151
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Tan BK, Por YC, Chen HC. Complications of head and neck reconstruction and their treatment. Semin Plast Surg 2012; 24:288-98. [PMID: 22550450 DOI: 10.1055/s-0030-1263070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck reconstruction is an intensive multistep process that requires attention to detail to achieve a successful result. The knowledge and prevention of complications as well as their management is an essential part of the training of the surgeon participating in head and neck reconstruction. This article explores the general complications, including free flap failure, carotid artery blowout, hardware exposure, and ectropion, as well as regional complications relating to operations of the scalp, cranium, base of skull, midface, mandible, and pharyngoesophagus.
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152
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Ma CY, Ji T, OW A, Zhang CP, Sun J, Zhou XH, Wang LZ, Sun KD, Han W. Surgical Site Infection in Elderly Oral Cancer Patients: Is the Evaluation of Comorbid Conditions Helpful in the Identification of High-Risk Ones? J Oral Maxillofac Surg 2012; 70:2445-52. [DOI: 10.1016/j.joms.2011.10.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/30/2022]
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153
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154
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Gugić J, Strojan P. Squamous cell carcinoma of the head and neck in the elderly. Rep Pract Oncol Radiother 2012; 18:16-25. [PMID: 24381743 DOI: 10.1016/j.rpor.2012.07.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/22/2012] [Accepted: 07/19/2012] [Indexed: 12/21/2022] Open
Abstract
The incidence of head and neck squamous cell carcinoma (HNSCC) peaks between the fifth and seventh decades of life. With prolongation of life expectancy, however, the proportion of elderly HNSCC patients is also increasing, which makes HNSCC in this life period an important issue for healthcare providers. With features characteristic to the older patient groups coupled with the inherent complexity of the disease, HNSCC in the elderly represents a considerable challenge to clinicians. Indeed, to expedite the progress and improve the healthcare system to meet the needs of this unique population of patients, several essential issues related to the clinical profile, diagnostics, optimal treatment and support are of concern and should be addressed in properly conducted clinical trials. In the present review, we analyzed a literature series comparing different age groups with regard to their clinical characteristics, therapy, outcome and quality of life in an attempt to determine their implications on treatment-decision-making for elderly patients with HNSCC.
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Affiliation(s)
- Jasenka Gugić
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000 Ljubljana, Slovenia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000 Ljubljana, Slovenia
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155
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Ferrari S, Copelli C, Bianchi B, Ferri A, Poli T, Ferri T, Sesenna E. Free flaps in elderly patients: outcomes and complications in head and neck reconstruction after oncological resection. J Craniomaxillofac Surg 2012; 41:167-71. [PMID: 22883078 DOI: 10.1016/j.jcms.2012.07.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Free flaps represent the first reconstructive option for many head and neck defects. The increasing life expectancy of the population results in increasing numbers of ageing patients facing complex reconstructive surgery. In this study we evaluated our experience with free-flap transfers in older patients, analysing the post-operative reconstructive and systemic complications. MATERIALS AND METHODS Between 2000 and 2009, 360 patients underwent free flap reconstruction of defects resulting from the treatment of head and neck tumours at the Operative Unit of Maxillofacial Surgery, University - Hospital of Parma, Italy. Fifty-five patients (15.3%) were more than 75 years old at the time of treatment. RESULTS At the end of the follow-up successful free-flap transfer was achieved in 360 of the 373 flaps harvested (96.5%). The overall reconstructive complication rate was 31.4%, (31.8% in the younger group and 29.1% in the remaining patients). Medical complications were observed in 29.2% of cases (less than 75 years: 28.8%; more than 75 years: 30.9%). The ASA status was associated with a statistically significantly higher incidence of complications within patients less than 75 years old (p < 0.0001). DISCUSSION AND CONCLUSIONS The results of this study, in agreement with previous studies, provide evidence that free-tissue transfer may be performed in ageing patients with a high degree of technical success. The chronologic age cannot be considered an appropriate criterion in the reconstructive decision. On the contrary, a careful selection of the patients based on comorbidities and general conditions (ASA status) is of primary importance in reducing post-operative complications and to improving the results of surgery.
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Affiliation(s)
- S Ferrari
- Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy
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156
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Okochi M, Okazaki M, Asato H. Oral antithrombotic treatment and postoperative thrombotic complications after head and neck reconstruction using free flaps. J Plast Surg Hand Surg 2012; 46:163-6. [DOI: 10.3109/2000656x.2012.697374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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157
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Chen YW, Chen CY, Chiang SC, Lui MT, Kao SY, Yang MH. Predictors and impact of microsurgical complications in patients with locally advanced oral squamous cell carcinoma. Cancer Sci 2012; 103:1672-8. [PMID: 22632121 DOI: 10.1111/j.1349-7006.2012.02345.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/03/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022] Open
Abstract
Microvascular free flap transfer for post-oncologic reconstructive surgery in oral cancer is considered to be a challenge due to the complexity of the anatomy and function of the region. We sought to identify possible factors associated with microsurgical complications and to assess the impact of these complications in relation to patient survival. Following the inclusion and exclusion protocol, 142 patients with stage III and IV oral squamous cell carcinoma (OSCC) who underwent immediate free flap reconstruction after tumor ablation were included in the study. Clinical and surgical procedural-related factors were retrieved from a database and analyzed retrospectively; survival data were evaluated using the Kaplan-Meier method. Major complications that required re-anastomosis of the flap vessels occurred in 23 patients (16.2%); total necrosis of the flaps, regardless of salvage treatment, occurred in seven cases, with 95.1% of full flap survival. The American Society of Anesthesiologists classification, types of neck dissection, and number of flaps were regarded as strong predictors for surgical complications. Patients with these complications appeared to have a shortened survival (5-year cancer-specific survival of approximately 60%, both in stage III and IV OSCC). However, the impact of surgical complications on survival was significant only in stage III OSCC (P = 0.037). Strategies to minimize surgical complications should be used to ensure better prognoses for these patients.
