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Khan U, Hathi K, MacKay C, Corsten M. The Complications of Osseous Reconstruction in the Head and Neck: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 171:631-641. [PMID: 38881407 DOI: 10.1002/ohn.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/11/2024] [Accepted: 04/06/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To compare the postoperative complications of the fibular free flap (FFF), scapula free flap (SFF), and osteocutaneous radial forearm free flap (OCRFFF) following osseous reconstruction in the head and neck. DATA SOURCES PUBMED, EMBASE, Cochrane. REVIEW METHODS A literature search and systematic review were performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A meta-analysis of proportions was conducted using a random effects model to compare operative time and postoperative complications. RESULTS The systematic review identified 26 studies comparing at least 1 variable of interest. The odds ratio estimates favored reduced rates of flap failure with the OCRFFF when compared to FFF (0.7, confidence interval [CI]: 0.29-1.11, P < .001), while FFF and SFF were similar. The mean difference estimates for operative time significantly favored FFF over SFF (-51.04 minutes, CI: -92.73 to -9.35, P = .016) and OCRFFF over FFF (66.77 minutes, CI: 52.74-80.8, P < .001). The FFF was more prone to hardware exposure, longer hospital stays, and donor site complications. Recipient wound complications and fistula rates were similar for all flap types. CONCLUSION Depending on the clinical context, the OCRFFF, FFF, and SFF are all robust options for reconstruction in the head and neck. The OCRFFF is associated with a reduced rate of flap failure and shorter operative times. The SFF requires longer operative times, although significant variation was observed between institutions. The FFF has broad reconstructive indications but is associated with more perioperative and long-term complications.
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Affiliation(s)
- Usman Khan
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kalpesh Hathi
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colin MacKay
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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2
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Harper J, Slade E, Cornette A, Kejner AE. Second sensor to improve near-infrared spectroscopy flap monitor utility: A prospective study. Microsurgery 2024; 44:e31142. [PMID: 38376250 DOI: 10.1002/micr.31142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/09/2023] [Accepted: 12/27/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVE This study assesses whether use of continuous noninvasive near-infrared spectroscopy (NIRS) sensor on head and neck free flap (FF) with a second sensor on nonoperated tissue improves distinction between systemic hypoperfusion and FF compromise. METHODS Single-institution, prospective study of patients undergoing head and neck FF reconstruction from December 2018 to April 2020. FFs were continuously monitored using NIRS on a monitor paddle with a second (control) sensor on the shoulder. Crude StO2 and percent change in StO2 were compared between the FF and control sensors on each patient, and percent change and percent difference between the control and the monitor paddle were documented to assess for congruity. Sentinel events (e.g., hypotension and hematoma) were documented to assess the association with change in StO2. These events and timing of StO2 changes were noted to assess associations with change in StO2. RESULTS A total of 48 patients had complete data. Donor sites included 35 soft-tissue FFs and 13 fibula FFs. Average StO2 was 73.7 ± 5.5 for FFs and 71.4 ± 5.0 for control sensors. There were seven sentinel events during the study. At the time of the events, StO2 dropped significantly more for the FF than the control sensor (FF = 52.2% drop; control = 6.2% drop; p = .016). NIRS signal denoted change prior to changes in implantable arterial Doppler in all cases. CONCLUSIONS The addition of a second sensor when using NIRS as a primary modality for FF monitoring may improve distinction between FF compromise events and systemic hypoperfusion. By increasing accuracy of the monitor, there is a potential for decreased resident burden and decreased use of higher level of care nursing, which could reduce overall costs.
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Affiliation(s)
- Jonathan Harper
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Emily Slade
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Adrianne Cornette
- Department of Pediatrics, University Hospitals, Cleveland, OH, United States
| | - Alexandra E Kejner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
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Shaikh N, Noor K, Jafary H, Chung J, Fancy T, Stokes W. Effect of 2 Teams and Operative Time on Complications After Oral Cavity Free Flap Reconstruction. Ann Otol Rhinol Laryngol 2023; 132:1430-1437. [PMID: 37012707 DOI: 10.1177/00034894231164802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Evaluate the effects of operative time and 2 team approach on complications after soft tissue free flap reconstruction for oral tongue cancer. METHODS Patients with oncologic glossectomy with myocutaneous or fasciocutaneous free flap reconstruction were included from the 2015 to 2018 American College of Surgery National Surgical Quality Improvement Program. The primary predictive variables assessed were operative time and 2 team approach; control variables included age, sex, body mass index (BMI), 5-question-modified frailty index (mFI-5), American Society of Anesthesiologists (ASA) class, and total work relative value units (wRVU). Outcomes assessed included 30-day mortality, 30-day reoperation, hospital length of stay beyond 30 days, readmission, medical and surgical complications, and non-home discharge. Multivariable logistic/linear regression models were used to predict surgical outcomes. RESULTS Microvascular soft tissue free flap reconstruction of the oral cavity after glossectomy was performed on 839 patients. Operative time was independently associated with readmission, prolonged length of stay, surgical complications, medical complications, and non-home discharge. A 2-team approach was independently associated with prolonged length of stay and medical complications. The mean operative time of the 1-team and 2-team approach was 8.73 and 9.13 hours. The 1-team approach did not significantly increase operative time (P = .16). CONCLUSIONS In the largest study to date of operative time on post-surgical outcomes after glossectomy and soft tissue free flap reconstruction, we found longer operative times increased rates of postoperative complications and non-home discharge. The 1-team approach is non-inferior to the 2-team approach with respect to operating time and complications.
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Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology, West Virginia University, Morgantown WV, USA
| | - Kinza Noor
- School of Medicine, West Virginia, Morgantown, WV, USA
| | - Haseeb Jafary
- Marshall University School of Medicine, Huntington, WV, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown WV, USA
| | - Tanya Fancy
- Department of Otolaryngology, West Virginia University, Morgantown WV, USA
| | - William Stokes
- Department of Otolaryngology, West Virginia University, Morgantown WV, USA
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McIlwain W, Inman J, Namin A, Kazi A, Shumrick C, Ducic Y. Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy. Semin Plast Surg 2023; 37:39-45. [PMID: 36776801 PMCID: PMC9911226 DOI: 10.1055/s-0042-1759797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.
