Complications of Reconstructive Surgery in Head and Neck Region: A Cross-Sectional Study from Bangladesh

Dr. Palash Chandra Sarkar, Dr. Md. Abu Hanif., Dr. Shamim Hassan, Dr. K.M Nurul Alam, Dr. Mohammad Rafiqul Islam, Dr. Md. Shafiul Akram, Dr. Saif Rahman Khan and Dr. Raisa Enayet Badhan
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Dr. Palash Chandra Sarkar: Junior Consultant, Department of Otolaryngology & Head-Neck Surgery, National Institute of ENT, Tejgaon, Dhaka.
Dr. Md. Abu Hanif.: Professor and Director, Department of Otolaryngology & Head-Neck Surgery, National Institute of ENT, Tejgaon, Dhaka.
Dr. Shamim Hassan: Consultan, Plastic Surgery, National Institute of ENT, Tejgaon, Dhaka.
Dr. K.M Nurul Alam: Assistant Professor, Department of Otolaryngology & Head-Neck surgery, National Institute of ENT, Tejgaon, Dhaka.
Dr. Mohammad Rafiqul Islam: Junior Consultant, Department of Otolaryngology & Head-Neck surgery, National Institute of ENT, Tejgaon, Dhaka.
Dr. Md. Shafiul Akram: Residential Surgeon, Department of Otolaryngology & Head-Neck surgery, National Institute of ENT, Tejgaon, Dhaka.
Dr. Saif Rahman Khan: Assistant Registrar, Department of Otolaryngology & Head-Neck surgery, National Institute of ENT, Tejgaon, Dhaka
Dr. Raisa Enayet Badhan: Medical officer, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka

International Journal of Research and Scientific Innovation, 2024, vol. 11, issue 9, 1090-1095

Abstract: Background Microvascular free flaps are ideal for reconstructing post-oncological surgery defects in the head and neck region. Free flaps provide ample tissue for reconstructing even large, complex defects, which gives oncosurgeons flexibility during tumor resections. Methods We performed 50 free flap head and neck reconstructions in 978 patients from June 2015 to September 2018. For reconstructing bone defects, our flap of choice was the free fibula. The surgical outcomes and complications according to flap were retrospectively reviewed and analyzed. Results The overall flap success rate was 98.1%. A total of 45 cases required emergency surgical re-exploration for compromised flaps and 19 of these flaps could not be salvaged. Venous insufficiency was the most common cause of surgical re-exploration. Flaps with delayed arterial thrombosis and vascular compression could not be salvaged. Other complications were partial flap necrosis, oro-cutaneous fistula, and donor site complications. No statistically significant differences were noted for complications in elderly and post-radiotherapy patients. Conclusions Free flap reconstruction is a robust and highly reliable option for head and neck defects and free flaps are a safe option for treating large defects. A second free flap should be the first choice in failed cases after the medical optimization of the patient. Free flap reconstruction is safe in elderly and post-radiotherapy patients.

Date: 2024
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