1
|
Shih PK, Chen JX, Morrison SD, Lin MC, Wang TH, Wu SC. Diet Outcome in Patients With Hypopharyngeal Defects Repaired With Different Reconstruction Flaps: A Comparative Study. Otolaryngol Head Neck Surg 2024; 171:387-394. [PMID: 38668643 DOI: 10.1002/ohn.792] [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: 08/07/2023] [Revised: 02/28/2024] [Accepted: 04/06/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES To assess potential risk factors influencing diet outcomes after reconstruction of subtotal hypopharyngeal defects using free patch- or tube-shaped anterolateral thigh (ALT) fasciocutaneous flaps. STUDY DESIGN Retrospective cohort study. SETTING First-level referral hospital. METHODS Between January 2011 and December 2020, we studied hypopharyngeal cancer patients who underwent the reconstruction of hypopharyngeal defects using free patch- or tube-shaped ALT fasciocutaneous flaps. The choice between patch- or tube-shaped ALT flaps depended on the defect's nature, favoring patch-shaped for subtotal defects and tube-shaped for circumferential defects. A restricted diet was characterized by a history of enterostomy or endoscopic esophageal dilation treatment postreconstruction. We analyzed patients with restricted diets at 1- and 3-year follow-up visits. RESULTS Ninety-eight patients were enrolled; 39 patch-shaped flaps, and 59 tube-shaped flaps. No significances were noted in demographics, postoperative radiotherapy (RT) or chemotherapy, rates of free flap reoperation/salvage, or complications. However, a significant difference emerged in diet outcomes at the 1-year follow-up (P = .005). The rate of a restricted diet was 6.08 times higher in patients with tube-shaped flaps compared to patch-shaped flaps (95% confidence interval [CI]: 1.95-18.94). Stratifying based on postoperative RT revealed a 5.47 times higher rate of a restricted diet in tube-shaped flap recipients compared to patch-shaped flap recipients (95% CI: 1.44-20.48). No significances were observed in 5-year survival rates. CONCLUSION Concerning postoperative RT, patch-shaped flaps exhibited a lower incidence of a restricted diet compared to tube-shaped flaps. Preservation of the posterior mucosa may play a crucial role in preventing RT-induced esophageal stricture.
Collapse
Affiliation(s)
- Pin-Keng Shih
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jian-Xun Chen
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shane D Morrison
- Department of Surgery, Division of Plastic Surgery, University of Washington Medical Center, Seattle, Washington, USA
| | - Mei-Chen Lin
- School of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ti-Hao Wang
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chi Wu
- School of Medicine, China Medical University, Taichung, Taiwan
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
2
|
Monaghan NP, Duckett KA, Nguyen SA, Newman JG, Albergotti WG, Kejner AE. Vascular events in patients with head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1557-1572. [PMID: 38334324 DOI: 10.1002/hed.27675] [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: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To assess the incidence of vascular events in patients with head and neck cancer. REVIEW METHODS Primary studies identified through April 2023. Meta-analysis was performed. RESULTS There were 146 studies included in the systematic review. Rates of events were collected in the overall group, those with chemoprophylaxis, and those that underwent surgery, radiation, or chemotherapy. Of 1 184 160 patients, 4.3% had a vascular event. Radiation therapy had highest risk of overall events and stroke when compared to surgery and chemotherapy. Chemotherapy had a higher risk of stroke and overall events when compared to surgery. CONCLUSIONS Vascular events occur in 4%-5% of patients with head and neck cancer. Our data does not support the use of routine anticoagulation. Patients undergoing radiation therapy had the highest frequency of events.
