zábrodský M, Vik K et al. Rekonstrukce rozsáhlých defektů v oblasti hlavy a krku volným lalokem z anterolaterálního stehna. Otorinolaryngol Foniatr 2011; 60 (4): 198–203.

11. Dort JC, Farwell DG, Findlay M et al. Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the Enhanced Recovery After Surgery Society. JAMA Otolaryngol Head Neck Surg 2017; 143 (3): 292–303. Doi: 10.1001/jamaoto.2016. 2981.

12. Khan U, Hathi K, MacKay C et al. The complications of osseous reconstruction in the head and neck: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2024; 171 (3): 631–641. Doi: 10.1002/ohn.793.