Use of free flaps in maxillofacial surgery. A review of 200 clinical cases

Aim. Microvascular ­flaps ­are ­today a fun­da­men­tal recon­struc­tion tech­nique in ­the ­field of max­il­lo­fa­cial sur­gery ­thanks to ­their ­high reli­abil­ity ­and ­the avail­abil­ity of dif­fer­ent tis­sues in ­terms of qual­ity ­and quan­tity. Methods. The ­results ­obtained in 200 ­micro-sur­gi­cal recon­struc­tion pro­ce­dures of ­the ­head ­and ­face ­are ana­lysed. Reconstruction fol­lowed can­cer abla­tion in 159 cas­es, ­and ­was ­due to ­facial par­al­y­sis, lim­it­ed ­mouth open­ing, oste­or­a­di­o­nec­ro­sis or ­severe max­il­lary atro­phy in ­the remain­ing 41 cas­es. Flaps ­used ­were: fib­u­la (73 cas­es), fas­cia-cuta­ne­ous com­po­nent of fore­arm (75 cas­es), rec­tus abdom­i­nis mus­cle (13 cas­es), lat­is­si­mus dor­si mus­cle (28 cas­es), ­iliac ­crest (7 cas­es), par­a­scap­u­lar ­system (2 cas­es) omen­tum (1 ­case), lat­er­al bra­chi­al­is (1 ­case). Postoperative mon­i­tor­ing com­prised ­both clin­i­cal exam­ina­tion ­and Doppler scan­ning; 48 com­plete­ly con­cealed ­flaps ­were mon­i­tored by Doppler scan­ning ­alone. Results. The suc­cess ­rate ­was 95.5%. In 14 cas­es, sur­gi­cal re-explo­ra­tion of ­the ­flap ­was ­required ­for vas­cu­lar insuf­fi­cien­cy; 78% of ­these ­flaps ­were ­saved. Neither ­prior sur­gi­cal inter­ven­tion, ­nor ­prior irra­di­a­tion of ­the sur­gi­cal ­field, ­nor ­the pres­ence of meta­bol­ic dis­eas­es neg­a­tive­ly influ­enced ­the suc­cess ­rate. Conclusion. The ­low ­rates of fail­ure ­and com­pli­ca­tions, togeth­er ­with ­the ­good ­results in mor­pho­log­i­cal ­and func­tion­al ­terms, ­make micro­vas­cu­lar ­flaps ­one of ­the ­most sig­nif­i­cant recon­struc­tion meth­ods ­for ­the ­oral ­and max­il­lo­fa­cial ­area, in par­tic­u­lar ­for exten­sive ­defects.