Supraclavicular artery island flap for head and neck reconstruction.

BACKGROUND: The ablative surgical resection has a critical importance for achieving better oncological outcomes for patients with head and neck cancer. However, radical surgical resections reveal the reconstruction requirement of complex anatomical structures. Microvascular free flaps have been recommended as a gold standard treatment choice for head and neck reconstruction following definitive oncological surgery. The supraclavicular artery island flap (SCAIF) is a thin and reliable fasciocutaneous pedicled flap that is simple and quick to harvest. MATERIAL AND METHODS: A total of 19 patients who underwent head and neck reconstruction with SCAIF were included in this study. The SCAIF was used for the reconstruction of oncological defects in 17 patients while it was used for the reconstruction of a skin defect on the lower face following radiotherapy in 1 patient and for cervical open wound (blast injury) closure in 1 patient. RESULTS: There were neither intraoperative nor postoperative major complications in any patient. The SCAIF has been used successfully in 18 of 19 patients for head and neck reconstructive surgery. Partial necrosis of the skin was detected in 1 patient (5.3%) only, while a total flap failure has not occurred in any patient. The partial skin necrosis was seen in an area of 1.5 cm of the distal end of the flap and was managed conservatively with local wound care. Wound dehiscence has not appeared in the flap donor area in any patient. CONCLUSION: The SCAIF constitutes a good alternative to free flaps, providing almost equivalent functional results and requiring less operative time and surgical effort.

Squamous cell carcinoma development in Fanconi anemia patients who underwent hematopoietic stem cell transplantation.

We examined SCC development of 24 FA patients, who received HSCT from HLA-matched relatives. In our BMT center, we applied low-dose CY + LFI + ATG (n:13) as conditioning regimen for FA patients between 1992 and 1999, and CY + BU + ATG (n:11) between 1999 and 2002. The aim of this study was to investigate SCC development after HSCT and examine features of the follow-up patients. The 10-year overall survival (OS) of the group with LFI + regimen was 43%, whereas the group without LFI regimen was 60%. There was a statistically significant relationship between infections (viral/bacterial) and overall survival (Fisher's Exact test P < .001). Five out of 13 long-term (>1 year) surviving patients developed SCC in the HNSCC (n:4) and esophagus (n:2) region (a patient with oral SCC developed a second primary esophageal SCC). The SCC rate in our FA patients was 38%, four of the SCC patients were transplanted with irradiation used conditioning regimens, three of them had acuteGvHD (Grade II-III), only one developed chronic GvHD. The interval between HSCT and SCC diagnosis was median 13 (range 6-18) years, the age for the development of cancer was median 21 (range 15-32) years. Survival after SCC was low, median 6 months (range 6-12), due to delayed SCC diagnosis, tumor progression under therapy and treatment-related toxicities of the usually reduced RT and/or CT.

A Rare and Subtle Etiology of Chronic Oropharyngeal Pain: Isolated Internal Carotid Artery Kinking without Stenosis.

Carotid artery kinking is a frequent finding in duplex ultrasonography. However, isolated morphological changes without significant carotid stenosis are rarely symptomatic. Neck pain is a rare symptom in patients with carotid artery kinks. The vascular etiology in patients with persistent neck pain is usually overlooked. A 58-year-old female patient with chronic neck pain presented to our clinic. Following multidisciplinary team review, the symptoms were found due to the kinking of the internal carotid artery. In this report, we present the clinical presentation of the patient with the kinking of the internal carotid artery without stenosis, surgical management of the pathology, and a brief literature review.

Displacement of a Broken Dental Injection Needle Into the Perivertebral Space.

