Microvascular craniofacial reconstruction in cancer patients

Background: Resections of large malignancies involving the middle and upper thirds of the face and cranium result in complex defects, posing a difficult challenge for the reconstructive surgeon. Free tissue transfer may be the best means of reconstruction. Methods: We reviewed 54 consecutive microvascular craniofacial reconstructions after tumor ablation performed at the University of Texas M.D. Anderson Cancer Center from May 1988 to September 1992. Information regarding patient characteristics, tumor stage and histology, history of prior therapy, the defect after tumor ablation, and the details of the reconstruction were entered in a microcomputer database at the time of the initial surgery. Free flap outcome, the number and type of complications, control of malignant disease, and the use of adjuvant therapy were recorded prospectively. Results: Patients had defects of the scalp and cranium (15 of 50) or of the maxilla/orbit/cranial base (35 of 50) after resections for a variety of tumors. Immediate reconstruction was completed in 40 patients and delayed in 10. Prior therapy included surgery (39 of 50) and/or radiotherapy (35 of 50). The free flap success rate was 96% (52 of 54). In patients with successful flaps, significant wound complications occurred in 13.5% of patients (seven of 52) and donor site problems in 11.1% (six of 54) for an overall complication rate of 24.1% (13 of 54). There were no operative deaths or neurologic complications. The timing of surgery or a history of prior surgical therapy or radiotherapy did not significantly influence the complication rates. Conclusion: Free tissue transfers provide optimal restoration of large craniofacial defects resulting from cancer resection.