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Volume 20, Number 2, June 2008
| | Complete Recovery from Complications of Microvascular Free-flap Transfers after Oral Tumour Extirpation |
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Yuuichi Sasakura,1 Usyaku Lee,1 Yasushi Ohmi,1 Shinobu Takagi,1 Gouichi Matsumoto,1 Kenji Suzuki,1 Hiroaki Konishi,1 Hiroyuki Miyazaki,1 Eiro Kubota,1 Jiro Maegawa2
1Department of Oral and Maxillofacial Surgery, Kanagawa Dental College Hospital, Yokosuka, and 2Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
Abstract
Objective: In this retrospective study, all free-flap transfers done at the Kanagawa Dental College, Kanagawa, Japan, for reconstruction following ablation of head and neck tumours were analysed. The 5 patients who developed complications following reconstructive surgery and the course of recovery were examined.
Patients and Methods: Thirty four microvascular free-flap transfer operations were performed, which included patients with cutaneous radial forearm (17; 50%), myocutaneous rectus abdominis (13; 38%), osteocutaneous scapula composite (2; 6%), osteocutaneous scapula composite with forearm chimera (1; 3%), and myocutaneous rectus abdominis with forearm chimera (1; 3%).
Results: Complications were seen in the forearm (n = 2), osteocutaneous scapula composite (n = 2), and chimeric (scapula composite + forearm) [n = 1] microvascular free flaps. The facial artery showed the most complications when used as a recipient artery, presenting 2 complications in 4 inosculation cases; only 2 complications (7%) were observed for the superior thyroid artery (n = 28). The most frequently used recipient vein, the internal jugular vein (n = 27), showed 3 complications (11%). The presenting complications were first observed at 0.5, 4, 36, and 58 hours (mean ± standard deviation, 19.8 ± 26.1 hours) in the 5 patients with complication. Thrombosis was related to the cause of all complications, including bending of the anastomosis (n = 1), distorted pedicle (n = 1), oppression of the pedicle (n = 1), oppression due to coagulation in the surrounding scar (n = 1), and unknown factors (n = 1). Complete recovery was achieved in all patients.
Conclusion: Early detection of complications, with diligent and meticulous postsurgical follow-up, is key to achieving complete recovery rates following free-flap transfer surgeries.
Key words: Postoperative complications, Reconstructive surgical procedures, Reoperation, Thrombosis
Asian J Oral Maxillofac Surg. 2008;20:53-58.
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