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Affiliation(s)
- Wesley McIlwain
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Arya Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aasif Kazi
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Ranganath K, Jalisi SM, Naples JG, Gomez ED. Comparing outcomes of radial forearm free flaps and anterolateral thigh free flaps in oral cavity reconstruction: A systematic review and meta-analysis. Oral Oncol 2022; 135:106214. [DOI: 10.1016/j.oraloncology.2022.106214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
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The Multiple-U Technique: A Novel Microvascular Anastomosis Technique That Guarantees Everted Anastomosis Sites with Solid Intima-to-Intima Contact. Plast Reconstr Surg 2022; 149:981e-984e. [PMID: 35311759 DOI: 10.1097/prs.0000000000009025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
SUMMARY The key to successful microvascular anastomosis is achieving intima-to-intima contact, which is not always easy. In this article, the authors propose the multiple-U technique, which is a novel microvascular anastomosis technique that characterizes easy and reliable intima-to-intima contact. The technique was performed on patients who underwent free flap reconstruction for head and neck defects at the Kaohsiung Chang Gung Memorial Hospital from September 1, 2020, to November 30, 2020. The immediate patency test results for all vessel anastomoses were positive, and the postoperative recovery courses of the patients were without any vascular complications. In conclusion, the multiple-U technique is a widely available technique that guarantees everted anastomosis sites and solid intima-to-intima contact. This technique can be performed on both arterial and venous anastomoses regardless of vessel size and wall thickness.
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Hohman MH, Vincent AG, Enzi AR, Ducic Y. Safe Free Tissue Transfer in Patients Older than 90 Years. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2021. [DOI: 10.1055/s-0041-1736419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objective This study aimed to evaluate the safety of microvascular free tissue transfer in the elderly patient population.
Methods We performed a 20-year retrospective review at a tertiary care private practice of patients of ≥ 90 years of age who underwent microvascular free tissue transfer and had at least 6 months of follow-up. Similarly, we reviewed patients aged 70 to 89 years who underwent free tissue transfer between 2018 and 2020 as a control group. Records were examined for type of flap, defect site, pathology, and occurrence of complications.
Results Overall 77 patients of 90 years or older met the inclusion criteria and 77 sequential patients aged 70 to 89 years were identified to serve as a control group. The overall complication rate among patients of ≥ 90 years of age was 18%, with flap-related complications in 4% (two partial flap loss and one total loss). The mortality rate was 1.3%. All patients of ≥ 90 years of age undergoing osteocutaneous reconstruction for osteoradionecrosis experienced complications, but only one was a flap complication (partial loss). Among patients aged 70 to 89 years, the overall complication rate was also 18%, with flap-related complications in 4% (two complete flap failures and one partial loss). The mortality rate in the control group was 2.6%.
Conclusion Soft tissue free flaps are a safe option in the elderly patient population and should be offered to patients who are medically optimized prior to surgery, regardless of age. Osteocutaneous reconstruction for osteoradionecrosis must be undertaken with caution. This study reflects level of evidence 4.
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Affiliation(s)
- Marc H. Hohman
- Department of Facial Plastic and Reconstructive Surgery, Madigan Army Medical Center, Tacoma, Washington
| | | | - Abdul R. Enzi
- Facial Plastic Surgery Associates, Fort Worth, Texas
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Benbassat B, Chantalat E, Chabrillac E, Roumiguie M, De Bonnecaze G, Vairel B, Sarini J, Vergez S, Dupret-Bories A. The external pudendal artery free flap in women: Anatomical study of a novel flap for buccopharyngeal reconstruction. Ann Anat 2021; 239:151828. [PMID: 34474125 DOI: 10.1016/j.aanat.2021.151828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Because of the widespread and high reliability of free flaps in head and neck reconstruction, the challenge today is to reduce donor site morbidity. The external pudendal artery (EPA) free flap has been described in men and provides a minimal functional and cosmetic impact. This study aimed to assess the feasibility of the EPA free flap in women for buccopharyngeal reconstruction. METHODS A dissection of the inguinal region was performed bilaterally on fresh female cadavers. The anatomy of the EPA and its angiosome were described, along with the design of the EPA free flap. A computed tomography angiographic study of the flap perfusion was performed. RESULTS Fourteen cadavers were dissected. The EPA was constant. Its diameter ranged from 1.12 to 2.96 mm (median 2.0 mm). The mean area of its angiosome was 167.3 ± 38.5 cm2. An axial fasciocutaneous flap was designed with a horizontal skin paddle measuring on average 9.2 × 6 cm and a pedicle length of 8.4 ± 1.9 cm. The mean flap thickness was 11.7 ± 6.8 mm and depended on individual factors. A primary closure was achieved in all cases with a scar hidden in the underwear. CONCLUSIONS This anatomical study demonstrates that the EPA seems constant despite variations in its origin pattern. Its diameter and angiosome allow the design of an EPA free flap in women. A clinical study should confirm that this flap is suitable for the repair of buccopharyngeal defects and could be added to the armamentarium of the head and neck reconstructive surgeon.
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Affiliation(s)
- Bastien Benbassat
- Department of Otorhinolaryngology and Head and Neck surgery, Toulouse University Hospital, Hôpital Larrey, 24 chemin de Pouvourville, 31400 Toulouse, France
| | - Elodie Chantalat
- Department of Anatomy, Toulouse University Hospital, 133 route de Narbonne, 31400 Toulouse, France
| | - Emilien Chabrillac
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Claudius Regaud, University Cancer Institute Toulouse - Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Mathieu Roumiguie
- Department of Urology, Toulouse University Hospital, Hôpital Rangueil, 1 avenue du Professeur Jean Poulhès, 31400 Toulouse, France
| | - Guillaume De Bonnecaze
- Department of Anatomy, Toulouse University Hospital, 133 route de Narbonne, 31400 Toulouse, France
| | - Benjamin Vairel
- Department of Otorhinolaryngology and Head and Neck surgery, Toulouse University Hospital, Hôpital Larrey, 24 chemin de Pouvourville, 31400 Toulouse, France
| | - Jérôme Sarini
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Claudius Regaud, University Cancer Institute Toulouse - Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Sébastien Vergez
- Department of Otorhinolaryngology and Head and Neck surgery, Toulouse University Hospital, Hôpital Larrey, 24 chemin de Pouvourville, 31400 Toulouse, France
| | - Agnès Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Claudius Regaud, University Cancer Institute Toulouse - Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France.
