Setting: Academic tertiary care medical center.

Patients and Methods: 400 consecutive microvascular free flaps were performed for reconstruction of the head and neck, with 95.5% of the defects arising after the treatment of malignancies. Donor sites included radial forearm flaps (n=183), fibula flaps (n=146), rectus abdominis flaps (n=38), subscapular system flaps (n=27), iliac crest flaps (n=5), and a jejunal flap. Patient-related characteristics (age, sex, diagnosis, comorbidity level, tumor stage, defect site, primary vs. secondary reconstruction, and history of prior surgery, radiation therapy, or chemotherapy) and the incidence of perioperative complications were recorded prospectively over a 7-year period.

Results: The perioperative mortality was 1.3%. Overall, perioperative complications occurred in 37.3% of all cases. Free flaps proved to be extremely reliable, with a 0.8% incidence of free flap failure and a 3% incidence of partial flap necrosis. Perioperative medical complications occurred in 20.5% of cases, with pulmonary (8.8%) and cardiac (6.5 %) complications predominating.

Conclusions: The current study confirms that free flaps are extremely reliable to achieve successful reconstruction of the head and neck. The American Society of Anesthesiology comorbidity index, which is relatively simple and widely utilized in clinical practice compared to previously advocated comorbidity scales, is shown to be an statistically significant (p=0.003) predictor of the incidence of perioperative medical complications