Patient characteristics
A total of 342 head and neck free flap reconstructions were performed
between January 2017 and July 2019. There were 219 males (64.1 %) and
123 females (35.9%) with a mean age of 65.1 years (range 11–93 years).
The majority of patients were ASA class III (n= 185, 57.8%) with a
median CCI of 5 (range 0 – 13). There were 73 patients (21.3%) who had
prior radiotherapy and 118 patients (34.4%) who had undergone prior
head and neck surgery. The mean operative time was 551 minutes or 9.2
hours (SD 196.6 min) with a median operative time of 520 minutes or 8.7
hours (range 145 – 1395 min). The most common sites were oral cavity
(n=161, 46.9%), skin / salivary gland (n= 129, 37.7%) and oropharynx
(n=29, 8.5%). Osseous resection was performed 121 patients (35.4%) and
a tracheostomy was performed in 114 patients (33.3%).
Defects were characterized as mucosal in 221 patients (64.7%) and
cutaneous in 121 patients (35.3%). Most patients underwent soft tissue
reconstruction only (n=218, 63.7%) with 124 patients (36.1%)
undergoing a composite reconstruction. The most common flap was the
anterolateral thigh (ALT) (n=135, 40%), followed by radial forearm
(n=94, 27.5%), and fibula (n=48, 14.0%), with five patients undergoing
a double free flap (Table 1).