Dental injection needle breakage is an uncommon problem in dental practice. Displacement of the broken fragment into anatomical spaces is, on the other hand, a serious complication that occurs most commonly during inferior alveolar nerve blocks as a result of material wear, incorrect application of the anesthesia technique, or sudden movement of the patient during injection. Further complications such as infection, trismus, and nerve paralysis may exacerbate the condition and, if not treated adequately, life-threatening conditions may develop over time as the fragment dislodges deeper in soft tissues. Clinical symptoms of the patient, as well as the findings gathered from detailed physical examination and radiographic evaluation, are important factors to consider before performing an exploratory surgery. Removal of a broken needle may be troublesome due to its proximity to vital anatomic structures. Multislice computed tomography is a reliable imaging modality that provides accurate information to pinpoint the exact location of the needle fragment.This report describes a case of needle breakage occurred during inferior alveolar nerve block which was performed to extract a third molar tooth and the migration of the broken fragment from the right mandibular ramus area into the perivertebral space, with special emphasis on the surgical retrieval technique with multiplanar computed tomography imaging guidance.

Safety and Efficacy of Chitosan-Dextran Hydrogel in the Middle Ear in an Animal Model.

OBJECTIVES: To investigate the efficacy of chitosan-dextran hydrogel (CDH) in preventing postoperative adhesions between the tympanic membrane (TM) and intratympanic structures, and to evaluate its ototoxicity in an animal study. METHODS: In the first step, ototoxicity was evaluated with 7 male albino guinea pigs (GPs) via auditory brainstem responses (ABR) before and 4 weeks after unilateral intratympanic injection of CDH and saline solution contralaterally. In the second step, 12 GPs underwent bilateral ear surgery. The middle ear (ME) mucosa was abraded, and the cavity was filled with CDH on one side and packed with Gelfoam on the contralateral side. A control group of 6 GPs underwent the same procedure except that no material was applied in the ME. The animals were euthanized at the end of the 7th week, and otomicroscopic findings were noted and the temporal bones harvested for the histologic examination. The findings were scored and compared. RESULTS: There was no statistically significant difference between the pre- and postoperative ABR thresholds. In the otomicroscopic findings, the most prominent difference between the two groups was the presence of retraction of the TM in the Gelfoam group. The histopathologic findings revealed a higher degree of inflammation in the Gelfoam group compared with the CDH group. CONCLUSION: This study demonstrated that CDH has no ototoxic effects in GPs. Its use as an ME packing material revealed significantly less TM retraction and inflammatory reaction compared with Gelfoam.

The incidence of thyroid cartilage invasion through the anterior commissure in clinically early-staged laryngeal cancer.

In this study, the incidence of thyroid cartilage invasion in early-stage laryngeal tumors involving anterior commissure was assessed. Medical charts and pathology reports of 62 patients who underwent supracricoid partial laryngectomy as the primary treatment of early-staged laryngeal squamous cell carcinoma were retrospectively reviewed. Patients were divided into two groups according to the macroscopic examination of the surgical specimen: tumors limited to the glottis with the involvement of anterior commissure (TLG); tumors invading both supraglottis and glottis with the involvement of anterior commissure (TISG). Thirty-seven of the cases were classified as TLG group (59.7 %) and the remaining 25 of them were classified as TISG group (40.3 %). Thyroid cartilage invasion was observed totally in ten patients (16.1 %), as macroscopic invasion in two cases and microinvasion in eight patients. Only two were in the TLG group (cartilage invasion rate of 5.4 %), the remaining eight were in the TISG group (cartilage invasion rate of 32 %). Thyroid cartilage invasion rate of TISG group was significantly higher than that of TLG group (p = 0.011, p < 0.05). Tumors limited to the glottis with AC involvement may be more suitable for endoscopic resection; on the contrary, tumors with vertical extension invading both AC and supraglottis should be evaluated more suspiciously due to high rate of thyroid cartilage invasion, which may still necessitate external laryngectomy techniques.

The Effect of Arytenoidectomy on Functional and Oncologic Results of Supracricoid Partial Laryngectomy.