Collapse
Affiliation(s)
- Neil P Monaghan
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A Duckett
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason G Newman
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - W Greer Albergotti
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexandra E Kejner
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
3
|
Moratin J, Dao Trong P, Semmelmayer K, Mrosek J, Zittel S, Bleymehl M, Ristow O, Freudlsperger C, Hoffmann J, Engel M. Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects-A Retrospective Cohort Study. J Clin Med 2023; 12:6208. [PMID: 37834851 PMCID: PMC10573281 DOI: 10.3390/jcm12196208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/31/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
Free flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap success, secondary endpoints were complication rates, hospitalization and surgery time. Cases with defect situations of the scalp and consecutive microvascular free flap reconstructions using either ALT flaps or vastus lateralis muscle flaps between 2014 and 2022 were retrospectively analyzed. Indications, perioperative handling and outcomes were compared. Twenty patients were included in the analysis. Ten patients (50%) received a free flap reconstruction using an ALT flap and ten patients (50%) received a vastus lateralis flap. A simultaneous two-team approach was possible in each case and the flap success rate was 100% with the need for one successful anastomosis revision. The mean defect size in our cohort was 147 ± 46 cm2. There were no significant differences in surgery time, duration of hospitalization or complication rate between both cohorts. Both free flaps, the ALT and the vastus lateralis flap, are suitable for the closure of large scalp defects. They provide high success rates, short surgery times without the need for patient repositioning and low donor-site morbidity. The vastus lateralis muscle flap bares the advantage of being perforator-independent and allows for the preparation of long vessels for anastomosis if needed while baring the disadvantage of a prolonged period of healing via granulation or the need for secondary surgery in terms of covering by split-thickness skin grafts which may interfere with necessary adjuvant treatment in oncological patients.
Collapse
Affiliation(s)
- Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Philip Dao Trong
- Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany;
| | - Karl Semmelmayer
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Jan Mrosek
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Sven Zittel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Moritz Bleymehl
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Oliver Ristow
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| | - Michael Engel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (J.M.); (S.Z.); (M.B.); (O.R.); (C.F.); (J.H.); (M.E.)
| |
Collapse
|
4
|
Naujokat H, Spille J, Bergholz R, Wieker H, Weitkamp J, Wiltfang J. Robot‐assisted scaffold implantation and two‐stage flap raising of the greater omentum for reconstruction of the facial skeleton: Description of a novel technique. Int J Med Robot 2022; 18:e2429. [DOI: 10.1002/rcs.2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery University Hospital of Schleswig‐Holstein Campus Kiel Kiel Germany
| | - Johannes Spille
- Department of Oral and Maxillofacial Surgery University Hospital of Schleswig‐Holstein Campus Kiel Kiel Germany
| | - Robert Bergholz
- Department of General Visceral Thoracic, Transplant and Pediatric Surgery University Hospital of Schleswig‐Holstein Campus Kiel Kiel Germany
| | - Henning Wieker
- Department of Oral and Maxillofacial Surgery University Hospital of Schleswig‐Holstein Campus Kiel Kiel Germany
| | - Jan‐Tobias Weitkamp
- Department of Oral and Maxillofacial Surgery University Hospital of Schleswig‐Holstein Campus Kiel Kiel Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery University Hospital of Schleswig‐Holstein Campus Kiel Kiel Germany
| |
Collapse
|
5
|
Righini CA, Colombé C. Hypopharyngeal reconstruction with gastro-omental free flap. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:397-401. [PMID: 33431349 DOI: 10.1016/j.anorl.2020.12.013] [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: 10/22/2022]
Abstract
Three types of reconstruction are possible following total laryngopharyngectomy (TLP) for advanced hypopharyngeal cancer: locoregional tubularized island flaps, gastric pull-up and free flaps. Gastro-omental free flap (GOFF) is rarely used in this setting. However, because of its composite nature, this flap has the advantage of being able to restore digestive continuity and reconstruct part of the skin of the neck when it needs to be sacrificed because of tumour invasion or poor trophicity. The GOFF is a reliable and robust flap particularly indicated in hostile environments: repeated neck surgery, atrophic and devascularized skin after radiotherapy, sepsis in the context of fistula and/or pharyngostomy. It requires the collaboration of two or even three surgical teams. In this article, we describe the flap harvesting technique and the complications and functional outcome.
