Extensive Local Flaps Among Head and Neck Patients With Multimorbidity. Review of Main Comorbidities Related to Increased Perioperative Risk in Free Flap Procedures

The field of head and neck surgery is marked by its complexity, particularly when addressing oncological treatment, including extensive resections and consecutive reconstructive procedures. This introductory exploration will set the foundation for a comprehensive review, shedding light on various factors that may hinder surgical success, mainly through the prism of patients' comorbidities. In these patients, frequently there is a need to simplify the surgical approach and choose the lower ''step" in the reconstructive ladder to balance between the esthetic or functional outcome and the rational perioperative risk for the patient. The analysis of 10 patients diagnosed with cancer of the various subunits in the head and neck area, who, due to the severe comorbidities, were excluded from microsurgical free flap procedures, was conducted. Furthermore, the 10 patients with similar comorbidities who underwent the free flap procedure were analyzed mainly regarding the postoperative complications. In addition, a brief literature review of mostly cited factors that can hinder microsurgical success, mainly through the prism of patients' comorbidities, was performed. The mean age of patients included in the study group was 73.9 years (range 66-83, SD±5.78). Most of the patients were classified as ASA group IV (70%). The postoperative course in the case of all patients included in the study group was uneventful regarding major postoperative complications. There were only 2 minor surgical site complications in the form of wound dehiscence and partial flap loss. Due to the numerous available donor sites within the head and neck region, local flaps and oncoplastic seem to be reasonable solutions in many cases that balance the achieved outcome and the risk of the procedure for the patient with multiple comorbidities.