The objective of this study was to investigate the causes of failure of oral reconstruction by free tissue transfer and thereby improve outcome. Oral microvascular reconstruction was performed in 171 patients between April 1995 and March 2002, and these patients were examined. In this series, rupture and thrombi in anastomotic vessels were found in 12 patients (7.0%). The number of cases of rupture, arterial thrombi, and venous thrombi in the anastomotic vessels were 5, 2, and 5, respectively. Although 6 cases responded to secondary microvascular anastomosis, 6 (3.5%) had total flap necrosis. In conclusion, ruptures and thrombi in anastomotic vessels may be prevented by prophylaxis of cervical infection, relief of pressure on anastomotic vessels, and meticulous surgical technique. Postoperatively cervical rest, close observation, and accurate evaluation of flap status are essential to avoid flap necrosis.
