Clinical Oral Investigations

, Volume 11, Issue 1, pp 89–92 | Cite as

Outcome and complications of 540 microvascular free flaps: the Hamburg experience

  • Philipp Pohlenz
  • Marco Blessmann
  • Felix Blake
  • Lei Li
  • Rainer Schmelzle
  • Max Heiland
Original Article


The aim of this study was to retrospectively analyze surgical outcome and complications of 540 free flap procedures performed at the Department of Oral and Maxillofacial Surgery of the University Medical Center Hamburg-Eppendorf during 1987–2005. A total of 532 patients were reconstructed with 540 flaps: 32% were latissimus dorsi flaps, 23% were radial forearm flaps, 21% were iliac crest flaps, 10% were fibula flaps, 6% were jejunal flaps, and 8% were other flaps. Thrombosis of one of the vessels and hematoma were the most frequent causes of failure in microvascular free tissue transfer. A total free flap failure occurred in 34 (6.2%) and a partial flap failure in 42 (7.7%) patients. The most reliable flap in regard to survival was the radial forearm flap. The present study confirms that free flaps are extremely reliable in achieving successful reconstruction of the head and neck.


Free flap Microsurgical reconstruction Head and neck defect Outcome Complications 


  1. 1.
    Conrad MH, Adams WP (2001) Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg 108:2088–2096PubMedCrossRefGoogle Scholar
  2. 2.
    Coskunfirat OK, Chen HC, Spanio S, Tang YB (2005) The safety of microvascular free tissue transfer in the elderly population. Plast Reconstr Surg 115:771–775PubMedCrossRefGoogle Scholar
  3. 3.
    Evans HB, Lampe HB (1987) The radial forearm flap in head and neck reconstruction. J Otolaryngol 16:382–386PubMedGoogle Scholar
  4. 4.
    Frampton MC, Breach NM, Archer DJ, Shaw HJ (1986) The use of free tissue transfer in reconstruction following head and neck tumour resection. J Laryngol Otol 100:97–103PubMedGoogle Scholar
  5. 5.
    Haughey BH, Wilson E, Kluwe L (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125:10–17PubMedCrossRefGoogle Scholar
  6. 6.
    Khouri RK, Cooley BC, Kunselman AR (2000) A prospective study of microvascular free flap surgery and outcome. Plast Reconstr Surg 105:2279–2280Google Scholar
  7. 7.
    Khouri RK, Sherman R, Buncke HJ, Feller AM, Hovius S, Benes CO, Ingram DM, Natarajan NN, Sherman JW, Yeramian PD, Colley BC (2001) A phase II trial of intraluminal irrigation with recombinant human tissue factor pathway inhibitor to prevent thrombosis in free flap surgery. Plast Reconstr Surg 107:408–415PubMedCrossRefGoogle Scholar
  8. 8.
    Macnamara M, Pope S, Sadler A, Grant H, Brough M (1994) Microvascular free flaps in head and neck surgery. J Laryngol Otol 108:962–968PubMedGoogle Scholar
  9. 9.
    Malata CM, Cooter RD, Batchelor AGG, Simpson KH, Browning FSC, Kay SPJ (1996) Microvascular free-tissue transfers in elderly patients: the leeds experience. Plast Reconstr Surg 98:1234–1241PubMedGoogle Scholar
  10. 10.
    Panje WR (1982) Free flaps versus myocutameous flaps in reconstruction of the head and neck. Otolaryngol Clin North Am 15:111–121PubMedGoogle Scholar
  11. 11.
    Schustermann MA, Kroll SS, Weber R, Byers R, Guillamondegui O, Goepfert H (1991) Intraoral soft tissue reconstruction after cancer ablation: a comparison of the pectoralis major flap and the free radial forearm flap. Am J Surg 162:397–399CrossRefGoogle Scholar
  12. 12.
    Schustermann MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H (1994) A single centers experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 93:472–478CrossRefGoogle Scholar
  13. 13.
    Simpson KH, Murphy PG, Hopkins PM, Batchelor AG (1996) Prediction of outcomes in 150 patients having mircovascular free tissue transfers to the head and neck. Br J Plast Surg 49:267–273PubMedCrossRefGoogle Scholar
  14. 14.
    Singh B, Bhaya M, Zimbler M (1997) Validation of the Charlson comorbidity index in patients with head and neck cancer: a multi-institutional study. Laryngoscope 107:1469–1475PubMedCrossRefGoogle Scholar
  15. 15.
    Singh B, Bhaya M, Zimbler M (1998) Impact of comorbidity on survival in young patients with head and neck squamous cell center. Head Neck 20:1–7PubMedCrossRefGoogle Scholar
  16. 16.
    Singh B, Cordeiro PG, Sanatmaria E, Shaha AR, Pfister DG, Shah JP (1999) Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 103:403–411PubMedGoogle Scholar
  17. 17.
    Suh JD, Sercarz JA, Abemayor E, Calcaterra TC (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 130:962–966PubMedCrossRefGoogle Scholar
  18. 18.
    Tabah R, Flynn M, Acland R (1984) Microvascular free tissue transfer in head and neck and esophageal surgery. Am J Surg 148:498–504PubMedCrossRefGoogle Scholar
  19. 19.
    Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, Biller HF (1998) Oromandibular reconstruction using microvascular composite flaps. Arch Otolaryngol Head Neck Surg 124:46–55PubMedGoogle Scholar
  20. 20.
    Vesper M, Heiland M, Blake F, Flinzberg S, Schmelzle R (2002) Clinical and histological results of sensory recovery after radial forearm flap transfer. Clin Oral Investig 6:114–118PubMedCrossRefGoogle Scholar
  21. 21.
    Watkinson JC, Breach NM (1991) Free flaps in head and neck reconstructive surgery: a review of 77 cases. Clin Otolaryngol 16:350–353PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Philipp Pohlenz
    • 1
  • Marco Blessmann
    • 1
  • Felix Blake
    • 1
  • Lei Li
    • 1
  • Rainer Schmelzle
    • 1
  • Max Heiland
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany

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