PURPOSE:Salivary leaks after H&N reconstruction is a difficult complication whose treatment remains controversial. Approaches to the management of these complications range from aggressive (i.e. muscle flap coverage) to supportive (i.e. wound care). The purpose of this study was to evaluate our approach to the management of salivary leaks in an effort to define an algorithm for their management. METHODS:A prospectively maintained database from a tertiary cancer center was used to identify patients who experienced a salivary leak after H&N reconstruction over a 7-year period. Medical records were analyzed to evaluate medical co-morbidities and postoperative outcome. RESULTS:637 patients underwent reconstruction during the study period. Of these, 35 patients (5.4%) developed salivary leaks postop. 25 patients (72%) were treated conservatively and 10 (28%) required operative intervention. One flap was lost. 6 patients (17%) had a delay to postoperative radiation. There were no carotid blow out or deaths attributable to the salivary leaks. The leaks took an average of 81 days to close. CONCLUSION:Most salivary leaks after free tissue transfer can be successfully managed with conservative treatment. Aggressive intervention is rarely indicated and should be considered if the risk of blow out is severe or conservative management is unsuccessful in a timely manner.