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Affiliation(s)
- Ya-Wei Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taiwan
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158
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Lassig AAD, Yueh B, Joseph AM. The effect of smoking on perioperative complications in head and neck oncologic surgery. Laryngoscope 2012; 122:1800-8. [PMID: 22753048 DOI: 10.1002/lary.23308] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/01/2012] [Accepted: 02/23/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cigarette smoking is the most important risk factor for head and neck cancer. Conventional wisdom suggests that smoking causes increased postoperative wound healing and systemic complications in this patient population, but it is unclear if the clinical literature supports this. STUDY DESIGN Systematic review. METHODS The authors performed a review of the literature from 1990 to 2010 on the effect of cigarette smoking on perioperative complications in head and neck surgery. RESULTS Thirty-six articles met eligibility criteria and were reviewed; 14 focused on extirpative surgery and 22 on reconstruction. Most of the evidence was comprised of case series and small cohort studies. We reviewed local wound healing and systemic complications, and 47% of studies supported an association between smoking and complications of surgery. CONCLUSIONS Evidence from the existing clinical literature is inconclusive on an association between cigarette smoking and perioperative complications after head and neck surgery. The negative impact of smoking is suggested; however, the majority of articles had significant methodological weaknesses. Prospective study of tobacco-induced complications is needed.
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Affiliation(s)
- Amy Anne D Lassig
- Department of Otolaryngology-Head and Neck Surgery, Division of General Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
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159
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Vaz JA, Côté DWJ, Harris JR, Seikaly H. Outcomes of free flap reconstruction in the elderly. Head Neck 2012; 35:884-8. [DOI: 10.1002/hed.23057] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 11/06/2022] Open
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160
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Kakarala K, Emerick KS, Lin DT, Rocco JW, Deschler DG. Free flap reconstruction in 1999 and 2009: changing case characteristics and outcomes. Laryngoscope 2012; 122:2160-3. [PMID: 22674647 DOI: 10.1002/lary.23457] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/27/2012] [Accepted: 05/03/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare free flap reconstructive cases from 1999 and 2009 with respect to patient characteristics, surgical characteristics, outcomes, and complications; and to discuss the evolution in free flap reconstruction at a single institution during this time period. STUDY DESIGN Retrospective cohort comparison. METHODS Free flap reconstruction cases from 1999 and 2009 were collected into two cohorts. Retrospective chart review was performed to extract patient characteristics, surgical characteristics, and outcomes. Cohorts were compared with respect to extracted data with statistical significance set at P < .05. RESULTS There were 39 free flap reconstructions performed in 1999 and 81 performed in 2009. Patients in the 2009 cohort had higher American Society of Anesthesiologists scores and incidence of cardiovascular disease (P = .009 and .0045, respectively). Median operative time decreased from 12 hours in 1999 to 9 hours in 2009 (P < .0001). Median length of stay decreased from 14 to 9 days (P = .0006). The rate of perioperative return to the operating room to manage complications decreased from 30% to 17% (P = .103). There were five unsalvaged flap failures in 1999 (12.8%) compared to two failures in 2009 (2.5%) (P = .036). CONCLUSIONS Patients undergoing free flap reconstruction are increasingly older and have more medical comorbidities. Despite these challenges, increased efficiency and teamwork stemming from accumulated institutional experience have led to decreased operative times, length of stay, and complication rates and increased overall success rates.
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Affiliation(s)
- Kiran Kakarala
- Division of Head and Neck Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA
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161
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Pohlenz P, Klatt J, Schön G, Blessmann M, Li L, Schmelzle R. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 2012; 41:739-43. [DOI: 10.1016/j.ijom.2012.02.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 12/21/2011] [Accepted: 02/15/2012] [Indexed: 11/17/2022]
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162
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Yano T, Tanaka K, Kishimoto S, Iida H, Okazaki M. Review of skull base reconstruction using locoregional flaps and free flaps in children and adolescents. Skull Base 2012; 21:359-64. [PMID: 22547961 DOI: 10.1055/s-0031-1287676] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Tumors of the skull base are rare in children, and reconstruction in such patients has rarely been reported. We reviewed 16 cases of skull base reconstruction in patients under 18 years. The study group consisted of 10 boys and 6 girls, whose ages ranged from 2 to 17 years. Of the 16 cases, eight tumors were benign and eight were malignant. Defects were anterior in six cases, lateral in eight cases, and anterolateral in two cases. Reconstruction was performed with locoregional flaps in 11 cases and with free flaps in 5 cases. No significant difference was found between locoregional flaps and free flaps in total operative time, intraoperative blood loss, or postoperative hospital stay. However, in some cases, total operative time, reconstruction time, and blood loss increased to a degree unacceptable for pediatrics. Minor complications occurred in three patients and a major complication occurred in one case. Of four patients, three patients with postoperative complications had undergone chemoradiotherapy. Because of the physical weakness of pediatric patients, complicated reconstructive procedure should be avoided. We believe locoregional flaps will become the first choice for reconstruction. However, if patients have large, complex defects and have received radiotherapy, appropriate free flaps should be used to avoid postoperative complications.
