Egypt, J. Plast. Reconstr. Surg., Vol. 37, No. 1, January: 81-88, 2013 Post-ablative Head and Neck Reconstruction with Free Flaps AHMED M. TOHAMY, M.Sc.; MOHAMMED M. EL-SHAZLY, M.D.; MOHAMED M. FATA, M.D.; MARK MC GURK M., M.D., F.R.C.S. and MAHMOUD A. EL-OTEIFY, M.D. The Departments of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt; Oral & Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt and Oral & Maxillofacial Surgery, Guy’s Hospital, King’s College University, London, UK ABSTRACT Background: Tissue defects in the head and neck region have long been a challenge for reconstructive surgeons. The ability of free flaps to transfer a large panel of tissue containing skin, mucosa, muscle or well-vascularized bone has allowed considerable progress and refinement of this type of recon- struction, with a higher level of rehabilitation for head and neck cancer patients. Patients and Methods: Prospective study conducted on 54 patients presenting with either oral cavity cancer or osse- oradionecrosis secondary to radiotherapy treatment for head and neck cancer and all requiring bony, soft tissue reconstruc- tion or both by using microvascular free flaps. Their age ranged at the time of operation from 32.8-85.7 years; 36 were men and 18 women. The initial disease leading to ablative surgery was a malignant tumour in 42 patients including 38 cases of squamous cell carcinoma (SCC) of the upper aerodi- gestive tract. The surgical defect involved different anatomical structures including mucosa, bone and skin. Various free flaps were used to repair these types of defects. Functional results were evaluated for the 38 patients with a SCC of the upper aerodigestive tract by the same clinician. Results: The overall success rate of free flaps was 92.6%. There were 4 free flap failures (total flap necrosis), including 2 radial forearm flaps and 1 fibular flaps and 1 ALT flap. Surgical non-thrombogenic complications at the recipient site occurred in 13 patients, giving a local complication rate of 24.1%. At the donor site, postoperative complications occurred in 8 cases including 3 infections (fibular flap), 1 hematoma (radial forearm flap) and 4 split thickness skin graft partial losses (radial forearm flap). Thus, the overall donor site complication rate was 14.8%. Functional and aesthetic out- comes were evaluated for patients with a SCC of the upper aero-digestive tract. They were very satisfactory in group 1 (oral surgery without mandibulectomy). The results were worse in group 2 (oral surgery with mandibulectomy) than in group 1. Conclusion: Free tissue transfers have proven to be very reliable to repair various types of defects in the head and neck area, with a low incidence of free flap failure and an acceptable level of complications. 81 INTRODUCTION Tissue defects in the head and neck region have long been a challenge for reconstructive surgeons. The goals and principles are to achieve adequate function and aesthetics and thereby to improve the quality of life [1]. Free tissue transfer has become increasingly popular for head and neck reconstruc- tion in the last 20 years. It greatly expands options for patients and surgeons, and does appear to result in improved patient outcomes compared with other reconstructive techniques applied to many head and neck sites [2]. The complexity of the anatomy and function of the head and neck region explains the disappointing functional and aesthetic results obtained with conventional myocutaneous flaps. The ability of free flaps to transfer a large panel of tissue containing skin, mucosa, muscle or well- vascularized bone has allowed considerable progress and refinement of this type of reconstruc- tion, with a higher level of rehabilitation for head and neck cancer patients [3]. This prospective study is a conjoined work between Plastic Surgery Department, Assiut Uni- versity Hospital, Assiut, Egypt and Oral and Max- illofacial Department, Guy’s hospital, King’s Col- lege University, London, United Kingdom. In this work, we have tried the free flap reconstruction possibilities in many types of pathologies and defects in the head and neck region. PATIENTS AND METHODS This is a prospective study conducted on 54 patients, attending outpatient cancer clinic of Oral & Maxillofacial Department of Guy's Hospital, London, United Kingdom and presenting with either oral cavity cancer or osseoradionecrosis