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Katsnelson JY, Tyrell R, Karadsheh MJ, Manstein E, Egleston B, Deng M, Baltodano PA, Shafqat MS, Patel SA. Postoperative Complications Associated with the Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis of 4,712 Patients from the ACS-NSQIP Database. J Reconstr Microsurg 2021; 38:343-360. [PMID: 34404103 DOI: 10.1055/s-0041-1733922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years. METHODS Patients undergoing head and neck reconstruction were identified in the 2011-2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay. RESULTS A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02-6.85, p = 0.045), sepsis (OR = 2.95, CI 1.52-5.71, p = 0.001), and infection (OR = 2.03, CI 1.39-2.96, p <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, p <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50-0.85, p = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12-0.92, p = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps. CONCLUSION Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay.
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Affiliation(s)
- Jacob Y Katsnelson
- Department of Surgery, Abington-Jefferson Health, Abington, Pennsylvania
| | - Richard Tyrell
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Murad J Karadsheh
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Ely Manstein
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Brian Egleston
- Biostatistics and Bioinformatics Facility, Temple University Health System, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mengying Deng
- Biostatistics and Bioinformatics Facility, Temple University Health System, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Pablo A Baltodano
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - M Shuja Shafqat
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania.,Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sameer A Patel
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania.,Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Colella G, Rauso R, De Cicco D, Boschetti CE, Iorio B, Spuntarelli C, Franco R, Tartaro G. Clinical management of squamous cell carcinoma of the tongue: patients not eligible for free flaps, a systematic review of the literature. Expert Rev Anticancer Ther 2020; 21:9-22. [PMID: 33081545 DOI: 10.1080/14737140.2021.1840359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The management of squamous cell carcinoma (SCC) of the tongue represents the most demanding treatment planning in head and neck surgery. Ablation followed by free flap reconstruction is considered the gold standard, but not all patients are suitable for this strategy. The aim of this review is to provide a comprehensive view of surgical reconstruction possibilities in patients not eligible for free flaps. METHODS Following PRISMA recommendations, a systematic literature review was conducted searching for original papers that investigated outcomes of patients treated by surgical ablation for tongue SCC followed by reconstruction with local or pedicled flaps. Selected papers were read and data extracted for qualitative analysis. RESULTS Twenty articles met the inclusion/exclusion criteria. The study design was case series in sixteen papers, cohort study in the remaining four. Four different local flaps (BMM, FAMM, NLIF, SMIF) and four regional flaps have been discussed in included studies (IHF, SFIF, SCM, PMMC). CONCLUSION The improved anatomical knowledge makes local flaps a reliable alternative to free tissue transfer in cases requiring small-/medium-sized defects. Regional flaps still represent cornerstones in reconstruction of the tongue. Ease of execution, costs-to-benefit ratio, low-rate complications, minimal donor site morbidity represent the best advantages choosing local/regional flaps.
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Affiliation(s)
- Giuseppe Colella
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Raffaele Rauso
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Davide De Cicco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Ciro Emiliano Boschetti
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Brigida Iorio
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Chiara Spuntarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Renato Franco
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Gianpaolo Tartaro
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
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Giovacchini F, Bensi C, Paradiso D, Docimo R, Tullio A. Association between blood transfusions and complications in head and neck reconstruction: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 278:2171-2185. [PMID: 32870364 DOI: 10.1007/s00405-020-06286-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this meta-analysis is to assess the correlation between blood transfusions and the medical/surgical complications after head and neck reconstructive surgery. METHODS The PRISMA protocol was used and the literature search was performed on Pubmed, Scopus, Cochrane Library and Web of Science up to March 13, 2020. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. RESULTS A total of 1219 records were screened after the electronic search, 22 of which were included in the qualitative analysis. Of there 22 scores, 18 articles were included in the meta-analysis. The OR for medical and surgical complications of transfused patients was 1,64 (95% CI 1.23-2.21); while, the OR for hospital readmission was 1.53 (95% CI 1.29-1.81). CONCLUSIONS The results of this meta-analysis suggested that blood transfusions are associated with both an increased risk of surgical and medical complications of head and neck flaps and with the hospital readmission.
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Affiliation(s)
- Francesco Giovacchini
- Maxillo-Facial Surgery Unit, Santa Maria Della Misericordia Hospital, Piazza Menghini 1, San Sisto, Perugia, Italy
| | - Caterina Bensi
- Paediatric Dentistry Post-Graduate School, University of Rome "Tor Vergata", Via Montpellier 1, Rome, Italy.
| | - Daniele Paradiso
- S.S.D. of Oral Surgery and Ambulatory, Santa Maria Della Misericordia Hospital, Piazza Menghini 1, San Sisto, Perugia, Italy
| | - Raffaella Docimo
- Paediatric Dentistry, Department of Surgical Sciences, University of Rome "Tor Vergata", Via Montpellier 1, Rome, Italy
| | - Antonio Tullio
- Maxillo-Facial Surgery, University of Perugia, Perugia, Italy
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Zaid W, Schlieve T. The Early Effects of Coronavirus Disease-2019 on Head and Neck Oncology and Microvascular Reconstruction Practice: A National Survey of Oral and Maxillofacial Surgeons Enrolled in the Head and Neck Special Interest Group. J Oral Maxillofac Surg 2020; 78:1859-1868. [PMID: 32745533 PMCID: PMC7366104 DOI: 10.1016/j.joms.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The coronavirus disease-2019 (COVID-19) pandemic has affected healthcare systems across the nation. The purpose of this study is to gauge the early effects of the COVID-19 pandemic on head and neck oncology and reconstructive surgery (HNORS) practice and evaluate their practice patterns especially ones that might be impacted by COVID-19 and compare them to the current literature. METHODS This study is a cross-sectional study that surveyed fellowship-trained oral and maxillofacial surgeons in HNORS. This cohort of surgeons was contacted via a generated email list of surgeons enrolled in the American Association of Oral and Maxillofacial Surgeons pathology special interest group. An electronic survey contained 16 questions to assess the COVID-19 effect on HNORS practice and capture their practice patterns from mid-March to mid-April 2020. Statistical analysis was performed to analyze counts, percentages, and response rates. RESULTS We had a 60% response rate (39 of 64); 72% of our responders worked at academic institutions, 18% marked themselves as hybrid academic/private practice, and only 10% were considered hospital-based surgeons. Only 8% of the survey respondents were requested to pause head and neck cancer surgery, whereas 24% were requested to pause free flap surgery during the pandemic. Fifty-five percent agreed that the head and neck and reconstructive surgery should be conducted during a pandemic. Finally, 45% thought that two weeks was a reasonable delay for head and neck cancer cases, whereas 29% thought they should not be delayed for any amount of time. Regarding practice patterns, microvascular reconstruction was the favored method (100%). Respondents generally admitted patients to an intensive care unit postoperatively (92%) and were kept on a ventilator (53%). CONCLUSION The COVID-19 pandemic had a small impact on the surgical treatment of patients with head and neck oncology. Most HNORS surgeons are practicing in accordance with recently published literature.