OBJECTIVE: The effect of arytenoid resection was investigated in patients who had undergone supracricoid partial laryngectomy (SCPL) by comparing functional and oncologic results between patients with both arytenoids preserved with those with one arytenoid resected. METHODS: Patients were divided into 2 groups: (1) both arytenoids preserved SCPL (BASCL) cases and (2) one arytenoid preserved SCPL (OASCL). The functional outcomes of the 2 groups were compared in terms of nasogastric tube removal time, decannulation time, incidence of aspiration pneumonia, and Performance Status Scale Scores for Head and Neck Cancer Patients for the late postoperative period. Additionally, the oncologic outcomes of both groups were compared using the 5-year local control rate, overall survival, disease-specific survival, and larynx preservation rate. RESULTS: Of the 68 patients who were enrolled in the study, 20 of them were in the OASCL group and 48 in BASCL group. There was no statistically significant difference in the early and late functional outcomes, and the oncologic outcomes were also similar. CONCLUSION: In addition to the proven oncologic safety, arytenoid resection does not increase the functional morbidity of the SCPL.

A new extended supracricoid laryngectomy technique for tongue base and hyoid bone involvement: crico-glosso-mandibulopexy technique.

In the conventional supracricoid laryngectomy technique, tumors extending beyond the lingual surface of the epiglottis with tongue base invasion are contraindicated due to the requirement of the hyoid bone resection. The loss of the hyoid bone causes intractable aspiration and renders the cricoidal pexy process impossible. Therefore, surgeons tend to treat such tumors with total or subtotal laryngectomies or organ preservation protocols. In this article, a new supracricoid partial laryngectomy technique for tumors requiring resection of the hyoid bone and the base of the tongue was described.

[Foreign body aspiration: an urgent airway condition]. / Yabanci cisim aspirasyonu: Acil bir havayolu durumu.

OBJECTIVES: This study aims to investigate demographic features, type and localization of foreign bodies, mean hospitalization duration, and peri- and postoperative complication ratios of patients with foreign body aspiration. PATIENTS AND METHODS: Seventy patients (23 males, 47 females; mean age 32±14.5 months; range 3 months to 10 years) who were diagnosed with foreign body aspiration in our clinic between January 2007 and August 2010, and performed rigid bronchoscopy under general anesthesia were included in this study. RESULTS: Main findings were cough, wheezing, and witnessed aspiration. No foreign body was detected in 14 patients (20%). Foreign bodies in 56 patients (80%) were successfully removed. Foreign bodies were located in the left bronchial tree in 23 patients (41%), right bronchial tree in 18 patients (32%), trachea in four patients (7%), bilateral bronchial tree in three patients (5%), carina in two patients (3%), subglottic region in two patients (3%), pyriform sinus in two patients (2%), laryngeal ventricle in one patient (1.7%), and right vocal cord in one patient (1.7%). Foreign bodies were hard-shelled nuts in 23 patients (41%), beans in 14 patients (25%), plastic materials in 11 patients (19%), and other bodies in eight patients (14%). CONCLUSION: Foreign body aspiration is a risky condition particularly for children under the age of four. Bronchoscopy is still the most commonly used and reliable diagnosis and treatment method. Foreign body aspiration should be kept in mind in children with persistent cough, wheezing, and unilateral pulmonary findings in radiologic imaging.

[A rare late complication of radiation therapy: bilaterally recurrent laryngeal nerve paralysis]. / Radyoterapinin nadir bir geç komplikasyonu: Iki tarafli reküren larengeal sinir paralizisi.

Peripheral neuropathy is a late complication of radiation therapy, which is least and probably threatening. As it occurs many years after the remission is achieved with a usually irreversible clinical presentation, it significantly increases morbidity in cancer survivors and has an adverse effect on the quality of life. In this article, we report a 39-year-old male patient of bilateral recurrent laryngeal nerve paralysis which developed eight years after the treatment of stage T1b glottic laryngeal carcinoma with primary radiation therapy and was treated by transverse laser cordotomy.

The impact of social and demographic features on comprehensive receptive and expressive performance in cochlear implant patients.

