Outcomes and complications of head and neck microvascular reconstruction in a resource limiting setting.

Free flap reconstruction in a resource limiting setting

Abstract

Background

This is a study on the complications and outcomes of head and neck microvascular reconstruction in a resource limiting centre. The aim is to evaluate the impact of the events in this limiting environment on the outcome of free tissue transfer for head and neck reconstruction and how this can be prevented to help improve outcomes.

Methodology

This was a retrospective cohort of cases seen over a 4- year period (2019-2022). All the patients that underwent free tissue transfer for head and neck ablative defects were included. The high-risk cases were evaluated using age > 60 years, Charlson comorbidity index and American Society of Anaesthesiologist (ASA) physical status evaluation scores as predicted variables. Outcomes and postoperative complications were also evaluated, and predictor variables analysed against complications.

Result

Twenty-three cases underwent free tissue transfer for specific head and neck defects over the study period. Their median age was 53 years and male to female ratio was 2:1. Fifty-six percent of the tumours were benign, 52% of flaps were fibular free flaps, while 44% were radial forearm free flaps. Twenty-six percent of the flaps failed while 74% survived. Thirty-nine percent of the flaps experienced complications while an 8% mortality occurred. High-risk cases with comorbidities showed no association to complications or outcomes.

Conclusion

This study suggests that the circumstance of a limited resource healthcare system impacts negatively on free tissue transfer outcome more than associated comorbidities, provided patients are properly selected.