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Affiliation(s)
- Waleed Zaid
- Associate Professor, Department of Oral and Maxillofacial Surgery, Site Director of Oral and Maxillofacial Surgery - Baton Rouge, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA.
| | - Thomas Schlieve
- Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Dallas, TXl, Residency Program Director, Division of Oral and Maxillofacial Surgery, Dallas, TX, Director of Oral and Maxillofacial Surgery, Parkland Memorial Hospital, Dallas, TX, Director of Oral and Maxillofacial Surgery, Texas Health Presbyterian- Dallas, Dallas, TX
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Abouyared M, Katz AP, Ein L, Ketner J, Sargi Z, Nicolli E, Leibowitz JM. Controversies in free tissue transfer for head and neck cancer: A review of the literature. Head Neck 2019; 41:3457-3463. [PMID: 31286627 DOI: 10.1002/hed.25853] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/14/2019] [Accepted: 06/14/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Microvascular free tissue transfer provides superior functional outcomes when reconstructing head and neck cancer defects. Careful patient selection and surgical planning is necessary to ensure success, as many preoperative, intraoperative, and postoperative patient and technical factors may affect outcome. AIMS To provide a concise, yet thorough, review of the current literature regarding free flap patient selection and management for the patient with head and neck. MATERIALS AND METHODS PubMed and Cochrane databases were queried for publications pertaining to free tissue transfer management and outcomes. RESULTS Malnutrition and tobacco use are modifiable patient factors that negatively impact surgical outcomes. The use of postoperative antiplatelet medications and perioperative antibiotics for greater than 24 hours have not been shown to improve outcomes, although the use of clindamycin alone has been shown to have a higher risk of flap failure. Liberal blood transfusion should be avoided due to higher risk of wound infection and medical complications. DISCUSSION There is a wide range of beliefs regarding proper management of patients undergoing free tissue transfer. While there is some data to support these practices, much of the data is conflicting and common practices are often continued out of habit or dogma. CONCLUSION Free flap reconstruction remains a highly successful surgery overall despite as many different approaches to patient care as there are free flap surgeons. Close patient monitoring remains a cornerstone of surgical success.
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Affiliation(s)
| | - Andrew P Katz
- University of Miami, Miller School of Medicine, Miami, Florida
| | - Liliana Ein
- University of Miami, Miller School of Medicine, Miami, Florida
| | - Jill Ketner
- University of Miami, Miller School of Medicine, Miami, Florida
| | - Zoukaa Sargi
- University of Miami, Miller School of Medicine, Miami, Florida
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Choi JE, Kim H, Choi SY, Park J, Chung MK, Baek CH, Jeong HS. Clinical Outcomes of a 14-Day In-Hospital Stay Program in Patients Undergoing Head and Neck Cancer Surgery With Free Flap Reconstruction Under the National Health Insurance System. Clin Exp Otorhinolaryngol 2019; 12:308-316. [PMID: 30813713 PMCID: PMC6635703 DOI: 10.21053/ceo.2018.01235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives Length of in-hospital stay (LOS) is often regarded as a surrogate marker of efficiency in medical care. A shorter stay can redistribute medical resources to more patients if patient outcomes would not be worsened. However, the adequate LOS remains largely understudied for a complex head and neck cancer (HNC) surgery and free flap reconstruction. Methods Active management of LOS (14-day LOS program) included detailed preoperative surgical planning, intensive wound care, postoperative early ambulation and positive psychological encouragement. It was applied to 43 patients undergoing HNC surgery and free flap reconstruction. Outcomes such as noninferior oncological results, rates of timely adjuvant treatments and complications were compared with those of 125 patients without active management of LOS. In addition, the medical costs of shortened LOS were compared with those of the control group. Cases undergoing HNC surgery as a salvage treatment were excluded from both groups for analyses. Results Active management of LOS resulted in less in-hospital period compared to the control group (15.0 vs. 21.0 days, P=0.001), and reduced medical costs significantly. Incidence of postoperative complications was comparable between the two groups. Oncological outcomes did not differ significantly according to LOS. In all patients in both groups, initial high T status (T3–4) and occurrence of postoperative complications were independent risk factors for long LOS (>30 days). Conclusion In patients undergoing HNC surgery with free flap reconstruction as an initial treatment, a 14-day LOS could be safe in terms of comparable oncological outcomes and postoperative complications. To achieve this goal safely, careful management for T3–4 tumors and prevention of postoperative complications seem to be necessary.
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Affiliation(s)
- Ji-Eun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heejung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongwon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Hoefert S, Lotter O. Change in reimbursement and costs in German oncological head and neck surgery over the last decade: ablative tongue cancer surgery and reconstruction with split-thickness skin graft vs. microvascular radial forearm flap. Clin Oral Investig 2017; 22:1741-1750. [DOI: 10.1007/s00784-017-2269-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
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Microvascular Reconstruction of Free Jejunal Graft in Larynx-preserving Esophagectomy for Cervical Esophageal Carcinoma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e632. [PMID: 27257562 PMCID: PMC4874276 DOI: 10.1097/gox.0000000000000613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Losing the ability to speak severely affects the quality of life, and patients who have undergone laryngectomy tend to become depressed, which may lead to social withdrawal. Recently, with advancements in chemoradiotherapy and with alternative perspectives on postoperative quality of life, larynx preservation has been pursued; however, the selection of candidates and the optimal reconstructive procedure remain controversial. In this study, we retrospectively reviewed our experience with free jejunal graft for larynx-preserving cervical esophagectomy (LPCE), focusing on microvascular reconstruction. METHODS Seven patients underwent LPCE for cervical esophageal carcinoma, and defects were reconstructed by free jejunal transfer subsequently. We collected preoperative and postoperative data of the patients and assessed the importance of the procedure. RESULTS We mostly used the transverse cervical artery as the recipient, and a longer operative time was required, particularly for the regrowth cases. The operative field for microvascular anastomosis was more limited and deeper than those in the laryngectomy cases. Two graft necrosis cases were confirmed at postoperative day 9 or 15, and vessels contralateral from the graft were chosen as recipients in both patients. CONCLUSIONS Microvascular reconstruction for free jejunal graft in LPCE differed in several ways from the procedure combined with laryngectomy. Compression from the tracheal cartilage to the pedicle was suspected as the reason of the necrosis clinically and pathologically. Therefore, we should select recipient vessels from the ipsilateral side of the graft, and careful and extended monitoring of the flap should be considered to make this procedure successful.
