Failure of free flap reconstruction and its prevention

In order to determine the causative factor of microvascular free flap failure and discuss its prevention, we rewiewed 126 patients undergone head and neck reconstruction by the flaps including 67 radial forearm flaps, 26 rectus abdominis myocutaneous flaps, 22 free jejunal flaps, and 11 free colon flaps at Oita Medical University. Out of the total number, 13 flaps (10%) developed a vascular complication and total free flap necrosis occurred in 8 flaps (6.3%). The incidence of diabetes mellitus, hypertension, and previous operation of head and neck was high and they were considered to be risk factors of the free flap f alure. The comlication was due to arterial failure in five flaps and venous congestion in 8 flaps. Cause of the arteial obstruction was thought to be arteriosclerosis which is intrinsic factor of artery itself. Reexploration for the rescue of flaps was attempted, but no flap could be salvaged. The trouble on veins was caused by extrinsic factors that included hematoma and the planning of microvascular anastomosis. Abnormality of the flap was found ralatively early and 5 of 8 flaps could be salvaged. In order to prevent the free flap necrosis, therefore, it was conclued as following. (1) Changing over from a free flap to a vascular pedicled flap should be considered when severe arteriosclerosis is observed during the operation. (2) Avoiding compression of the vein by hematoma and abscess et al, and appropriate planning of microvascular anastomosis are important. (3) The reexploration is initiated as soon as posible in venous congestion.