Postoperative complications in 318 cases of microvascular head and neck reconstruction

Abstract

The objective of this retrospective study was to analyze the incidence and causes of postoperative complications in patients following head and neck cancer surgery with microvascular free flap reconstruction. We reviewed 318 patients in 3 years who had undergone head and neck cancer surgery with microvascular free flap reconstruction. Complications were classified according to the Clavien-Dindo classification system （CDC）. As a result, 115 patients （36.2％） of the total had major complications （CDC Grade Ⅲa and above）. With regards to microvascular complications, postoperative pedicle thrombosis occurred in 20 cases （6.3％）. Vascular reanastomosis was carried out in 14 cases, of which 12 cases were salvaged. Complete flap necrosis occurred in 8 cases （2.5％）. As for pulmonary complications, 17 cases required mechanical ventilation due to postoperative respiratory failure. These complications significantly prolonged hospital stay. Although serous fluid collection, chylous or lymphatic fistula occurred in around 5％ each, there was little effect on prolonged hospital stay. In the present study, the flap salvage rate was improved in comparison with our previous report on 1,031 patients in 8 years. This fact highlighted the importance of postoperative seamless observation and appropriate re-exploration.