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17
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Rosenthal E, Couch M, Farwell DG, Wax MK. Current concepts in microvascular reconstruction. Otolaryngol Head Neck Surg 2016; 136:519-24. [PMID: 17418245 DOI: 10.1016/j.otohns.2006.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Eben Rosenthal
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, USA
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18
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The "Rolled-Up Sleeve" Technique for Microvascular Venous Anastomosis in Head and Neck Reconstruction: Animal Study and Clinical Series. Ann Plast Surg 2016; 76 Suppl 1:S121-4. [PMID: 26808756 DOI: 10.1097/sap.0000000000000686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Venous anastomosis is challenging especially when encountering the thin recipient vein wall in the head and neck region. The authors developed the "rolled-up sleeve" technique to solve this scenario. METHODS An animal study was performed to access the safety and reliability of the "rolled-up sleeve" technique. This technique was performed in 53 consecutive patients during head and neck reconstruction. RESULTS In the animal study, all anastomoses were patent. Histological analysis revealed neo-endothelialization over the anastomotic site. This technique was applied to 59 recipient veins: branch of internal jugular vein (27), external jugular vein (17), superficial temporal vein (9), retromandibular vein (4), facial vein (2), and internal mammary vein (2). No venous thrombosis occurred in these clinical series. CONCLUSIONS The "rolled-up sleeve" technique is a useful procedure that can be performed safely to deal with thin vascular walls for venous anastomoses in head and neck reconstructions.
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Hong C, Yeo H, Son D. Vascular Remodeling with a Microvascular Anastomotic Coupler System: A Case Report. ACTA ACUST UNITED AC 2015. [DOI: 10.15596/arms.2015.24.1.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Changbae Hong
- College of Physical Education, Keimyung University, Daegu, Korea
| | - Hyeonjung Yeo
- Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Daegu Son
- Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Korea
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20
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Cho EH, Garcia RM, Pien I, Kuchibhatla M, Levinson H, Erdmann D, Levin LS, Hollenbeck ST. Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps. Microsurgery 2015; 36:276-83. [PMID: 25808692 DOI: 10.1002/micr.22406] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/15/2015] [Accepted: 02/27/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Successful foot and ankle soft tissue reconstruction is dependent on a clear understanding of the vascular supply to the foot. The aim of this study was to identify risk factors for reconstructive failure following foot and ankle free tissue transfer. METHODS The authors retrospectively reviewed their 17-year institutional experience with 231 foot and ankle free flaps performed in 225 patients to determine predictors of postoperative foot ischemia and flap failure. Postoperative foot ischemia was defined as ischemia resulting in tissue necrosis, separate from the reconstruction site. RESULTS Six (3%) patients developed postoperative foot ischemia, and 28 (12%) patients experienced flap failure. Chronic ulceration (P = 0.02) and an elevated preoperative platelet count (P = 0.04) were independent predictors of foot ischemia. The presence of diabetes was predictive of flap failure (P = 0.05). Flap failure rates were higher in the setting of an abnormal preoperative angiogram (P = 0.04), although the type and number of occluded arteries did not influence outcome. Foot ischemia was more frequent following surgical revascularization in conjunction with free tissue transfer and the use of the distal arterial bypass graft for flap anastomosis (P < 0.01). Overall, no differences were observed in foot ischemia (P = 0.17) and flap failure (P = 0.75) rates when the flap anastomosis was performed to the diseased artery noted on angiography, compared with an unobstructed native tibial artery. CONCLUSIONS Foot and ankle free tissue transfer may be performed with a low incidence of foot ischemia. Patients with diabetes, chronic ulceration, and an elevated preoperative platelet count are at higher risk for reconstructive failure. © 2015 Wiley Periodicals, Inc. Microsurgery 36:276-283, 2016.
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Affiliation(s)
- Eugenia H Cho
- Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC
| | - Ryan M Garcia
- Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC
| | - Irene Pien
- Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University Health System, Durham, NC
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC
| | - Detlev Erdmann
- Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC
| | - L Scott Levin
- Department of Orthopaedics, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Scott T Hollenbeck
- Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC
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Nicoli F, Chilgar RM, Sapountzis S, Yeo MS, Lazzeri D, Ciudad P, Kiranantawat K, Sönmez TT, Maruccia M, Lim SY, Constantinides J, Chen HC. Reconstruction after orbital exenteration using gracilis muscle free flap. Microsurgery 2014; 35:169-76. [DOI: 10.1002/micr.22339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgeryUniversity of Rome “Tor Vergata”Rome Italy
| | - Ram M. Chilgar
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgeryMaharashtra University of Health SciencesNashik Maharashtra India
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Matthew Sze‐Wei Yeo
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic SurgeryVilla Salaria ClinicRome Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Maxillofacial SurgeryFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkok Thailand
| | - Tolga Taha Sönmez
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Oral and Maxillofacial SurgeryMedical FacultyRWTH Aachen UniversityAachen Germany
| | - Michele Maruccia
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Seong Yoon Lim
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Joannis Constantinides
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgerySt. Thomas' HospitalLondonUK
| | - Hung Chi Chen
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
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Broer PN, Weichman KE, Tanna N, Wilson S, Ng R, Ahn C, Choi M, Karp NS, Levine JP, Allen RJ. Venous coupler size in autologous breast reconstruction-does it matter? Microsurgery 2013; 33:514-8. [PMID: 24038542 DOI: 10.1002/micr.22169] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/15/2013] [Accepted: 07/17/2013] [Indexed: 11/09/2022]
Affiliation(s)
- P. Niclas Broer
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
| | - Katie E. Weichman
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
| | | | - Stelios Wilson
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
| | - Reuben Ng
- Department of Epidemiology and Biostatistics; Yale University; New Haven; CT
| | - Christina Ahn
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
| | - Mihye Choi
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
| | - Nolan S. Karp
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
| | - Jamie P. Levine
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
| | - Robert J. Allen
- Institute of Reconstructive Plastic Surgery; New York University; New York; NY
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23
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Grewal AS, Erovic B, Strumas N, Enepekides DJ, Higgins KM. The utility of the microvascular anastomotic coupler in free tissue transfer. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 20:98-102. [PMID: 23730156 DOI: 10.1177/229255031202000213] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. The microvascular anastomotic coupling device is an elegant, friction-fit ring pin device that is becoming more widely used. OBJECTIVE To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer. METHODS A comprehensive database search was performed to identify eligible publications. Inclusion criteria were anastomotic coupler utilization and free-tissue transfer. Recorded information from eligible studies included patient age, follow-up, radiation history, number of free-flaps and failure rates, reconstruction subsites, number of coupled venous and arterial anastomoses, coupling time, conversion to sutured anastomosis, coupler size and thrombosis rates. RESULTS Twenty-five studies reporting on 3207 patients were included in the analysis. A total of 3576 free-flaps were performed within the following subsites: 1103 head and neck, 2094 breast, 300 limb or body, and 79 nonspecified. There were only 26 reported flap failures (0.7%). A total of 3497 venous and 342 arterial coupled anastomoses were performed. The primary outcome measure was thrombosis rates, and there were 61 venous (1.7%) and 12 arterial (3.6%) thromboses reported. Mean coupling time was 5 min, and 30 anastomoses (0.8%) were converted to suture. CONCLUSION Flap survival and revision-free application of the microvascular coupler occurred in more than 99% of cases. There is a substantial time savings with coupler use. Venous and arterial thrombosis rates are comparable with the best results achieved by sutured anastomosis and, when used by experienced surgeons, the coupler achieves superior results.
