[Complications of reconstructive surgery using free flaps in the maxillofacial region]. / Complicanze della chirurgia ricostruttiva mediante lembi liberi del distretto maxillo-facciale.

ABSTRACT

The subject of our investigation was a group of twenty-nine patients with cervico-facial malignant neoplasms. The 29 patients, whose ages ranged from 12 to 68, with a mean age of 40, underwent surgery between January 1992 and January 1995. Cranial base and/or maxillo-facial defects were restored by free flap tissue transfer. Thirty-one micro-surgical free flaps were performed and post-operative monitoring was carried out for about 15-20 days. The aim of the present study is to show the importance of clinical semeiology which permits an early diagnosis of post-operative complications. Furthermore, post-operative monitoring of microsurgical free tissue transfer enables an etiological diagnosis and surgical vascular salvage of the flap to be made at the most opportune time. Many Authors report microsurgical transfer success at 95%-96% because timely detection and resolution of complication can minimize flap failure. We report our experience with 31 free flaps performed in 29 patients. Three of the patients needed a second transfer due to the failure of the first. Two underwent free flap transfers, while a pedicle flap was carried out on the other. In fourteen, latissimus dorsi free flaps were used (in 2 cases the procedure had to be performed twice), the forearm and the jejunum were employed in eight patients and the rectus abdominis in one.