Background A remarkable development through the evolution of free flap techniques has led to the modern reconstructive head and neck surgery. This study aimed to review experiences from head and neck free-flap reconstructions performed at our institution over an 18-year period. Methods Between 1995 and 2012, 594 free-flap operations were performed on 541 head and neck patients at the Department of Plastic Surgery, Helsinki University Hospital, Finland. We retrospectively recorded hospital chart data regarding patient demographics, tumor characteristics, surgical treatment, and outcome. Results The mean age of patients increased from 53 years (1995-2000) to 56 (2007-2012), while the gender distribution remained constant (60% males). The most commonly used flap type between 1995 and 2000 was radial forearm flap (50%), while during the periods of 2001 through 2006 and 2007 through 2012 the anterolateral thigh flap was the most common method (42 and 36%, respectively). The number of different flap types and flap combinations increased during these periods (15 flap types during 1995 through 2000; 17 flap types during 2001 through 2006; and 24 flap types during 2007 through 2012). Despite a wider range of flap options used during the period 2001 through 2012, the overall flap survival rate (97%) remained constant. The prevalence of surgical complications decreased from 26% (2001 through 2006) to 21% (2007 through 2012). Conclusions During the study period, the number of flap types increased and reconstructions became more individualized. The overall surgical complication rate decreased although the mean age of patients increased.
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