OBJECTIVES: This study aims to observe the effects of social and demographic factors on the language development of prelingual pediatric cochlear implant patients. PATIENTS AND METHODS: Between April 2006 and April 2010, 44 children (26 boys, 18 girls; mean age 81.1±16.9 months; range 54 to 115 months) who were prelingually implanted and who had an implant experience of at least 36 months were retrospectively analyzed. Only the patients without mental-motor retardation, cochlear anomaly and revision surgery and who continued their education without any interruption were selected. Receptive and expressive vocabulary tests were performed on these patients. Social and demographic features including gender, implant age, parents' education status and annual income were recorded. The relationship between language development and socio-demographic factors were investigated. RESULTS: Patients implanted before the age of 36 months showed better levels of receptive and expressive language. Children with higher maternal education levels showed significantly better expressive and receptive equivalent language ages. Annual income of the families had significant positive impacts on the language development of the children who were implanted before the age of 36 months. CONCLUSION: Both expressive and receptive language skills over 36 months of implant experience are significantly associated with age at the time of the implant and socio-economic status of the parents.

[The relationship between operation type, adjuvant radiation therapy, spinal accessory nerve and quality of life in patients with laryngeal cancer]. / Larenks kanserli hastalarda ameliyat tipi, adjuvan radyoterapi ve spinal aksesuvar sinir ile yasam kalitesi arasindaki iliski.

OBJECTIVES: In this study, we aimed to investigate the effect of operation type, adjuvant radiation therapy (RT), and preserved spinal accessory nerve on the quality of life in patients with laryngeal cancer. PATIENTS AND METHODS: A total of 191 consecutive patients (185 males, 6 females; mean age 59±10 years; range 42 to 79 years) who were operated due to laryngeal cancer were included. The quality of life scores were estimated using the Washington University Quality of Life Questionnaire, version IV. The patients were divided into six groups according to the operation type, the need for postoperative RT and preserved or operated spinal accessory nerve during the neck dissection. Group 1 consisted of patients with total or near total laryngectomy; group 2 consisted of those with partial laryngeal surgery; group 3 consisted of those with postoperative RT; group 4 consisted of those without postoperative RT; group 5 consisted of those with preserved 11th cranial nerve during the neck dissection, and group 6 consisted of those with non-preserved 11th cranial nerve during the neck dissection. The questionnaire scores were compared among the groups. RESULTS: The compact quality of life scores were 77.4±11.3 in group 1, 86.2±7.2 in group 2, 79.1±9.5 in group 3, 83.4±10.6 in group 4, 87.3±9.4 in group 5, and 79.4±10.8 in group 6. There was a statistically significant difference in the compact quality of life scores among the surgery groups, neck dissection groups and RT groups (p=0.018, p<0.001, p<0.001, respectively). There was no effect of preserved 11th cranial nerve on daily activity, swallowing, chewing, appearance, recreation, salivation, taste, speech, mood, and anxiety parameters. This nerve was not preserved in 71.9% of the patients who were urged to change their job due to shoulder problems. The difference was statistically significant (p<0.001). CONCLUSION: According to our study results, we concluded that partial laryngectomy improved the quality of life, rather than total or near-total laryngectomy, while postoperative RT had an adverse effect on the quality of life and preserved spinal accessory nerve during the neck dissection had a positive impact on the quality of life in patients with laryngeal cancer.

Evaluation of Post-Swallow Residue with Visual Analysis of Swallowing Efficiency and Safety in Patients with Idiopathic Parkinson's Disease.

Objectives: Dysphagia is common in idiopathic Parkinson's disease (IPD) and is associated with impairments in both swallowing safety and swallowing efficiency. The goals of this study were to define post-swallow residue patterns in people with IPD and describe pathophysiological endoscopic findings affecting residue accumulation. Methods: This was a prospective single-blinded cross-sectional cohort study of patients with the diagnosis of IPD recruited from a Movement Disorder Clinic. Clinical variables included patient age, cognitive function, and measures of disease severity, and laryngoscopic examinations with a flexible endoscopic evaluation of swallowing (FEES) were completed for each patient. Visual Analysis of Swallowing Efficiency and Safety (VASES) was used to analyze FEES. Post-swallow residue outcomes and non-residue endoscopic outcomes including the Bowing index, Penetration Aspiration Scale (PAS) score, premature leakage, and build-up phenomenon were evaluated. Multiple regression models were used to evaluate factors affecting the residue at different anatomic levels. Results: Overall 53 patients completed the study. The multiple regression analyses showed a relation between (1) the presence of residue at the level of oropharynx and epiglottis with premature leakage, (2) the presence of residue at the level of the laryngeal vestibule and vocal folds with build-up phenomenon, and (3) the presence of residue at the level of the hypopharynx, laryngeal vestibule, and subglottis with airway invasion. Conclusion: Residue pattern during FEES is associated with specific swallow dysfunctions in IPD. Using residue localization and quantification may be a helpful tool in assessing the impact of targeted swallowing interventions in patients with IPD and dysphagia.

