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Postoperative morbidity of free flaps in head and neck cancer reconstruction: a report regarding 215 cases

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Abstract

Objectives

The aim of this study was to identify the factors responsible for free flap failure, the surgical complications, and the non-oral feeding period in patients treated for an oral squamous cell carcinoma.

Materials and methods

This multicentric study included 215 patients treated by tumour resection with immediate free flap reconstruction for an OSCC between 2010 and 2016. All of the patient medical files were reviewed and the data regarding the patient medical history, the tumour-related features, the surgical procedure, and the postoperative recovery were compiled. A statistical analysis with univariate and multivariate logistic regression was carried out.

Results

The free flap success rate was 94.4% in our series. A postoperative complication occurred in 101 patients (41%). Minor surgical complications were shown to increase the free flap failure rate (OR 3.32; p = 0.04). A major surgical complication was encountered in 48 patients (22.3%), and these were linked to minor surgical complications (OR 2.89; p = 0.004) and the use of a tracheostomy (OR 5.76, p = 0.002). Conversely, a medical history of high blood pressure had a protective effect (p = 0.04). The non-oral feeding rate at the end of the hospital stay was 28.4%, and it correlated with the tracheostomy (p = 0.002), as well as the major and the minor surgical complications (p = 0.04).

Conclusion-clinical relevance

Free flap reconstruction is a safe and reliable technique with head and neck cancer reconstruction. Postoperative care favouring early and safe oral-feeding, and avoiding a tracheostomy can reduce the incidence of surgical complications after OSCC reconstruction.

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Authors and Affiliations

  1. Service de Chirurgie Maxillo-faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France

    Maria Poisson, Julie Longis, Benoit Piot & Hélios Bertin

  2. Service de chirurgie Maxillo-faciale et Stomatologie, Hôpital Roger Salengro, CHRU Lille, rue du Pr. Emile Laine, 59037, Lille Cedex, France

    Matthias Schlund

  3. Service de Biostatistiques, CHU de Nantes-Direction de la Recherche, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France

    Morgane Pere

  4. Service d’ORL et Chirurgie Cervico-faciale, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France

    Guillaume Michel

  5. Service d’ORL et Chirurgie Cervico-faciale, CHU Félix Guyon, 2 rue des Topazes, 97400, Saint-Denis, France

    Antoine Delagranda

  6. Service d’ORL et Chirurgie Cervico-faciale, Hôpital Huriez CHRU de Lille, Inserm U908lab research, rue Michel Polonovski, 59000, Lille, France

    François Mouawad

Authors
  1. Maria Poisson
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Correspondence to Maria Poisson.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Poisson, M., Longis, J., Schlund, M. et al. Postoperative morbidity of free flaps in head and neck cancer reconstruction: a report regarding 215 cases. Clin Oral Invest 23, 2165–2171 (2019). https://doi.org/10.1007/s00784-018-2653-1

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