The learning curve in head and neck reconstruction with microvascular free flaps: a retrospective review

Background: Tissue defect around the head and neck region is a great challenge for reconstructive surgeons. Successful outcomes of surgery is influenced by many factors such as surgical technique in recipient and donor site, meticulous microvascular anastomosis, position of vascular pedicle, and post-surgery monitoring. The learning curve is important for any new microvascular surgeons. Objectives: Evaluate the quality of training for a new otolaryngologist, head and neck surgeon, on their performance of free flaps in facial plastic and reconstructive surgery using a retrospective review. Methods: Nineteen microvascular free flaps in patients from the ENT Center of Rajavithi Hospital were reviewed between November 2008 and October 2009. Incidences of free flap survival, and partial and complete necrosis were examined. Results: Eighteen patients with microvascular free flaps had head and neck cancer. 88.9% of the patients had squamous cell carcinoma. There were nine radial forearm free flaps, five anterolateral thigh free flaps, two rectus abdominis free flap, two iliac-free flap, and one fibular-free flap. The overall success rate of the free flap reconstructions was 84%. One partial and three total necrosis were done on the 19 flaps. Conclusion: Causes of free flap failure were similar and not dependent on the experienced of the surgeons. The postgraduate training program in facial plastic and reconstructive surgery is effective in providing new microvascular surgeons the skills to perform successful microvascular and reconstructive surgeries. Keywords: Free flaps, head and neck reconstruction, learning curve, microvascular surgery