[The use of botulinum toxin type A in masseter muscle hypertrophy: long-term effects and lasting improvement]. / Masseter kas hipertrofisinde botulinum toksin tip A uygulamasi: Uzun dönem etkiler ve kalici iyilesme.

OBJECTIVES: In this study, we aimed to evaluate the long-term efficacy of botulinum toxin A injection in reducing the masseter muscle thickness. PATIENTS AND METHODS: Between 2007 and June 2008, we retrospectively analyzed the data from 28 patients (21 females, 7 males; mean age: 25.5±4.5 years; range 20 to 46 years) with benign masseter hypertrophy treated with botulinum toxin A injections. All patients were diagnosed by the morphometric analysis of the masseter muscle. The injections were repeated intermittently every six months and totally for six times. The patients were recalled and the last measurement was performed at a mean follow-up of 13.2 months. RESULTS: The values obtained following consecutive injections were compared and a statistically significant reduction in thickness of masseter muscle thickness after every single injection was found (p<0.001). The final measurement following treatment discontinuation revealed that this reduction was long-lasting. CONCLUSION: Botulinum toxin A injection is a safe and long-term effective therapy for the masseter muscle hypertrophy.

Oncologic and functional outcomes of open surgery in early supraglottic tumors: is it still a valid technique?

OBJECTIVES: In this study, we aimed to analyze the oncologic and functional outcomes of supraglottic laryngectomy. PATIENTS AND METHODS: Medical records of 91 cases (85 males, 6 females; mean age 55.4 years; range 30 to 75 years) who underwent surgery due to early supraglottic laryngeal cancer in our clinic were retrospectively analyzed. Statistical analysis was performed using chi-square test and Fisher's exact test. Mean values were estimated by means of t-test, while survival curves were drawn using Kaplan-Meier method. RESULTS: With respect to oncologic assessment, disease-free survival rate was 81%, the rate of regional recurrence was 6%, the rate of local recurrence was 8%, the rate of distant metastasis was 7% and the rate of occult neck metastasis was 25%. Metastatic neck disease and extracapsular invasion in the lymphatic ganglia were found to be the most critical parameters in terms of survival. With respect to functional assessment, the mean time of decannulation was 41 days, while the mean time of nasogastric tube removal was 19 days. It was observed that cases with a Forced Expiratory Volume in 1 second (FEV-1) of <75% experienced more aspiration-related problems. The functional outcomes were worse in the cases who underwent bilateral neck dissection and postoperative radiotherapy. CONCLUSION: Open surgery is a more effective treatment modality in the early supraglottic tumors in terms of oncologic and functional outcomes. It should be continued to be use as an alternative method to the novel and expensive technologies including transoral robotic surgery or transoral laser surgery.

[Revision surgery in cochlear implantation]. / Koklear implantasyonda revizyon cerrahisi.

OBJECTIVES: In this study, we evaluated the reasons and management approaches for revision cochlear implant surgery. PATIENTS AND METHODS: Thirty-two patients (20 males, 12 females; mean age 7.4 years; range 15 month to 54 years) who underwent revision cochlear implantation in our clinic were divided into two group, including reimplantation or non-reimplantation group. RESULTS: Of patients who underwent revision surgery, 22 had reimplantation, while remaining 10 were not required reimplantation. The mean time from the first surgery to revision surgery was 17.3±15.2 months (range 1-59 months). In patients who underwent primary surgery in our clinic, the revision and reimplantation rates were 5.2% and 3.4%, respectively. The reasons for revision surgery included software failure of the device (n=7), local flap problems (n=7), reference electrode problems (n=5), magnet displacement (n=2), electrode migration to vestibule (n=2), extracochlear insertion of electrode (n=2), broken electrode (n=2), device failure following head trauma (n=2), facial stimulation and paralysis (n=1), electrode exposition from the external ear canal (n=1), and electrode exposition to the middle ear (n=1). CONCLUSION: The most common reasons for the revision cochlear implant surgery are software failure of the device, local flap problems and electrode failures. In revision surgery, the problems should be solved without damaging the implant, if the implant is running.

