RECONSTRUCTIVE MICROSURGERY WITH FREE FLAPS IN HEAD AND NECK CANCER: A NARRATIVE REVIEW OF THE CURRENT LITERATURE ON SURGICAL TECHNIQUES, RESULTS AND COMPLICATIONS (Atena Editora)

Abstract

Objective: To discuss the relevance of reconstructive microsurgery with free flaps in patients with tissue defects resulting from resection of head and neck cancer, as well as the influence of this reconstruction on the potential improvement of patients' quality of life and the possible reduction in the need for additional surgeries. Methodology: Literature review conducted through searches in the Scielo and Pubmed databases. A total of 178 articles were identified, of which 18 were selected after applying exclusion criteria, all published from 2013 to 2022. Results: Microsurgery with free flaps is indicated in situations of extensive tumor removal to achieve superior aesthetic and functional results, as well as reduce morbidity in the donor area. It is not recommended for the repair of small defects, in which grafts or local flaps are used. The main flaps used include the antebrachial radial, fibular and latissimus dorsi muscle flaps. Furthermore, the free flap of the medial femoral condyle, of bone nature, has advantages such as flexibility, ease of implantation and capacity for remodeling. Donor site morbidity and complications are generally minimal, including hematoma, seroma, suture abscess, and necrosis. Serious complications, such as radial nerve injury and dehiscence, were only observed in the lateral arm flap. Final considerations: Reconstruction microsurgery with free flaps constitutes an efficient and safe approach for the management of patients undergoing resection of head and neck neoplasms. We highlight better aesthetic and functional outcomes, decreased morbidity in the donor area and the feasibility of performing more complex procedures.