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163
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Miyamoto S, Sakuraba M, Nagamatsu S, Kamizono K, Hayashi R. Comparison of reconstruction plate and double flap for reconstruction of an extensive mandibular defect. Microsurgery 2012; 32:452-7. [DOI: 10.1002/micr.21976] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/31/2012] [Accepted: 02/02/2012] [Indexed: 11/05/2022]
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164
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le Nobel GJ, Higgins KM, Enepekides DJ. Predictors of complications of free flap reconstruction in head and neck surgery: Analysis of 304 free flap reconstruction procedures. Laryngoscope 2012; 122:1014-9. [PMID: 22407907 DOI: 10.1002/lary.22454] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/13/2011] [Accepted: 10/21/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The objectives of this study were to classify and analyze perioperative complications following free flap reconstruction in the head and neck and investigate potential predictors of these complications. METHODS A retrospective chart analysis of 304 consecutive free flap reconstructions for defects in the head and neck were examined. Patient and operative characteristics as well as complications were recorded prospectively and analyzed using ordinal logistic regression. RESULTS The overall complication rate was 32.6% with a perioperative mortality rate of 0.3%. The flap loss rate was 2.0% and the partial flap necrosis rate was 1.0%. Multivariate analysis demonstrated a significant correlation between perioperative complication and tumor stage as well as reconstruction site. CONCLUSIONS The rate and grade of complications with free flap reconstruction in the head and neck were found to be low. Higher tumor stage and pharyngoesophageal reconstruction were found to be associated with increased complication grades, whereas preoperative radiation alone and chemoradiation were not. Smoking and alcohol use, age, diabetes mellitus, peripheral vascular disease, and preoperative myocardial infarction as well as preoperative cerebrovascular accident were not found to be associated with increased complications. No statistically significant difference in complication grades was found with different flap types or indications for reconstruction.
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Affiliation(s)
- Gavin J le Nobel
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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165
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Perisanidis C, Herberger B, Papadogeorgakis N, Seemann R, Eder-Czembirek C, Tamandl D, Heinze G, Kyzas PA, Kanatas A, Mitchell D, Wolff KD, Ewers R. Complications after free flap surgery: do we need a standardized classification of surgical complications? Br J Oral Maxillofac Surg 2012; 50:113-8. [DOI: 10.1016/j.bjoms.2011.01.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 01/25/2011] [Indexed: 11/17/2022]
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166
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Sze HC, Ng W, Chan OS, Shum TC, Chan LL, Lee AW. Radical radiotherapy for nasopharyngeal carcinoma in elderly patients: The importance of co-morbidity assessment. Oral Oncol 2012; 48:162-7. [DOI: 10.1016/j.oraloncology.2011.08.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
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167
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Makiguchi T, Hashikawa K, Sugiyama D, Yokoo S, Terashi H, Nibu K, Kumagai S, Tahara S. Risk Factors of Anastomotic Thrombosis in 200 Head and Neck Free Flaps among Asian Patients. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ss.2012.35046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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168
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Mücke T, Rau A, Weitz J, Ljubic A, Rohleder N, Wolff KD, Mitchell DA, Kesting MR. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions. Oral Oncol 2011; 48:367-71. [PMID: 22155256 DOI: 10.1016/j.oraloncology.2011.11.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/14/2011] [Accepted: 11/21/2011] [Indexed: 02/08/2023]
Abstract
Despite the refinement of microsurgical techniques, microsurgical free flap transfer in patients with a history of previous radiotherapy, neck dissection or free flaps remains a challenge in oncologic reconstructive surgery. Previous studies on the prognostic factors for postoperative complications have been largely retrospective and shown conflicting results. Our aim was to design a prospective study to identify negative outcome predictors of free flap surgery in previously treated oral cancer patients. Prospective study including all patients who required microsurgical free flap transfer for reconstruction of the oral cavity between July of 2007 and June of 2010 with subset analysis of those cases in whom previous surgical or nonsurgical oncological treatment for head and neck cancer had been carried out. A total of 360 free flaps were performed in 358 patients, of whom 61 had previous neck dissection and 58 had undergone radiation therapy. Operation time was significantly found to be longer in irradiated patients. The need for microsurgical revision, postoperative wound infection and free flap loss were significantly associated with the ASA score and a previous neck dissection. Wound infection was seen significantly more often after radiotherapy. Previous neck dissections and radiotherapy as well as the ASA score are significant negative predictors for success in free flap transfer. For patients with prior oncologic treatments in their medical history, we recommend detailed preoperative assessment of the vascular status and an intensified postoperative care to reduce complication rates to improve outcome in oncologic reconstructive surgery.