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation.

INTRODUCTION: Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. OBJECTIVES: To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. METHODS: The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. RESULTS: Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10-21 days). All patients achieved oral intake in a median time of 74 days (range, 15-180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21-300 days). The mean followup duration was 38.3 months (range, 10-71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. CONCLUSION: Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

[A case of secondary post-tonsillectomy bleeding: necrosis of the internal carotid artery]. / Tonsillektomi sonrasi sekonder kanama olgusu: Internal karotis arter nekrozu.

Post-tonsillectomy hemorrhage is a relatively common complication but life-threatening bleedings are rare. In this paper, we present a case who had undergone tonsillectomy with bipolar diathermy in an another hospital and who was referred to our clinic following a massive hemorrhage from the tonsil bed on the 27th postoperative day. Upon determining that the bleeding was caused by the necrosis of the internal carotid artery, the ligation of the internal carotid artery was performed.

[Malignant peripheral nerve sheath tumor in the parotid gland developed on the basis of neurofibromatosis type 1]. / Nörofibromatozis tip 1 zemininde gelisen parotis bezi yerlesimli habis periferik sinir kilifi tümörü olgusu.

Malignant peripheral nerve sheath tumors arising from the parotid gland are very rare. They can develop as sporadic cases, or on the basis neurofibromatosis type 1. Tumors originating from the parotid gland are generally easy to palpate and have a solid characteristic. Even if the tumor is malignant in character, the incidence of facial paralysis at the time of diagnosis is around 15% in various studies. However, a malignant tumor originating from the nerve itself may not be noticed during the physical examination for a long period time although it cases facial paralysis and may be mistaken with other non-neoplastic diseases involved in the etiology of facial paralysis leading to a delay in the diagnosis and treatment. Especially patients with type 1 neurofibromatosis have a great tendency to develop malignant peripheral nerve sheath tumors. In this article a case of malignant peripheral nerve sheath tumor developed on the basis of neurofibromatosis type 1 was reported.

Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists.

OBJECTIVE: To determine flap success rate and complications in patients who underwent microvascular free tissue reconstruction after major head and neck ablative surgery and to report the improvement in the results. METHODS: Medical records of 124 patients who were operated on in 2012 to 2019 were retrospectively reviewed. Indications for different free flap types, success rates and re-exploration rates, donor site morbidities, and reasons for flap loss were analyzed. Patients were divided into two groups to identify the effects of the anticoagulant and the antiaggregant treatments on postoperative results. RESULTS: There were 127 flaps in 124 patients, including two different free flaps each in three patients that were harvested and used in the same surgical session. Of the total 127 flaps, 82 (64.6%) were radial forearm flaps, 39 (30.7%) were fibula flaps, and 6 (4.7) were rectus abdominis flaps. Four patients were re-explored for flap perfusion problems, and 18 patients were re-explored for hematoma drainage (n=22/124, %17.3). The rate of hematoma and re-exploration was higher in patients who received anticoagulant and antiaggregant treatments synchronously (p=0.02). Three flaps were lost, and the overall success rate was 97.6%. Two patients died from perioperative complications. No major complications were observed at the donor site; minor complications were observed in 30 patients. CONCLUSION: The success rate for the 127 flaps in 124 patients were found comparable to those reported in the literature. These results show that successful outcomes can be achieved with experience and a head and neck team dedicated to improving the results in microsurgical reconstruction, and flap failure rarely occurs if perioperative care of the patients is given meticulously.