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INTRODUCTION: The patency of reconstructive free flaps used in head and neck cancer reconstruction is usually superior to that of nonfree flaps, but postoperative wound infection is the major cause of flap loss in the free-flap group. The purpose of this study was to investigate whether the incidence of infection was reduced in free flaps by capping the defect with serrated bony margins.
METHODS: Charts were reviewed for all patients treated with free flaps for head and neck reconstruction at the Otolaryngology-Head and Neck Surgery Unit at the George Washington University Medical Center between 2004 and 2007. Patients were followed-up for a mean of 18 months after reconstruction. Postoperative wound infections were classified as high-grade, with evidence of sepsis, or low-grade with no evidence of infection.
RESULTS: Total flap loss occurred in 1.5% of all patients. Mean flap size was 3.1 × 5.6 cm, and the majority of patients had advanced head and neck cancer. The overall infection rate was 5.1%. Three patients had high-grade infections of their flaps, with all becoming septic. High-grade wound infections were noted in patients with wounds covering the parotid gland (n = 2) and skin of the neck (n = 1). All high-grade wound infections could be attributed to dehiscence of a skin graft overlying the defect. Low-grade infections were observed in 3 patients, 2 of whom had immediate wound infections. Two of these patients had a history of postoperative radiation therapy. One patient had delayed wound infections not related to exposure to radiation.
CONCLUSION: Given the low incidence of total free-flap loss, there was no significant
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