Free flaps and literature review.

BACKGROUND: Microvascular free flaps are a reliable and efficient method for restoring head and neck defects. Here we describe 169 free flap procedures, and determine the success rate of these reconstructions. METHODS: This study included data from all patients who underwent microsurgical reconstruction for head and neck defects at St. John's Hospital in Bruges between 1994 and 2012. We analysed sex, age, American Society of Anaesthesiologists (ASA) score, smoking, prior radiotherapy, and deep circumflex iliac artery (DCIA) harvesting technique to determine their influences on flap complications and overall complications. RESULTS: Our study included 169 free flap procedures, with a flap success rate of 92%. The rate of systemic complications was 21%. The DCIA split harvesting technique was associated with a significantly higher incidence of flap complications. Increased age (357 years) was associated with a higher incidence of overall complications. CONCLUSION: In our present series, the DCIA split harvesting technique was associated with a significantly higher frequency of total flap failure. This increased failure rate was attributed to important haematomas that compromised venous circulation. We also found that patient age was a significant factor for the development of postoperative complications.

Intraoral transmental suction lipectomy.

Intraoral transmental suction lipectomy (TMSL) is performed by entering the suction canula through the chin osteotomy/ostectomy gap into the sub- and/or supraplatysmal fat tissue layers. The aim of the study was to know patients' and operators' satisfaction with the procedure, and to know the kind and frequency of the complications. Twenty patients were consecutively treated and reviewed after a minimum of 5 years. All were satisfied with the overall results. It proved difficult to differentiate between the results of the liposuction and those of the genioplasty and/or orthognathic profile correction. From a surgeon's point of view, 11 showed excellent, nine good and one moderate results. Complications included one local subcutaneous infection, four transient neurosensory disturbances at the lower lip and two marginal branch weaknesses. All complications were resolved by the time of the long-term follow-up appointment. TMSL offers the psychological advantage of being performed without skin incision. Cosmetic results and complications are similar to those obtained with the transcutaneous liposuction techniques.