Comprehensive Analysis of 200 Cases of Free Flap Reconstruction in Head and Neck Surgery

Abstract

Background: Firstly, we sought to categorize patients and procedures to better understand the diversity of cases in this field. Additionally, we aimed to trace the evolution of donor site preferences over time, shedding light on how surgical practices have changed. Furthermore, we rigorously evaluated both medical and surgical outcomes, seeking to identify areas for improvement and optimization. Lastly, a primary focus was identifying the variables associated with complications during the reconstruction process. Methods: For our research, we conducted a comprehensive analysis of computerized medical records pertaining to 190 patients who collectively underwent 200 reconstruction procedures at Krishna Hospital, KIMS , karad. To facilitate a more in-depth examination, we meticulously compiled a retrospective database encompassing 140 of these patients. This database encompassed an extensive array of 50 perioperative variables, as well as 10 distinct measures related to adverse outcomes. Results: Throughout our study, we observed a notable shift in preferred donor sites for various types of reconstructions. The fibula emerged as the favored donor site for mandibular reconstruction, while the radial forearm took precedence for pharyngoesophageal reconstruction. In the course of 200 procedures, we recorded a mortality rate of 2.2%, with a median length of hospital stay at 10 days, and an impressive flap survival rate of 95%. We identified certain factors that were associated with significant medical complications, such as administering over 7 liters of crystalloid during surgery and patients aged over 55. Conclusion: In free flap head and neck reconstruction, the risk to patients and transferred tissue remains relatively low. However, it is imperative to take into account specific patient factors during the selection process, including age, smoking history, and weight loss. Additionally, managing fluid balance both during and after surgery is crucial for successful outcomes.