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Affiliation(s)
- Amandeep S Grewal
- University of Toronto, Sunnybrook Health Sciences Centre, Department of Otolaryngology, Head and Neck Surgery,Toronto
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Frederick JW, Sweeny L, Carroll WR, Peters GE, Rosenthal EL. Outcomes in head and neck reconstruction by surgical site and donor site. Laryngoscope 2013; 123:1612-7. [PMID: 23686870 DOI: 10.1002/lary.23775] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Define surgical outcomes of specific donor sites for free tissue transfer in head and neck reconstruction. STUDY DESIGN Retrospective cohort review at an academic tertiary care center. METHODS A review was made of free tissue transfer procedures performed at a university-based tertiary care facility from October 2004 to April 2011. A total of 1,051 patients underwent six types of free flaps: fasciocutaneous radial forearm (53%), osteocutaneous radial forearm (16%), rectus abdominis (11%), fibula (10%), anterior lateral thigh (7%), and latissimus dorsi (2%). Demographic data were collected, and outcomes measured were: length of hospital stay, flap viability, and major complications (infection, fistula, and hematoma). RESULTS Of the 1,051 flaps performed, the most common operative site was oral cavity (40%, n = 414) followed by hypopharynx/larynx (22%, n = 234), cutaneous (20%, n = 206), oropharynx (9%, n = 98), midface (7%, n = 76), and skull base (2%, n = 23). The median hospital stay was 7.9 days (range, 1-76), and the overall failure rate was 2.8%. Cutaneous defects required the shortest length of hospitalization (5.8 days, P < .0001), a low free flap failure rate (1.5%, n = 3), and limited major complications (6%, n = 12). Conversely, oropharynx defects were associated with the longest hospitalization (8.9 days). Midface defects had a high incidence of complications (15%, n = 11, P = .10). Defects above the angle of the mandible had higher overall complications when compared to below. Similarly, reconstruction for primary or recurrent cancer had a total failure rate of 2.5%, whereas secondary reconstruction and radionecrosis had a failure rate of 4.0% (P = .29). Additionally, there was no statistical difference between outcomes based on donor site. CONCLUSIONS This review demonstrates that certain subsets of patients are at higher risk for complications after free tissue transfer. Patients undergoing free flap reconstruction for cutaneous defects have substantially shorter hospital stays and are at lower risk of flap complications, whereas reconstruction for radionecrosis and secondary reconstruction tend to have higher overall flap failure rates.
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Affiliation(s)
- John W Frederick
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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25
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George RK, Krishnamurthy A. Microsurgical free flaps: Controversies in maxillofacial reconstruction. Ann Maxillofac Surg 2013; 3:72-9. [PMID: 23662264 PMCID: PMC3645616 DOI: 10.4103/2231-0746.110059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps.
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Affiliation(s)
- Rinku K George
- Department of Head & Neck Oncology & Reconstructive Surgery, Cancer Institute (W.I.A), Adyar, Chennai, India
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26
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Head and neck reconstruction using microsurgery: a 9-year retrospective study. Eur Arch Otorhinolaryngol 2013; 270:2737-43. [DOI: 10.1007/s00405-013-2390-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/29/2013] [Indexed: 01/24/2023]
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27
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Godefroy WP, Klop WMC, Smeele LE, Lohuis PJFM. Free-Flap Reconstruction of Large Full-Thickness Lip and Chin Defects. Ann Otol Rhinol Laryngol 2012; 121:594-603. [DOI: 10.1177/000348941212100906] [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: We describe our experience in the reconstruction of large 3-layer lip defects using free revascularized lower-arm and fibula flaps. Methods: Between 2005 and 2009, nine patients underwent free-flap reconstruction after oncological surgery involving the lip and chin with or without mandibular involvement. The flap techniques are described, and postoperative functional and aesthetic results were recorded. Results: There were no flap failures. All patients showed intact oral function and good aesthetic results. Two patients died of distant metastases, 8 months and 17 months after surgery. Conclusions: Three-layer defects of the lip ideally require free-flap reconstruction, which has a high probability of achieving good functional and aesthetic results.
