Abstract
To clarify the major points of head and neck reconstruction by microvascular free flap, we reviewed the complications in 78 cases of which 34 were rectus abdominis myocutaneous flaps, 28 were radial forearm flaps, 15 were free jejunal flaps and 1 scapular osteo-cutaneous flap. The analysis about post-operative complications at the recipient site was mainly performed from the point of view of the history of previous surgery and/or radiotherapy. There were 5 cases (6.4%) with major complications which required surgical repair. Out of the 5 cases, there were 3 cases with total free flap necrosis and 2 cases with abdominal complications in relation to harvesting free jejunum. The necrosis was mainly due to the plan of microvascular anastomosis and not the relationship of previous surgery and radiotherapy. It was thought to be resolved by improvement in the skill of the microvascular surgeon. There were 28 cases (35.9%) with minor complications which did not require surgical repair. Out of the 28 cases, there were 17 cases with wound infection including fistula formation, 3 cases with partial flap necrosis, and 4 cases with fluid collection. The wound infection was found to be more frequent in cases which received radical radiotherapy over 45 Gy, than in those who received pre-operative radiotherapy around 40 Gy. Careful examination was necessary to identify any wound infections for the post-operative management of free flap reconstruction in the case with radical radiotherapy.