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Affiliation(s)
- Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
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169
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Burton JN, El-Deiry MW. Use of ultrasonic shears in the harvest of the free osteocutaneous fibula flap. Ann Otol Rhinol Laryngol 2011; 120:563-8. [PMID: 22032068 DOI: 10.1177/000348941112000902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Traditionally, the fibula free flap has been raised by electrocautery and sharp dissection with clipping and tying of vessels. Use of the ultrasonic scalpel has been proposed to be a faster, more hemostatic, and less traumatic method of harvest. METHODS We performed a retrospective chart review of 58 patients who underwent fibula free flap reconstruction between 2007 and 2010. The main outcome measures were blood loss, operative time, and flap harvest time. RESULTS Use of the ultrasonic shears was not associated with a statistically significant reduction in intraoperative blood loss, operative time, or flap harvest time. However, the flap harvest time did trend toward statistical significance (p = 0.073). Use of distribution-based effect sizes demonstrated a moderate clinically important difference in favor of the ultrasonic shears for both operative time and flap harvest time. CONCLUSIONS The use of ultrasonic shears is comparable to traditional methods of fibula free flap harvest and can be considered an alternative method of harvest.
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Affiliation(s)
- Jon N Burton
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, USA
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170
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Minimizing complications in salvage head and neck oncological surgery following radiotherapy and chemo-radiotherapy. Curr Opin Otolaryngol Head Neck Surg 2011; 19:125-31. [PMID: 21297476 DOI: 10.1097/moo.0b013e3283440ee3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The term salvage surgery denotes oncological surgery after failed radiotherapy or chemoradiotherapy (CRT). Salvage surgery is a high-risk endeavour as it carries a significant risk of complications. The purpose of this review is to assess the ways in which complications from salvage surgery can be prevented and minimized. This is a complex subject and complications are often multifactorial and interrelated. There are many aspects that can be discussed; however, to address each of them individually would be impossible and beyond the scope of this article. We will, therefore, focus this review on the most relevant aspects to current practice for head and neck surgeons. RECENT FINDINGS Salvage surgery after failure of radiotherapy and CRT remains controversial and many aspects still lack evidence. Many patients with recurrent cancer are not suitable for salvage surgery due to severe co-morbidities or disease progression. Salvage surgery is best carried out in tertiary centres by experienced multidisciplinary teams. Preoperative assessment and evaluation is critical to success and to minimize complications. Surgical principles include single incisions, delicate tissue handling, use of frozen sections, adopting a critical approach to neck dissections and the use of flaps, secondary surgical voice restoration for laryngectomies and appropriate postoperative care. SUMMARY This review emphasizes the importance of a multidisciplinary approach by experienced teams, the centralization of resources and teams, a structured and thorough patient assessment, surgical planning and a systematic attention to detail when addressing patients undergoing salvage surgery.
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171
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David S, Dassonville O, Poissonnet G, Chamorey E, Vallicioni J, Demard F, Médard de Chardon V, Santini J, Bozec A. Les échecs de la chirurgie reconstructrice cervicofaciale par lambeaux libres : facteurs favorisants et prise en charge. ANN CHIR PLAST ESTH 2011; 56:308-14. [DOI: 10.1016/j.anplas.2010.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 07/01/2010] [Indexed: 11/28/2022]
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Hampshire PA, Guha A, Strong A, Parsons D, Rowan P. An evaluation of the Charlson co-morbidity score for predicting sepsis after elective major surgery. Indian J Crit Care Med 2011; 15:30-6. [PMID: 21633543 PMCID: PMC3097539 DOI: 10.4103/0972-5229.78221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Severe sepsis is a significant cause of morbidity and mortality following major surgery. The Charlson co-morbidity score (CCS) has been shown to be associated with severe sepsis following major surgery for cancer. This prospective observational study investigated the effect of patient factors (CCS, gender, age and malignancy) and intraoperative factors (duration of surgery and allogeneic blood transfusion) on the incidence of sepsis after elective major surgery, and the impact of patient co-morbidities on length of stay in critical care. MATERIALS AND METHODS We prospectively identified a cohort of 101 patients undergoing elective major surgery in a university teaching hospital. The CCS was calculated before surgery, and the incidence of sepsis was documented following surgery. We investigated whether age, malignancy, intraoperative allogeneic blood transfusion, length of surgery or gender were associated with sepsis following surgery. RESULTS Twenty-seven (27%) patients developed sepsis. Using multivariate logistic regression, the duration of surgery was associated with the development of sepsis after surgery (P = 0.054, odds ratio 1.2). The CCS was not associated with sepsis in this population of cancer and non-cancer patients undergoing elective major surgery, but was associated with longer length of stay in the intensive care unit (P = 0.016). CONCLUSIONS Duration of surgery, but not patient co-morbidity as assessed by the CCS, may predict the postoperative incidence of sepsis. CCS could be used as a guide to predict consumption of critical care resources by elective surgical patients. A higher CCS was associated with a longer ICU stay. Resources, such as postoperative goal directed therapy, may be useful in reducing length of stay, hospital costs and risks of infective complications in this subgroup of patients with higher CCS.