Collapse
Affiliation(s)
- C A Righini
- CHU de Grenoble Alpes (CHUGA), 38043 Grenoble Cedex 09, France; Faculté de médecine Grenoble Alpes, 38043 Grenoble Cedex 09, France; Unité Inserm UJF/U823, Centre de Recherche Albert Bonniot, 38043 Grenoble Cedex 09, France.
| | - C Colombé
- CHU de Grenoble Alpes (CHUGA), 38043 Grenoble Cedex 09, France; Faculté de médecine Grenoble Alpes, 38043 Grenoble Cedex 09, France
| |
Collapse
|
6
|
Komanduri SK, Hormuzdi D, Desai SS, Patil DB, Khivasara JS, Kulkarni SGS, Desai SS. Free Gastric Flap for Oral Reconstruction-a Feasibility Study in Oral Defects. Indian J Surg Oncol 2021; 12:172-176. [PMID: 33814849 DOI: 10.1007/s13193-020-01276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background Free flap transfer is a standard practice in reconstruction of oral defects. Fasciocutaneous flaps are commonly used for reconstruction of soft tissue defects. Replacement of oral mucosa with skin often causes discomfort, foreign body sensation, dysgeusia, problems with skin hair and morbidity at the donor site. Morbidity at the donor site may interfere with physical activity among manual labourers. Materials and methods We prospectively analysed nine cases of oral cavity defects reconstructed with free gastro-omental flap over 4 months from March to July 2019. A free gastric flap based on right and left gastric artery and vascular arcade was harvested from the body of stomach. Feasibility, technical aspects, advantages and disadvantages of the flap are reviewed. Results Flap survival was 100%. No re-exploration for salvage was required. Flap was monitored for viability by colour change and capillary refill. All the nine cases healed well. One patient required readmission for bleeding from the raw area exposed at the margins of the flap. Patient satisfaction and quality of life was satisfactory. Long pedicle length, rich submucosal vascular network, dual pedicles available for anastomosis, like to like mucosal tissue replacement and low donor site morbidity make it a reliable option in the armamentarium of oral reconstruction. Conclusion Free gastro-omental flap is a feasible and reliable tissue available for reconstruction of oral soft tissue defects.
Collapse
Affiliation(s)
| | - Dinshaw Hormuzdi
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
| | | | - Dipti Babasaheb Patil
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
| | | | - Sanika G S Kulkarni
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
| | - Shivani Sharad Desai
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
| |
Collapse
|
7
|
Sun W, Wen WP, Zhu XL. Preservation of Internal Branch of Superior Laryngeal Nerve during Surgery for Hypopharyngeal Cancer. EAR, NOSE & THROAT JOURNAL 2020; 101:175-180. [PMID: 32804572 DOI: 10.1177/0145561320949474] [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: 11/16/2022] Open
Abstract
OBJECTIVES This study was performed to evaluate the significance of intraoperative preservation of the internal branch of the superior laryngeal nerve (ibSLN) during surgery for hypopharyngeal squamous cell carcinoma (HSCC). METHODS Twelve patients with HSCC underwent surgery between January 2017 and December 2018. Sensation in the hypopharyngeal mucosa was tested using a flexible laryngeal endoscope on postoperative day 5. RESULTS Surgeries were successfully performed in 10 patients with HSCC arising from the internal wall of the pyriform fossa and in 2 patients with HSCC arising from the posterior wall of the hypopharynx. The main trunk of the ibSLN was preserved in all patients. Testing of sensation in the hypopharyngeal mucosa revealed the presence of the cough reflex in all patients. All patients achieved a full normal oral diet at a median of 8.5 days (range, 6-11 days) and removal of the tracheal tube at a median of 10 days (range, 7-12 days). CONCLUSIONS Our results showed that preservation of the ibSLN during surgery for HSCC is feasible and important in the recovery of sensation in the hypopharyngeal mucosa.
