Factors affecting success in head and neck region reconstructions performed with free tissue transfer

Despite the high success rates reported in literature for head and neck reconstructions using free tissue transfer, flap loss remains a notable issue. Understanding the factors contributing to flap failure could further reduce these rates. This study aims to comprehensively evaluate the factors affecting flap revision and survival in head and neck reconstructions. Patients with tissue defects in the head and neck region who underwent reconstruction with free flaps were included in the study. Data were collected on age, gender, smoking status, comorbidities, defect location and etiology, type of flap used, recipient artery and vein selected, need for revision, and flap survival. The relationship between these variables and both flap success and revision rates were analyzed. No statistically significant differences were found in arterial and venous anastomotic revision rates or flap survival based on variables such as age, gender, flap type, smoking status, comorbid systemic diseases, number of recipient artery/vein, and vein anastomoses. However, the etiology of the defect influenced arterial revision rates and flap survival. Reconstruction of defects of malignant etiology showed a higher success rate. Both perforator-based and conventional flaps demonstrated similar success rates in head and neck reconstructions. The study reveals that patient characteristics such as age, diabetes mellitus, hypertension, and tobacco use are not contraindications for free tissue transfer. Finally, the choice of recipient vessels in the head and neck region does not significantly impact flap success, indicating flexibility in vessel selection.