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Affiliation(s)
- Peter A Hampshire
- Department of Critical Care Medicine, Royal Liverpool University & Broadgreen Hospitals NHS Trust, Prescot Street, Liverpool L7 8XP, UK
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173
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Free flap reconstruction in the head and neck region following radiotherapy: a cohort study identifying negative outcome predictors. Plast Reconstr Surg 2011; 127:1901-1908. [PMID: 21228745 DOI: 10.1097/prs.0b013e31820cf216] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND With the increased use of radiotherapy in the treatment of head and neck cancers, free tissue transfer in an irradiated field is now common. Reported outcomes with free tissue transfer reconstructions in irradiated areas are often unclear and contradictory. This is attributable in part to small sample size and heterogeneity in patients and procedures. The goals of this study were, first, to determine the outcome of head and neck reconstructions in an irradiated field using a large retrospective cohort and, second, to identify negative outcome predictors that could potentially be modified to reduce the morbidity in these procedures. METHODS Patients undergoing free flap reconstruction in irradiated head and neck regions between July of 2005 and July of 2007 were identified. Charts, including operative and radiotherapy records, were reviewed. Multiple logistic regressions were performed to identify negative outcome predictors. RESULTS During the study period at the authors' institution, 984 patients underwent head and neck free flap reconstruction. Of these, 137 had free tissue transferred to irradiated fields. Patients received an average radiotherapy dose of 64.5 Gy. The overall flap success rate was 96.4 percent. The postoperative complication rate was 47 percent. There was an overall 22 percent reoperation rate and a 28 percent infection rate. Segmental mandibulectomy, larger flap size, and infection were found to be significant negative outcome predictors. CONCLUSIONS This study confirms that free flap transfer to previously irradiated head and neck areas has a success rate comparable to that of transfer to nonirradiated zones. However, previously irradiated patients have a high risk of complications. Infection, as a modifiable risk factor, should be treated aggressively.
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174
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Effects of taurine on reperfusion injury. J Plast Reconstr Aesthet Surg 2011; 64:921-8. [DOI: 10.1016/j.bjps.2010.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/09/2010] [Accepted: 12/07/2010] [Indexed: 11/19/2022]
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175
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Monroe MM, Cannady SB, Ghanem TA, Swide CE, Wax MK. Safety of vasopressor use in head and neck microvascular reconstruction: a prospective observational study. Otolaryngol Head Neck Surg 2011; 144:877-82. [PMID: 21493297 DOI: 10.1177/0194599811401313] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the safety of intraoperative vasopressor administration in a prospective series of patients undergoing free tissue transfer surgery for a variety of indications. STUDY DESIGN Prospective observational noninferiority study. SETTING Tertiary academic hospital. SUBJECTS A total of 169 consecutive patients undergoing free tissue transfer for a variety of indications between late 2007 and 2009. METHODS Intraoperative vasopressor use and surgical outcomes data were prospectively collected. This study was designed to test the noninferiority of intraoperative vasopressor exposure versus no intraoperative vasopressor use on early flap failure. RESULTS A total of 169 free flaps were performed during the study period. Six early free flap failures occurred overall. The proportion of patients experiencing early flap failure was 4.4% (4/90) in those exposed to intraoperative vasopressors versus 2.5% (2/79) in those not exposed, with an absolute difference of 1.9 percentage points (90% confidence interval, -1.4 to 5.2). Thirty-eight percent of patients in the vasopressor group experienced medical and/or surgical complications other than total flap loss versus 43% in the nonvasopressor group (odds ratio, 0.80; 95% confidence interval, 0.43-1.49). CONCLUSIONS Intraoperative vasopressor use may be more common than previously realized in free tissue transfer surgery. Intraoperative vasopressor use does not result in a significant absolute increase in the rate of flap deaths.
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Affiliation(s)
- Marcus M Monroe
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health-Sciences University, Portland, Oregon 97239, USA
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176
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Does Previous Chest Wall Irradiation Increase Vascular Complications in Free Autologous Breast Reconstruction? Plast Reconstr Surg 2011; 127:496-504. [DOI: 10.1097/prs.0b013e3181fed560] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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177
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Rohleder NH, Wolff KD, Hölzle F, Wagenpfeil S, Wales CJ, Hasler RJ, Kesting MR. Secondary Maxillofacial Reconstruction with the Radial Forearm Free Flap: A Standard Operating Procedure for the Venous Microanastomoses. Ann Surg Oncol 2011; 18:1980-7. [DOI: 10.1245/s10434-011-1555-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Indexed: 11/18/2022]
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178
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Management of post-operative maxillofacial oncology patients without the routine use of an intensive care unit. J Maxillofac Oral Surg 2011; 9:329-33. [PMID: 22190819 DOI: 10.1007/s12663-010-0147-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022] Open
Abstract
AIM To assess the safety and efficacy of immediate postoperative management of major maxillofacial oncology patients in a High Dependency Unit (HDU). PATIENTS AND METHODS All operated maxillofacial oncology patients were included. Detailed records and clinical parameters were assessed for diagnosis, procedure, diagnosis, American Society of Anaesthiologists (ASA) grade, procedure, type of reconstruction, duration of surgery, post operative location, days of hospitalization risk factors and complications if any. RESULTS All the patients were placed in a HDU care for 48 h for closed monitoring and thereafter were shifted to the head and neck general ward. Only 7/117 (6%) patients required ICU admission because of development of systemic complications. Of our cases, 108/117 made an uneventful recovery (92.3%) with no serious complications. We noted a correlation between the incidence of perioperative complications and risk factors of ASA status (χ(2) = 7.81, P = 0.005). Majority of the patients (94%) were managed successfully in the HDU care in the post operative period. Survival of free flaps proved to be extremely reliable with a survival rate of 99.1% (1/15 failed). CONCLUSIONS The routine use of a HDU care for 48 hours followed by shifting the patient to a maxillofacial head and neck general ward is more appropriate for management of post-operative maxillofacial oncology patients. This practice has helped in offering high quality, cost effective and efficient services without having any adverse effect on the quality of care.