Collapse
Affiliation(s)
- Wei Sun
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
| | - Wei-Ping Wen
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Lin Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
8
|
Gal I, Edri R, Noor N, Rotenberg M, Namestnikov M, Cabilly I, Shapira A, Dvir T. Injectable Cardiac Cell Microdroplets for Tissue Regeneration. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e1904806. [PMID: 32003928 PMCID: PMC7113023 DOI: 10.1002/smll.201904806] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/01/2020] [Indexed: 05/19/2023]
Abstract
One of the strategies for heart regeneration includes cell delivery to the defected heart. However, most of the injected cells do not form quick cell-cell or cell-matrix interactions, therefore, their ability to engraft at the desired site and improve heart function is poor. Here, the use of a microfluidic system is reported for generating personalized hydrogel-based cellular microdroplets for cardiac cell delivery. To evaluate the system's limitations, a mathematical model of oxygen diffusion and consumption within the droplet is developed. Following, the microfluidic system's parameters are optimized and cardiac cells from neonatal rats or induced pluripotent stem cells are encapsulated. The morphology and cardiac specific markers are assessed and cell function within the droplets is analyzed. Finally, the cellular droplets are injected to mouse gastrocnemius muscle to validate cell retention, survival, and maturation within the host tissue. These results demonstrate the potential of this approach to generate personalized cellular microtissues, which can be injected to distinct regions in the body for treating damaged tissues.
Collapse
Affiliation(s)
- Idan Gal
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Reuven Edri
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nadav Noor
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Materials Science and Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Matan Rotenberg
- Department of Materials Science and Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michael Namestnikov
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | | | - Assaf Shapira
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tal Dvir
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Materials Science and Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol Center for Regenerative Biotechnology, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
9
|
Hoesli R, Brennan JR, Rosko AJ, Birkeland AC, Malloy KM, Moyer JS, Prince MEP, Shuman AG, Chinn SB, Stucken CL, Casper KA, Spector ME. Intraoperative Fluorescent Angiography Predicts Pharyngocutaneous Fistula After Salvage Laryngectomy. Ann Surg Oncol 2019; 26:1320-1325. [PMID: 30805812 DOI: 10.1245/s10434-019-07262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Technology to assess tissue perfusion is exciting with translational potential, although data supporting its clinical applications have been lagging. Patients who have undergone radiation are at particular risk of poor tissue perfusion and would benefit from this expanding technology. We designed a prospective clinical trial using intraoperative indocyanine green angiography to evaluate for wound-healing complications in patients undergoing salvage laryngectomy after radiation failure. PATIENTS AND METHODS This prospective trial included patients undergoing salvage laryngectomy at a National Cancer Institute-designated tertiary cancer center between 2016 and 2018. After tumor extirpation and prior to reconstruction, 10 mg indocyanine green dye was infused and the fluorescence (FHYPO) and ingress rate of the pharyngeal mucosa recorded. The primary outcome measure was formation of a pharyngocutaneous fistula (PCF). RESULTS Patients who developed a PCF had significantly lower FHYPO (87 vs 172, p < 0.001) and ingress rates (6.7 vs 15.8, p = 0.043) compared with those who did not develop a fistula. There were no fistulas in patients with FHYPO > 150 (n = 21) or ingress > 15 (n = 15). There was a 50% fistula rate in patients with FHYPO ≤ 103 (n = 10) and ingress rate ≤ 6 (n = 6). CONCLUSIONS Intraoperative indocyanine green angiography can assess hypoperfusion in patients and predict risk of PCFs after salvage laryngectomy, and can thus intraoperatively risk-stratify patients for postoperative wound-healing complications.
