Definition of quality indicators in microsurgery in head and neck reconstruction based on a 5-year follow-up without a loss

Background: Microsurgical tissue transfer is a standard procedure in reconstructive surgery of defects in head and neck oncology patients. According to the literature vascular thrombosis occurs in 8-14% of cases and is considered to be the main reason for flap failure. A review of the literature on this subject was carried out and related to the quality guidelines of the Department of Cranio-Maxillofacial Surgery in the Maastricht University Medical Centre. We defined quality indicators and, quality goals for the reconstruction of head and neck defects. We investigated whether or not these parameters are practicable in a specialized head and neck cancer unit. Patients and methods: We included 81 consecutive patients with oral cancer/osteoradionecrosis of the mandible who received a microsurgical free tissue transfer for reconstruction. The patients were treated hi our institution between August 2007 and December 2011. Patient data were collected in a prospective database. Follow-up was conducted in the Department of Cranio-Maxillofacial Surgery. Data were analysed for the defined reference groups, and the results were compared with the quality goals. Results: Median follow-up was 29.1 (range 1-55) months. There were only six (7.4%) immediate complications leading to compromised flaps. Among the complications were four (5.0%) anastomosis-related complications and two haematomas (2.5%). There was no flap loss. Based on the quality goals we were able to reach an overall flap success rate of 100%. Conclusion: Most of the defined quality goals can be attained in a specialized head and neck unit. Careful patient selection, pharmacologic, non-pharmacologic and surgical measures for preventing thrombosis, such as meticulous micro-vascular surgery are considered to be essential. No consensus in the literature was found on how complications could best be prevented. The role of a standardized pre-, peri- and postoperative management is presented. The importance of thorough planning and the technical skill of the reconstructive surgeon are highlighted. The debate on quality goals has the potential to enable further improvement in the care of head and neck cancer patients.