Objectives: To evaluate and analyze complications and flap failure after ablative surgery for the head and neck cancer.

Material and method: Patients treated with primary surgery for head and neck cancer and reconstructed with means of free tissue transfer during the period from March 1996 to January 2010 were analyzed. During this period we treated 222 patients and performed 228 free flaps.

Results: All together 9 flaps failed (3.9%). The causes for the failure were as follows: vascular insufficiency in 5 cases, infections in 3 cases and uncontrollable hemorrhage in 1 case. The flaps that failed were in 8 cases radial forearm and in 1 case osteocutanous fibular flap. All other flaps survived. All together we performed 33 revisions. In 4 cases we found patent vessels and nothing was done. In 21 cases we revised the vessel microanasthomosis and were successful in 12 cases and failed in 9 cases. In 9 cases there was a problem in geometry of the pedicle (8 cases venous end and 1 case in arterial end), external compression with subsequent thrombosis of the venous end was the cause in 5 patients. In five patients we encountered a massive hemorrhage from the ACE and in three patients a massive necrotizing infection developed and the flaps microcirculation failed. All flaps revised in the first 24 h were salvaged (8 flaps revised and all salvaged), but not latter.

Conclusions: We stress the importance of monitoring with different technology and early revision in case of complications.

Conflict of interest : None declared.