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Serrano NA, Trenité GN, Yueh B, Farwell DG, Futran ND, Méndez E. Risk Factors Associated With Repair of Orbital and Lateral Skull
Defects. ACTA ACUST UNITED AC 2012. [DOI: 10.1001/archfaci.2011.1301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nicholas A. Serrano
- University of Washington School of Medicine (Mr Serrano), Surgery and Perioperative Care Service, Veterans Affairs Puget Sound Health Care System (Dr Méndez), and Program in Epidemiology, Fred Hutchinson Cancer Research Center (Dr Méndez), Seattle, Washington; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Trenité); and Departments of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis (Dr Yueh), University of California at Davis, Sacramento (Dr
| | - Gilean N. Trenité
- University of Washington School of Medicine (Mr Serrano), Surgery and Perioperative Care Service, Veterans Affairs Puget Sound Health Care System (Dr Méndez), and Program in Epidemiology, Fred Hutchinson Cancer Research Center (Dr Méndez), Seattle, Washington; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Trenité); and Departments of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis (Dr Yueh), University of California at Davis, Sacramento (Dr
| | - Bevan Yueh
- University of Washington School of Medicine (Mr Serrano), Surgery and Perioperative Care Service, Veterans Affairs Puget Sound Health Care System (Dr Méndez), and Program in Epidemiology, Fred Hutchinson Cancer Research Center (Dr Méndez), Seattle, Washington; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Trenité); and Departments of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis (Dr Yueh), University of California at Davis, Sacramento (Dr
| | - D. Gregory Farwell
- University of Washington School of Medicine (Mr Serrano), Surgery and Perioperative Care Service, Veterans Affairs Puget Sound Health Care System (Dr Méndez), and Program in Epidemiology, Fred Hutchinson Cancer Research Center (Dr Méndez), Seattle, Washington; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Trenité); and Departments of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis (Dr Yueh), University of California at Davis, Sacramento (Dr
| | - Neal D. Futran
- University of Washington School of Medicine (Mr Serrano), Surgery and Perioperative Care Service, Veterans Affairs Puget Sound Health Care System (Dr Méndez), and Program in Epidemiology, Fred Hutchinson Cancer Research Center (Dr Méndez), Seattle, Washington; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Trenité); and Departments of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis (Dr Yueh), University of California at Davis, Sacramento (Dr
| | - Eduardo Méndez
- University of Washington School of Medicine (Mr Serrano), Surgery and Perioperative Care Service, Veterans Affairs Puget Sound Health Care System (Dr Méndez), and Program in Epidemiology, Fred Hutchinson Cancer Research Center (Dr Méndez), Seattle, Washington; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Trenité); and Departments of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis (Dr Yueh), University of California at Davis, Sacramento (Dr
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Guerin-Lebailly C, Mallet Y, Lambour V, Fournier C, Bedoui SE, Van JT, Lefebvre JL. Functional and sensitive outcomes after tongue reconstruction: About a series of 30 patients. Oral Oncol 2012; 48:272-7. [DOI: 10.1016/j.oraloncology.2011.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 11/28/2022]
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30
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Schneider DS, Wu V, Wax MK. Indications for pedicled pectoralis major flap in a free tissue transfer practice. Head Neck 2011; 34:1106-10. [DOI: 10.1002/hed.21868] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 04/08/2011] [Accepted: 05/25/2011] [Indexed: 11/11/2022] Open
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31
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Andrades P, Militsakh O, Hanasono MM, Rieger J, Rosenthal EL. Current strategies in reconstruction of maxillectomy defects. ACTA ACUST UNITED AC 2011; 137:806-12. [PMID: 21844415 DOI: 10.1001/archoto.2011.132] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To outline a contemporary review of defect classification and reconstructive options. DESIGN Review article. SETTING Tertiary care referral centers. RESULTS Although prosthetic rehabilitation remains the standard of care in many institutions, the discomfort of wearing, removing, and cleaning a prosthesis; the inability to retain a prosthesis in large defects; and the frequent need for readjustments often limit the value of this cost-effective and successful method of restoring speech and mastication. However, flap reconstruction offers an option for many, although there is no agreement as to which techniques should be used for optimal reconstruction. Flap reconstruction also involves a longer recovery time with increased risk of surgical complications, has higher costs associated with the procedure, and requires access to a highly experienced surgeon. CONCLUSION The surgeon and reconstructive team must make individualized decisions based on the extent of the maxillectomy defect (eg, the resection of the infraorbital rim, the extent of palate excision, skin compromise) and the need for radiation therapy.
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Affiliation(s)
- Patricio Andrades
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, University of Chile Clinical Hospital and Hospital del Trabajador de Santiago, Santiago, Chile
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Rodríguez IA, López-López MT, Oliveira ACX, Sánchez-Quevedo MC, Campos A, Alaminos M, Durán JDG. Rheological characterization of human fibrin and fibrin-agarose oral mucosa substitutes generated by tissue engineering. J Tissue Eng Regen Med 2011; 6:636-44. [DOI: 10.1002/term.466] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 02/24/2011] [Accepted: 07/05/2011] [Indexed: 01/22/2023]
Affiliation(s)
- I. A. Rodríguez
- Department of Histology B, School of Dentistry; National University of Cordoba; Argentina
| | - M. T. López-López
- Department of Applied Physics; University of Granada, Campus de Fuentenueva; Granada; Spain
| | - A. C. X. Oliveira
- Tissue Engineering Group, Department of Histology; University of Granada; Spain
| | | | - A. Campos
- Tissue Engineering Group, Department of Histology; University of Granada; Spain
| | - M. Alaminos
- Tissue Engineering Group, Department of Histology; University of Granada; Spain
| | - J. D. G. Durán
- Department of Applied Physics; University of Granada, Campus de Fuentenueva; Granada; Spain
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Hanasono MM, Lin D, Wax MK, Rosenthal EL. Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck 2011; 34:580-8. [PMID: 21416549 DOI: 10.1002/hed.21712] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2010] [Indexed: 11/12/2022] Open
Abstract
The use of chemoradiation therapy in laryngeal cancer has resulted in significant reconstructive challenges. Although reconstruction of salvage laryngectomy defects remains controversial, current literature supports aggressive management of these defects with vascularized tissue, even when there is sufficient pharyngeal tissue present for primary closure. Significant advancement in reconstructive techniques has permitted improved outcomes in patients with advanced disease who require total laryngopharyngectomy or total laryngoglossectomy. Use of enteric and fasciocutaneous flaps result in good patient outcomes. Finally, wound complication rates after salvage surgery approach 60% depending on comorbid conditions such as cardiac insufficiency, hypothyroidism, or extent of previous treatment. Neck dehiscence, great vessel exposure, fistula formation, or cervical skin necrosis results in complex wounds that can often be treated initially with negative pressure dressings followed by definitive reconstruction. The timing of repair and approach to the vessel-depleted neck also present challenges in this patient population. Currently, there is significant institutional bias in the management of the patient with postchemoradiation salvage laryngectomy. Future prospective multi-institutional studies are certainly needed to more clearly define optimal treatment of these difficult patients.