Collapse
Affiliation(s)
- Rebecca Hoesli
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
| |
Collapse
|
10
|
Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach. Head Neck 2018; 41:16-29. [DOI: 10.1002/hed.25192] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/03/2018] [Accepted: 03/02/2018] [Indexed: 11/08/2022] Open
|
11
|
Vidhyadharan S, Thankappan K, Janarthanan R, Balasubramanian D, Sharma M, Mathew J, Sudheer OV, Iyer S. Gastro-omental free flap for reconstruction of tongue defects. Oral Oncol 2018; 83:134-139. [PMID: 30098769 DOI: 10.1016/j.oraloncology.2018.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this paper is to report the technique and outcomes of the use of gastro-omental free flap reconstruction in glossectomy defects. MATERIALS AND METHODS This is a prospective case series of 9 patients of tongue squamous cell carcinoma, who underwent either subtotal or partial glossectomy and reconstruction with gastro-omental free flap. The flap anatomy, surgical technique and the outcomes including the swallowing and speech are presented. RESULTS Five patients underwent partial glossectomy and 4 had sub-total glossectomy. The median age was 43 years; and the median follow up was 11.4 months. Laparoscopic harvest was done in 8 patients. There was one flap loss. Seven patients underwent postoperative radiotherapy. Functional evaluation was done in 5 patients who were disease free. Four could tolerate soft diet orally, one patient was on liquid to pureed diet. Speech was intelligible in 4. None of the patients had any complications related to laparotomy or laparoscopy. CONCLUSION Gastro-omental flap provided a secretory mucosal surface and was beneficial in the saliva depleted patients post radiotherapy. The laparoscopic harvest of this flap has minimized donor site morbidity. One patient had a flap loss. Two patients reported superficial ulcerations on the surface, one of them had to undergo surgical debulking to correct it while the other healed with conservative measures. Speech and swallowing outcomes of the reconstructed tongue was good, especially in patients with partial glossectomy. The reconstructed gastric mucosal flaps tolerated the adjuvant radiation well.
Collapse
Affiliation(s)
- Sivakumar Vidhyadharan
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India.
| | - Ramu Janarthanan
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Viswha Vidyapeetham Kochi, Kerala, India
| | - Deepak Balasubramanian
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
| | - Mohit Sharma
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Viswha Vidyapeetham Kochi, Kerala, India
| | - Jimmy Mathew
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Viswha Vidyapeetham Kochi, Kerala, India
| | - Othiyil Vayoth Sudheer
- Department of Gastro - Intestinal Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
| |
Collapse
|
12
|
Rosko AJ, Birkeland AC, Bellile E, Kovatch KJ, Miller AL, Jaffe CC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME. Hypothyroidism and Wound Healing After Salvage Laryngectomy. Ann Surg Oncol 2017; 25:1288-1295. [PMID: 29264671 DOI: 10.1245/s10434-017-6278-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients undergoing salvage laryngectomy are predisposed to radiation-induced hypothyroidism and impaired wound healing secondary to the tissue effects of prior treatment. The impact of hypothyroidism on postoperative wound healing is not established. METHODS A single-institution retrospective case series was performed. The inclusion criteria specified preoperatively euthyroid adults who underwent salvage laryngectomy with concurrent neck dissection between 1997 and 2015 for persistent or recurrent laryngeal squamous cell carcinoma after radiation or chemoradiation therapy (n = 182). The principal explanatory variable was postoperative hypothyroidism, defined as thyroid-stimulating hormone (TSH) higher than 5.5 mIU/L. The primary end points of the study were pharyngocutaneous fistulas and wounds requiring reoperation. Multivariate analysis was performed. RESULTS The fistula rate was 47% among hypothyroid patients versus 23% among euthyroid patients. In the multivariate analysis, the patients who experienced hypothyroidism in the postoperative period had a 3.6-fold greater risk of fistula [95% confidence interval (CI) 1.8-7.1; p = 0.0002]. The hypothyroid patients had an 11.4-fold greater risk for a required reoperation (24.4 vs 5.4%) than the euthyroid patients (95% CI 2.6-49.9; p = 0.001). The risk for fistula (p = 0.003) and reoperation (p = 0.001) increased with increasing TSH. This corresponds to an approximate 12.5% incremental increase in the absolute risk for fistula and a 10% increase in the absolute risk for reoperation with each doubling of the TSH. CONCLUSION Postoperative hypothyroidism independently predicts postoperative wound-healing complications. The association of hypothyroidism with fistula formation may yield opportunities to modulate wound healing with thyroid supplementation or to provide a biomarker of wound progression.
