Free Flap Reconstruction
The radial forearm free flap (RFFF) was most commonly used for cheek reconstruction (n=15; 31.9%) followed by anterolateral thigh (ALT) flap (n=13; 27.7%), scapular / parascapular free flap (n=10; 21.3%), FFF (fibula free flap; n=6; 12.8%), supraclavicular free flap (n=2; 4.3%), and serratus anterior free flap (SAFF; n=1; 2.1%), respectively. Altogether, cutanoues, myocutcaneous and osteocuteanous free flaps were harvested in 19 (40.4%), 12 (25.5%) and 16 (34.0%) cases, respectively (Table II). As indicated in Table II, RFFF was most commonly used for reconstruction of one-layer skin or mucosal defects (14 out of 19; 73.7%), while the ALT flap was mostly used as myocutaneous flap (10 out of 12; 83.3%), and the scapular / parascapular free flap for bone reconstruction (10 out of 16; 62.5%) (Table II). In 8 patients (17.0%) free flaps were oversized and too bulky. Bulkiness of the free flap occurred particularly in zone I defects (30.8% vs. 11.8%), more likely in through-and-through defects (29.4% vs. 10.0%), and after harvest of free scapular / parascapular free flaps (40.0% vs. 10.8%). However, differences failed to reach statistical significance (p=0.288; p=0.118; p=0.331) and revision surgery with thinning of the free flap was performed in 6 out of 8 patients in order to optimize final cosmetic results.
We had two losses of free flaps resulting in a free flap success rate of 95.7%, while flap revision due to venous congestion was necessary in 3 (6.4%) cases. In those two cases with flap loss an ALT and a latissimus dorsi flap were used for revision surgery.