Maxillofacial surgery compendium: insights from 1373 microvascular free flap reconstructions in the head and neck area.

This study aims to provide an overview of patient characteristics, treatment modalities, and associated complications following microvascular free flap reconstructions in maxillofacial surgery, based on data from a large national tertiary care centre. Adult patients who received a microvascular free flap between April 2017 and December 2024 were analysed in this descriptive retrospective single-centre study. Follow up was recorded until February 2025. Fibular (FFF), scapular (SFF), deep circumflex artery (DCIA), radial forearm (RFF), anterolateral thigh (ALT) and latissimus dorsi (LDF) free flaps were included. Variables were stratified by flap type and the N-1 χ-test used to test for statistical significance of complication rates across years. A total of 1373 cases met the inclusion criteria. DCIA flaps suffered the highest rates of early flap loss (8.7%; x¯ = 3.6%) and wound infection (39.1%; x¯ = 13.5%). SFFs had the highest rate of anastomotic revision (25.0%; x¯ = 6.9%) and longest mean (SD) surgery duration: 715 ± 181 min. Donor site complications were most common among RFFs (36.0%) and FFFs (34.5%). Overall, wound infection rates were higher among bony rather than soft tissue flaps (23.0% vs. 7.8%). FFFs were associated with fewer recipient-site complications than SFFs and DCIA flaps, but donor site complications were higher. Among soft tissue flaps, complication rates did not differ significantly. Overall, complications at the recipient site were more frequent among bony compared to soft tissue flaps.