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179
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Hanasono MM, Skoracki RJ, Silva AK, Yu P. Adipofascial perforator flaps for "aesthetic" head and neck reconstruction. Head Neck 2010; 33:1513-9. [PMID: 21928425 DOI: 10.1002/hed.21637] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most head and neck reconstructions are performed for wound closure or functional rehabilitation with aesthetic restoration being an important but secondary consideration. METHODS Contour deformities in 40 patients undergoing head and neck resections were reconstructed immediately with adipofascial perforator flaps, including 37 anterolateral thigh and 3 deep inferior epigastric perforator flaps. RESULTS Reconstructions could be grouped into 1 of 3 defect areas: temporal fossa (n = 3), malar cheek (n = 13), and parotid-mastoid (n = 24). The mean time needed for reconstruction in excess of the oncologic resection was 3.1 hours. There were no flap losses. In no case did a complication delay adjuvant therapy and no patient experienced a decrease in level of activity related to donor site morbidity. CONCLUSION Immediate restoration of facial contour with adipofascial perforator flaps is warranted in head and neck oncologic patients to help improve self-image and maintain quality of life.
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Affiliation(s)
- Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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180
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Abstract
Reoperative reconstruction of the midface is a challenging issue because of the complexity of this region and the severity of the aesthetic and functional sequela related to the absence or failure of a primary reconstruction. The different situations that can lead to the indication of a reoperative reconstructive procedure after previous oncologic ablative procedures in the midface are reviewed. Surgical techniques, anatomic problems, and limitations affecting the reoperative reconstruction in this region of the head and neck are discussed.
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Affiliation(s)
- Julio Acero
- Department of Oral and Maxillofacial Surgery, Gregorio Marañon Hospital, Complutense University, Madrid, Spain.
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181
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Microvascular free tissue transfer after prior radiotherapy in head and neck reconstruction – A review. Surg Oncol 2010; 19:227-34. [DOI: 10.1016/j.suronc.2009.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/29/2009] [Accepted: 06/01/2009] [Indexed: 11/17/2022]
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182
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Avery C, Crank S, Neal C, Hayter J, Elton C. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol 2010; 46:829-33. [DOI: 10.1016/j.oraloncology.2010.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 11/15/2022]
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183
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Paleri V, Wight RG, Silver CE, Haigentz M, Takes RP, Bradley PJ, Rinaldo A, Sanabria A, Bień S, Ferlito A. Comorbidity in head and neck cancer: A critical appraisal and recommendations for practice. Oral Oncol 2010; 46:712-9. [DOI: 10.1016/j.oraloncology.2010.07.008] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 11/26/2022]
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184
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Transaxillary-subclavian transfer of pedicled latissimus dorsi musculocutaneous flap to head and neck region. J Craniofac Surg 2010; 21:771-5. [PMID: 20485045 DOI: 10.1097/scs.0b013e3181d7a3cc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Free-tissue transfer is the reconstruction of choice for most head and neck defects. However, pedicled flaps are also used, especially in high-risk patients and after failure of a free flap. The aim of this study was to compare transaxillary-subclavian pedicled latissimus dorsi musculocutaneous (PLDMC) flap, pectoralis major musculocutaneous flap, and free-tissue transfer for head and neck reconstruction in American Society of Anesthesiologists grades II and III patients. During the last 4 years, PLDMC flap with a modified transaxillary-subclavian route for transfer to the neck was used in 8 patients, pectoralis major musculocutaneous flap was used in 7 patients, and free flaps were used in 12 patients for head and neck reconstructions. These 3 methods were compared regarding the flap dimensions, complications, flap outcome scores, hospitalization time, and cost of the treatment. Mean age of the patients, mean American Society of Anesthesiologists scores, mean dimensions of the flaps, and mean hospitalization time did not differ significantly among the 3 groups. Regarding the operation time, flap complications, outcomes, and cost of total treatment, although statistically not significant, PLDMC group offered the fastest reconstruction with highest flap outcome scores and minimum cost. Free-tissue transfer is the procedure of choice especially for functional reconstruction of head and neck region. Occasionally, there exist cases in whom a pedicled flap could offer a safer option. The PLDMC flap transferred via the transaxillary-subclavian route may be preferred than, with advantages including increased arc of rotation, safer pedicle location, shorter duration of the procedure, and reduced complication rates and costs.
