Abstract
The incidences and the causes of flap necrosis were evaluated in 209 patients who had primary reconstruction after radical resection of head and neck cancer during 1982-1993 in Akita University and 1989-1993 in Chiba University. Incidences of extensive necrosis including total and major necrosis in 110 pedicled flaps were 1.8% (1/53) in DP flap including DP flap with clavicle, 3.0% (1/33) in PMMC including PMMC with rib, 5.8% (1/17) in LDMC and 0% (0/7) in other flaps. The incidences of minor troubles including minor and marginal necrosis and suture dehiscence were 5.6%, 3.0%, 29.4% and 0%, respectively. Retrospectively the causes of extensive necrosis in pedicled tissue transplantation were apparent which could have been prevented. Most minor troubles were observed in advanced cancer patients who had full dose preoperative irradiation and showed low albuminemia postoperatively due to massive blood loss during the operation. Incidences of extensive necrosis in 99 free transplantation with microvascular anastomosis were 4.4% (2/45) in forearm flap, 10.5% (2/19) in rectus abdominis mc flap with or without rib, 0% (0/1) in LDMC, 0% (0/3) in scapular flap with bone. 0% (0/2) in serratus antrior mc flap with rib incorporated with LDMC, 33.3% (3/9) in scapular flap with bone incorporated with LDMC with or without serratus anterior mc flap. Incidences of minor troubles in those tranplanted tissues were 2/45, 0/19, 1/1, 2/20, 0/3, 0/2 and 1/9 respectively. Recipient vessels in 5 out of 7 cases had full doses preoperative irradiation. The causes of extensive necrossis in free tissue transplantation could not be specified in most cases.
