Microvascular free flaps are considered to be the gold standard in reconstructive head and neck surgery. However, reduced postoperative transplant perfusion is one of the serious postoperative complications and calls for close and reliable monitoring. Procalcitonin, C-reactive protein, and leukocytes are closely associated with local and systemic inflammatory reactions and might have prognostic capacity concerning tissue necrosis. This study aimed to evaluate perioperative serum levels of these three biomarkers to assess their potential in postoperative flap monitoring. A total of 100 patients with microvascular head and neck reconstructions were included in the study. Perioperative serum levels of parameters were measured and the clinical data were analyzed and correlated. A total of 13% of all flaps developed reduced postoperative perfusion. Analysis of the parameters revealed statistically significant differences in the overall patient collective over time, irrespective of clinically reduced flap perfusion. Co-factors such as sex and history of tobacco and alcohol abuse showed significant differences. The efficacy of the parameters in free flap monitoring has not been verified, although the role of procalcitonin in postoperative monitoring, with special regard to the early detection of infections, is underlined by the present study results.
Microvascular free flaps in head and neck reconstructive surgery represent the gold standard in restoring form and function following ablative tumour surgery, for extensive post-traumatic defects, and for birth-related deformities. In particular, in cancer cases with a histologically proven safe margins resection, an immediate reconstruction with soft tissue and even with bony free flaps is favoured to improve the patient’s postoperative quality of life . This seems to be particularly true for intraoral defects .
Generally, microvascular free flaps can be subdivided into different groups depending on the type of tissue involved: (1) cutaneous, (2) fasciocutaneous, (3) myocutaneous, (4) osseocutaneous, and (5) osseous free flaps. Moreover, composite tissue flaps consisting of various types of tissues for the restoration of complex defects can be planned individually. Microvascular free flaps can be performed safely and ensure a fairly predictable outcome. A study by Suh et al., who investigated approximately 400 microvascularly re-anastomosed transplants retrospectively, revealed a total loss of the transplant in less than 1% of the cases, a partial loss in 3%, and a perioperative mortality of 1.3% .
The present study investigators have been able to show transplant survival rates for radial forearm flaps (RFF) of about 97% . However, reduced postoperative transplant perfusion is one of the serious complications in reconstructive microvascular surgery. A disruption of arterial afflux on the one hand, or an obstruction of the venous drain on the other, can each result in clinically reduced transplant perfusion ( Fig. 1 ). Reasons for these conditions are manifold, including microthrombosis, haematoma, and an insufficient micro-anastomosis.