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185
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Lee S, Thiele C. Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in preirradiated soft tissue. J Oral Maxillofac Surg 2010; 68:2169-78. [PMID: 20605307 DOI: 10.1016/j.joms.2009.08.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 08/24/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Several factors are associated with free flap complications in head and neck reconstruction after radiotherapy. The present study aimed to identify the correlation between irradiation and the healing of wounds after microvascular free flap transfer and to clarify the molecular mechanisms for the differences in healing between irradiated and nonirradiated patients. PATIENTS AND METHODS A retrospective study of 81 cases of microvascular free flap transfer was conducted. Tissue samples were obtained from 3 different regions of the patients (nonirradiated oral mucosa, irradiated skin, and nonirradiated skin). Expression of transforming growth factor-beta(1) was monitored by immunohistochemistry and immunoblot analysis. The levels of matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 were investigated qualitatively and quantitatively. RESULTS Multivariate analysis revealed that only preoperative irradiation was a significant predictor of free flap complications (P = .006), with a 4 times greater risk (odds ratio 4.141). It was also shown that patients with an advanced tumor stage and those who had received chemotherapy after radiotherapy were twice as likely to develop free flap complications. Transforming growth factor-beta(1) was overexpressed in free flaps for as long as 6 months after radiotherapy. It was remarkably observed in the granulation tissue in the preirradiated skin. Moreover, extracellular matrix remodeling regulated by transforming growth factor-beta(1) was detected with decreased matrix metalloproteinase-1 and increased TIMP-1 expression in the irradiated skin. CONCLUSION The healing of surgical wounds created by microvascular free flap transfer correlated negatively with preoperative radiotherapy. Extracellular matrix remodeling was also detectable in the free flap for up to 6 months after radiotherapy completion.
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Affiliation(s)
- Sooyeon Lee
- Department of Oral and Craniomaxillofacial Surgery/Plastic Surgery, University of Jena, Jena, Thueringen, Germany.
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186
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Gardiner M, Nanchahal J. Strategies to ensure success of microvascular free tissue transfer. J Plast Reconstr Aesthet Surg 2010; 63:e665-73. [DOI: 10.1016/j.bjps.2010.06.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 05/30/2010] [Accepted: 06/09/2010] [Indexed: 11/26/2022]
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187
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Eom JS, Koh KS, Al-Hilal TA, Park JW, Jeon OC, Moon HT, Byun Y. Antithrombotic efficacy of an oral low molecular weight heparin conjugated with deoxycholic asset on microsurgical anastomosis in rats. Thromb Res 2010; 126:e220-4. [DOI: 10.1016/j.thromres.2010.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 05/28/2010] [Accepted: 06/02/2010] [Indexed: 11/25/2022]
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188
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Factors predicting fistula following radial forearm free flap reconstruction for head and neck cancer. Oral Oncol 2010; 46:684-7. [DOI: 10.1016/j.oraloncology.2010.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/13/2010] [Accepted: 07/13/2010] [Indexed: 11/16/2022]
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189
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Suh JD, Blackwell KE, Sercarz JA, Cohen M, Liu JH, Tang CG, Abemayor E, Nabili V. Disease relapse after segmental resection and free flap reconstruction for mandibular osteoradionecrosis. Otolaryngol Head Neck Surg 2010; 142:586-91. [DOI: 10.1016/j.otohns.2009.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/14/2009] [Accepted: 12/03/2009] [Indexed: 10/19/2022]
Abstract
Objective: The objective of this study was to assess the outcomes, complications, and incidence of disease recurrence of mandibular osteoradionecrosis (ORN) after resection and microvascular free flap reconstruction. Study Design: Case series with chart review. Setting: Academic medical center. Subjects And Methods: Retrospective patient data review of 40 patients with mandibular ORN who were treated by segmental mandibulectomy and microvascular reconstruction between 1995 and 2009. All patients received radiation therapy for previous head and neck cancer, and 12 of 40 patients received concurrent chemotherapy. All patients failed to respond to conservative management. There were 26 males and 14 females, with a median age of 62 years. Median follow-up was 17.4 months. Results: There were no free flap failures. The incidence of wound-related complications was 55 percent. Median time to complication was 10.6 months. Ten (25%) patients developed symptoms of residual or recurrent ORN, with 70 percent of the recurrences arising in unresected condyles that were adjacent to the segmental mandibulectomy. Statistical analysis revealed that current smokers were at reduced risk to develop residual or recurrent ORN. Conclusion: This present study confirms that microvascular free flaps are reliable for treatment of advanced mandibular ORN. Nevertheless, there remains a 55 percent incidence of wound-healing complications. The lack of objective clinical criteria to judge the appropriate amount of mandible resection in patients with ORN remains an unresolved issue that resulted in the development of recurrent ORN in 25 percent of patients. Further investigations are needed to better understand the pathophysiology of ORN to prevent postoperative wound complications and disease recurrence.