Collapse
Affiliation(s)
- Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Ashley L Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Craig C Jaffe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto Health System, Toronto, ON, Canada
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
| |
Collapse
|
13
|
Hypopharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S104-S110. [PMID: 27841124 PMCID: PMC4873926 DOI: 10.1017/s0022215116000529] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With an age standardised incidence rate of 0.63 per 100 000 population, hypopharynx cancers account for a small proportion of the head and neck cancer workload in the UK, and thus suffer from the lack of high level evidence. This paper discusses the evidence base pertaining to the management of hypopharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care.
Collapse
|
14
|
Klochikhin AL, Markov GI, Chistyakov AL, Kosheleva NN. [The cross-plastic correction of the soft tissue defect on the neck with the use of a pectoral flap harvested from the opposite side]. Vestn Otorinolaringol 2016; 81:84-85. [PMID: 27876746 DOI: 10.17116/otorino201681584-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors describe a patient presenting with initially multiple metachronous cancer spreading over the right-handed side of the mouth floor and the right-handed part of the lower jaw. The patient who underwent cross-plastic surgery for the correction of the extensive soft tissue defect on the neck with the use of the musculocutaneous pectoral flap with the axial blood supply is described. The observation during the 14 year follow-up period confirmed the good functional outcome of the treatment.
Collapse
Affiliation(s)
- A L Klochikhin
- Yaroslavl State Medical University, Yaroslavl, Russia, 150000
| | - G I Markov
- Yaroslavl State Medical University, Yaroslavl, Russia, 150000
| | - A L Chistyakov
- Yaroslavl State Medical University, Yaroslavl, Russia, 150000
| | - N N Kosheleva
- Yaroslavl State Medical University, Yaroslavl, Russia, 150000
| |
Collapse
|
15
|
Soffer-Tsur N, Peer D, Dvir T. ECM-based macroporous sponges release essential factors to support the growth of hematopoietic cells. J Control Release 2016; 257:84-90. [PMID: 27671876 DOI: 10.1016/j.jconrel.2016.09.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
The success of hematopoietic stem cells (HSCs) transplantation is limited due to the low number of HSCs received from donors. In vivo, HSCs reside within a specialized niche inside the 3D porous spongy bone. The natural environment in the niche is composed of structural proteins, glycosaminoglycans (GAGs) and soluble factors that control cells fate. However, the designed scaffolds for in vitro culture do not fairly recapitulate this microenvironment and cannot efficiently control HSCs fate. Here we report on the development of new omental ECM-based 3D macroporous sponges for hematopoietic cell culture. The scaffolds' structure, porosity and stability were characterized and optimized. Analysis of the biochemical content revealed that they were composed of collagens and GAGs, including sulfated GAGs. This morphology and composition enabled growth factors interaction with the sulfated GAGs, as indicated by the high loading capacity and release profile of three different hematopoietic niche factors. Finally, the ability of the ECM-based scaffolds to efficiently support the growth of hematopoietic cells by releasing stem cell factor (SCF) was demonstrated.
Collapse
Affiliation(s)
- Neta Soffer-Tsur
- Laboratory for Tissue Engineering and Regenerative Medicine, Tel Aviv 69978, Israel; Laboratory for Precision NanoMedicine, School for Molecular Cell Biology and Biotechnology, Tel Aviv 69978, Israel
| | - Dan Peer
- Laboratory for Precision NanoMedicine, School for Molecular Cell Biology and Biotechnology, Tel Aviv 69978, Israel; Department of Materials Science and Engineering, Tel Aviv 69978, Israel; Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tal Dvir
- Laboratory for Tissue Engineering and Regenerative Medicine, Tel Aviv 69978, Israel; Department of Materials Science and Engineering, Tel Aviv 69978, Israel; Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel.
