Management of complications and compromised free flaps following major head and neck surgery
Retrospective cohort published in Eur Arch Otorhinolaryngol (2015)
Abstract
Microvascular free flaps are preferred for most major head and neck reconstruction surgeries because of better functional outcomes, improved esthetics, and generally higher success rates. Numerous studies have investigated measures to prevent flap loss, but few have evaluated the optimal treatment for free flap complications. This study aimed to determine the complication rate after free flap reconstructions and discusses our management strategies. Medical records of 260 consecutive patients who underwent free flap reconstructions for head and neck defects between July 2006 and June 2010 were retrospectively reviewed for patient and surgical characteristics and postoperative complications. The results revealed that microvascular free flaps were extremely reliable, with a 3.5 % incidence of flap failure. There were 78 surgical site complications. The most common complication was neck wound infection, followed by dehiscence, vascular congestion, abscess, flap necrosis, hematoma, osteoradionecrosis, and brisk bleeding. Twenty patients with poor wound healing received hyperbaric oxygen therapy, which was ineffective in three patients who eventually experienced complete flap loss. Eleven patients with vascular congestion underwent medicinal leech therapy, which was effective. Among the 78 patients with complications, 44 required repeat surgery, which was performed for postoperative brisk bleeding in three. Eventually, ten patients experienced partial flap loss and nine experienced complete flap loss, with the latter requiring subsequent pectoralis major flap reconstruction. Microvascular free flap reconstruction represents an essential and reliable technique for head and neck defects and allows surgeons to perform radical resection with satisfactory functional results and acceptable complication rates.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
260-patient retrospective at Ohio State 2006-2010: 3.5% flap failure rate; 11 patients with vascular congestion received medicinal leech therapy with effective resolution.
Por qué esto importa para la hirudoterapia
Este estudio revisó retrospectivamente las historias clínicas de 260 pacientes consecutivos que fueron sometidos a reconstrucción con colgajos libres por defectos de cabeza y cuello entre julio de 2006 y junio de 2010, informando una incidencia de 3,5 % de fracaso del colgajo y 78 complicaciones del sitio quirúrgico. El resumen señala que, entre las estrategias de manejo, once pacientes con congestión vascular fueron tratados con hirudoterapia medicinal, la cual fue eficaz. Para el dominio de la ASH, esto aporta un reporte clínico de la hirudoterapia utilizada para la congestión vascular en colgajos libres de cabeza y cuello comprometidos. Sin embargo, no se proporcionan detalles sobre la especie de sanguijuela, el protocolo, la duración, las complicaciones ni la efectividad comparativa, y la hirudoterapia es un elemento secundario dentro de un estudio más amplio sobre el manejo de complicaciones quirúrgicas.
Citación
Management of complications and compromised free flaps following major head and neck surgery.
Kucur C et al. · European archives of oto-rhino-laryngology, 2015
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026