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Affiliation(s)
- Jeffrey D. Suh
- Division of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Keith E. Blackwell
- Division of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Joel A. Sercarz
- Division of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Marc Cohen
- Division of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Jerome H. Liu
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Christopher G. Tang
- Division of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Elliot Abemayor
- Division of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Vishad Nabili
- Division of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
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190
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Yoshimoto S, Kawabata K, Mitani H. Factors involved in free flap thrombosis after reconstructive surgery for head and neck cancer. Auris Nasus Larynx 2010; 37:212-6. [DOI: 10.1016/j.anl.2009.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 06/09/2009] [Accepted: 07/05/2009] [Indexed: 11/17/2022]
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191
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Pattani KM, Byrne P, Boahene K, Richmon J. What makes a good flap go bad?: A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope 2010; 120:717-23. [DOI: 10.1002/lary.20825] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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192
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Wise SR, Harsha WJ, Kim N, Hayden RE. Free flap survival despite early loss of the vascular pedicle. Head Neck 2010; 33:1068-71. [PMID: 20175197 DOI: 10.1002/hed.21354] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2009] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sean R Wise
- Department of Otolaryngology, Naval Medical Center San Diego, San Diego, CA, USA
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193
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Patel RS, McCluskey SA, Goldstein DP, Minkovich L, Irish JC, Brown DH, Gullane PJ, Lipa JE, Gilbert RW. Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck. Head Neck 2010; 32:1345-53. [DOI: 10.1002/hed.21331] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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194
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Curry J, Sargi Z. Principles of Skull Base Reconstruction After Ablative Head and Neck Cancer Surgery. ACTA ACUST UNITED AC 2010. [DOI: 10.5005/jp-journals-10003-1021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract
“Resection of malignancies of the skull base can result in significant functional and cosmetic morbidity as well as mortality. Reconstructive efforts provide not only functional and cosmetic rehabilitation, but also allow for the avoidance of potentially disastrous complications such as cerebrospinal fluid leak or meningitis. The optimal reconstruction is determined both by a patient based approach and a defect based approach. Skull base defects can be addressed by the separate components of the craniofacial skeleton in which they involve, and therefore the individual reconstructive issues which must be addressed. In this article, we describe an approach to skull base reconstruction and the technical aspects of the available reconstructive options.
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195
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Bianchi B, Copelli C, Ferrari S, Ferri A, Sesenna E. Free flaps: Outcomes and complications in head and neck reconstructions. J Craniomaxillofac Surg 2009; 37:438-42. [DOI: 10.1016/j.jcms.2009.05.003] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 05/19/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022] Open
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196
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Zafereo ME, Weber RS, Lewin JS, Roberts DB, Hanasono MM. Complications and functional outcomes following complex oropharyngeal reconstruction. Head Neck 2009; 32:1003-11. [DOI: 10.1002/hed.21290] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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197
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Kao HK, Chang KP, Ching WC, Tsao CK, Cheng MH, Wei FC. Postoperative Morbidity and Mortality of Head and Neck Cancers in Patients With Liver Cirrhosis Undergoing Surgical Resection Followed by Microsurgical Free Tissue Transfer. Ann Surg Oncol 2009; 17:536-43. [DOI: 10.1245/s10434-009-0805-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Indexed: 01/21/2023]
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198
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Salama A, McClure S, Ord R, Pazoki A. Free-flap failures and complications in an American oral and maxillofacial surgery unit. Int J Oral Maxillofac Surg 2009; 38:1048-51. [DOI: 10.1016/j.ijom.2009.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 05/05/2009] [Indexed: 10/20/2022]
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199
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Hanasono MM, Friel MT, Klem C, Hsu PW, Robb GL, Weber RS, Roberts DB, Chang DW. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head Neck 2009; 31:1289-96. [DOI: 10.1002/hed.21100] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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200
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Yoshimoto S, Kawabata K, Mitani H. Analysis of 59 cases with free flap thrombosis after reconstructive surgery for head and neck cancer. Auris Nasus Larynx 2009; 37:205-11. [PMID: 19700252 DOI: 10.1016/j.anl.2009.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 05/18/2009] [Accepted: 06/25/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There have been few reports addressing methods of dealing with free flap thrombosis after reconstructive surgery for head and neck cancer. The present study, through a detailed analysis of the subsequent course of patients who developed postoperative flap thrombosis, aims to clarify possible methods of salvage surgery in the event of vascular occlusion despite rigorous postoperative follow-up. METHODS We analyzed 59 cases of postoperative thrombosis in 1031 patients who underwent free flap transfer and considered the most appropriate salvage surgery in the event of total flap necrosis. RESULTS The flap salvage rate through vascular reanastomosis was highest for radial forearm flaps, with salvage of jejunal flaps being problematic if postoperative thrombosis occurred. For cases of postoperative thrombosis among patients who underwent reconstruction using a jejunal flap, the period of hospitalization was significantly extended for those patients in whom a second jejunal flap grafting was impossible. For cases of postoperative thrombosis among patients who underwent reconstruction using a radial forearm flap (FA), rectus abdominis flap (RA), or anterior lateral thigh flap (ALT), no significant difference was observed between those undergoing re-grafting with a free flap and those with a pedicled flap. CONCLUSION We concluded that, among patients who undergo reconstruction using a jejunal flap, thrombosis should be discovered at an early stage to enable another jejunal flap re-grafting. For patients who undergo reconstruction using a FA, RA, or ALT, if thrombosis can be discovered at an early stage, there is a possibility of salvaging the flap by means of vascular reanastomosis. If it should prove impossible to salvage the flap, however, primary suture of the defect or reconstruction with a pedicled flap may also be considered.
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Affiliation(s)
- Seiichi Yoshimoto
- Department of Head and Neck, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, Japan.
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