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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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34
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35
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Masià J, Sommario M, Cervelli D, Vega C, León X, Pons G. Extended deep inferior epigastric artery perforator flap for head and neck reconstruction: A clinical experience with 100 patients. Head Neck 2010; 33:1328-34. [DOI: 10.1002/hed.21628] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 07/06/2010] [Accepted: 08/12/2010] [Indexed: 11/11/2022] Open
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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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Feasibility of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma. J Craniomaxillofac Surg 2010; 38:350-4. [DOI: 10.1016/j.jcms.2009.04.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 04/02/2009] [Accepted: 04/30/2009] [Indexed: 11/21/2022] Open
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38
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Kadota H, Fukushima J, Nakashima T, Kumamoto Y, Yoshida S, Yasumatsu R, Shiratsuchi H, Morita M, Komume S. Comparison of salvage and planned pharyngolaryngectomy with jejunal transfer for hypopharyngeal carcinoma after chemoradiotherapy. Laryngoscope 2010; 120:1103-8. [DOI: 10.1002/lary.20887] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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39
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1000 Consecutive Venous Anastomoses Using the Microvascular Anastomotic Coupler in Breast Reconstruction. Plast Reconstr Surg 2010; 125:792-8. [DOI: 10.1097/prs.0b013e3181cb636d] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Mallet Y, El Bedoui S, Penel N, Ton Van J, Fournier C, Lefebvre J. The free vascularized flap and the pectoralis major pedicled flap options: Comparative results of reconstruction of the tongue. Oral Oncol 2009; 45:1028-31. [DOI: 10.1016/j.oraloncology.2009.05.639] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 05/26/2009] [Accepted: 05/26/2009] [Indexed: 11/24/2022]
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41
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Kadota H, Sakuraba M, Kimata Y, Hayashi R, Ebihara S, Kato H. Larynx-preserving esophagectomy and jejunal transfer for cervical esophageal carcinoma. Laryngoscope 2009; 119:1274-80. [DOI: 10.1002/lary.20493] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Iseli TA, Yelverton JC, Iseli CE, Carroll WR, Magnuson JS, Rosenthal EL. Functional outcomes following secondary free flap reconstruction of the head and neck. Laryngoscope 2009; 119:856-60. [DOI: 10.1002/lary.20200] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
For head and neck reconstruction after tumor ablation surgery, free flaps are mostly the chosen treatment modality for most of the centers. Coping with venous insufficiency and increasing venous outflow of the flap during this process increases the success rate. To increase venous outflow, triple-lumen central venous catheter is inserted to one of the donor veins of the flap that has venous insufficiency and one intact vein anastomosis.
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45
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Andrades P, Rosenthal EL, Carroll WR, Baranano CF, Peters GE. Zygomatic-maxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flap. Head Neck 2009; 30:1295-302. [PMID: 18642322 DOI: 10.1002/hed.20874] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate morbidity, functional, and aesthetic outcomes in midface zygomatic-maxillary buttress reconstruction using the osteocutaneous radial forearm free flap (OCRFFF). METHODS A retrospective review of 24 consecutive patients that underwent midface reconstruction using the OCRFFF was performed. All patients had variable extension of maxillectomy defects that requires restoration of the zygomatic-maxillary buttress. After harvest, the OCRFFF was fixed transversely with miniplates connecting the remaining zygoma to the anterior maxilla. The orbital support was given by titanium mesh when needed that was fixed to the radial forearm bone anteriorly and placed on the remaining orbital floor posteriorly. The skin paddle was used for intraoral lining, external skin coverage, or both. The main outcome measures were flap success, donor-site morbidity, orbital, and oral complications. Facial contour, speech understandability, swallowing, oronasal separation, and socialization were also analyzed. RESULTS There were 6 women and 18 men, with an average age of 66 years old (range, 34-87). The resulting defects after maxillectomy were (according to the Cordeiro classification; Disa et al, Ann Plast Surg 2001;47:612-619; Santamaria and Cordeiro, J Surg Oncol 2006;94:522-531): type I (8.3%), type II (33.3%), type III (45.8%), and type IV (12.5%). There were no flap losses. Donor-site complications included partial loss of the split thickness skin graft (25%) and 1 radial bone fracture. The most significant recipient-site complications were severe ectropion (24%), dystopia (8%), and oronasal fistula (12%). All the complications occurred in patients with defects that required orbital floor reconstruction and/or cheek skin coverage. The average follow-up was 11.5 months, and over 80% of the patients had adequate swallowing, speech, and reincorporation to normal daily activities. CONCLUSIONS The OCRFFF is an excellent alternative for midface reconstruction of the zygomatic-maxillary buttress. Complications were more common in patients who underwent resection of the orbital rim and floor (type III and IV defects) or external cheek skin.
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Affiliation(s)
- Patricio Andrades
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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46
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47
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Lidman D, Niklasson M. Survival and function in patients with tumours of the head and neck operated on and reconstructed with free flaps. ACTA ACUST UNITED AC 2008; 42:77-85. [PMID: 18335351 DOI: 10.1080/02844310701850538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
From 1983 to 2003, 131 patients were operated on in the head and neck region with 139 free flaps. They were operated on using a team approach of ear, nose, and throat surgeons and plastic surgeons, and sometimes maxillofacial surgeons. The tumours were squamous cell carcinoma (SCC) 104 (80%), salivary gland cancer 13 (10%), sarcoma 5 (4%), basal cell carcinoma 4 (3%), and others 4 (3%). The staging of the primary intraoral SCC tumours (n=79) was 42% in stage II, 28% in stage III, and 30% in stage IV. The survival of patients with primary oral SCC was compared with a previously treated previous series that gave an increase in tumour-related five-year survival from 48% to 58%. Most flaps were radial forearm flaps (73%). Fifteen percent were vascularised bone transfers. A questionnaire was sent to patients who had had oral/oropharyngeal tumours to measure function and satisfaction, to which 47/49 responded. The results including ability to chew and swallow; speech was good, with a median score of 0.78 (range 1-0).
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Affiliation(s)
- Disa Lidman
- Department of Plastic Surgery, Hand Surgery and Burns, University Hospital, Linköping, Sweden.
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48
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Rosenthal EL, King T, McGrew BM, Carroll W, Magnuson JS, Wax MK. Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects. Head Neck 2008; 30:589-94. [DOI: 10.1002/hed.20744] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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49
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Marques Faria JC, Rodrigues ML, Scopel GP, Kowalski LP, Ferreira MC. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg 2008; 61:172-9. [DOI: 10.1016/j.bjps.2007.10.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 04/03/2007] [Accepted: 10/16/2007] [Indexed: 11/29/2022]
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50
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Wolff KD, Hölzle F, Wysluch A, Mücke T, Kesting M. Incidence and time of intraoperative vascular complications in head and neck microsurgery. Microsurgery 2008; 28:143-6. [PMID: 18286659 DOI: 10.1002/micr.20468] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Klaus-Dietrich Wolff
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum rechts der Isar, Technische Universität München, Germany.
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