Microsurgical free flap reconstruction performed by head and neck surgeons: a retrospective cohort study of 125 patients of a single institution

Microsurgical Free Flap Reconstruction (MFFR) is a keystone in head and neck surgery because it offers better functional outcomes, less donor site morbidity, improved esthetics, and higher success rates. To provide a comprehensive overview of our experience with MFFR, exploring its indications, procedural details, outcomes, and emerging trends in postoperative care. A retrospective cohort study was conducted on 125 patients who underwent MFFR between June 2016 and July 2024 at the Hospital Santa Casa de Misericordia, Porto Alegre, Brazil. Patient demographics, tumor characteristics, flap type, surgical details, and postoperative outcomes were analyzed, including flap survival and the need for intensive care unit (ICU) admission. 125 patients (57.6% male; mean age: 59 (SD 15.9)) were included. The most common tumor location was the oral cavity. The predominant diagnosis was head and neck squamous cell carcinoma (60.8%), and the most commonly used free flap was the anterolateral thigh (ALT) flap (37.6%). The overall flap success rate was 93.7%, while the incidence of flap failure was 6.4%. The main causes of flap failure were arterial thrombosis (37.5%) and venous thrombosis (25%). Notably, 72.2% of patients did not require ICU admission postoperatively, with no significant difference in outcomes between patients managed in the ICU and those managed in non-ICU settings. MFFR is a reliable technique when performed by an experienced head and neck team, achieving high success rates even when performed in non-ICU settings. Carefully selected patients can be safely managed outside the ICU, presenting a cost-effective model of care in resource-limited environments. Further studies are warranted to refine patient selection criteria and postoperative monitoring protocols.