| |
Collapse
|
16
|
Mahalingam S, Srinivasan R, Spielmann P. Quality-of-life and functional outcomes following pharyngolaryngectomy: a systematic review of literature. Clin Otolaryngol 2016; 41:25-43. [DOI: 10.1111/coa.12466] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- S. Mahalingam
- University of Edinburgh; Edinburgh UK
- Department of Otolaryngology; Head and Neck Surgery; East Surrey Hospital; Redhill UK
| | - R. Srinivasan
- Department of Otolaryngology; Head and Neck Surgery; East Surrey Hospital; Redhill UK
| | - P. Spielmann
- Department of Otolaryngology; Head and Neck Surgery; East Surrey Hospital; Redhill UK
- Department of Otolaryngology; Head and Neck Surgery; Ninewells Hospital; University Department of Otolaryngology; Dundee UK
| |
Collapse
|
17
|
Soffer-Tsur N, Shevach M, Shapira A, Peer D, Dvir T. Optimizing the biofabrication process of omentum-based scaffolds for engineering autologous tissues. Biofabrication 2014; 6:035023. [DOI: 10.1088/1758-5082/6/3/035023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
18
|
Fakhry N, Chamorey E, Michel J, Collet C, Santini L, Poissonnet G, Santini J, Dessi P, Giovanni A, Dassonville O, Bozec A. Salvage Circular Laryngopharyngectomy and Radial Forearm Free Flap for Recurrent Hypopharyngeal Cancer. Laryngoscope 2013; 123:910-5. [DOI: 10.1002/lary.23781] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 08/06/2012] [Accepted: 09/17/2012] [Indexed: 11/11/2022]
|
19
|
Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg 2012; 20:77-88. [PMID: 22327791 DOI: 10.1097/moo.0b013e328350a5cc] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The present review is focused on the main reconstructive options currently used after partial or circumferential resection of the hypopharynx and cervical esophagus. The advantages and disadvantages of pectoralis major myocutaneous (PMMC) pedicled flap, fasciocutaneous free flaps as radial forearm and anterolateral thigh (ALT), and visceral free grafts like jejunum and gastro-omental are overviewed. RECENT FINDINGS For partial hypopharyngeal defects with limited extension to the cervical esophagus, no specific pedicled or free flap is deemed superior over others: the patient's body habitus and surgeon's preference remain the most important factors affecting the reconstructive choice. In contrast, after circumferential hypopharyngectomy, pharyngocutaneous fistula (PCF) and stricture rates of PMMC are higher than those obtained by free flaps. In the most recent series applying ALT and jejunum, PCF and stricture occurrence is comparable, whereas reduced mortality, overall complication rate, and donor-site morbidity of ALT and its better swallowing and speech outcomes have contributed to make this option progressively more popular. On the other hand, gastro-omental seems to offer an unparalleled amount of highly vascularized tissue to manage the difficult situation of salvage surgery after chemoradiation, even though complication rates remain not negligible and this technique has not been widely adopted. SUMMARY The reconstructive armamentarium of head and neck surgeons involved in hypopharyngeal and cervical esophagus reconstruction should encompass every option described herein in order to appropriately deal with specific clinical needs and patient requirements. However, fasciocutaneous free flaps (especially ALT) seem to play an ever greater role in restoration of pharyngoesophageal continuity.
Collapse
|
20
|
Miyamoto S, Sakuraba M, Nagamatsu S, Hayashi R. Salvage total pharyngolaryngectomy and free jejunum transfer. Laryngoscope 2011; 121:947-51. [DOI: 10.1002/lary.21742] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
21
|
Reliable option for salvage pharyngoesophageal reconstruction. Plast Reconstr Surg 2011; 127:1734-1735. [PMID: 21460683 DOI: 10.1097/prs.0b013e31820a6432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
Patel RS, Goldstein DP, Brown D, Irish J, Gullane PJ, Gilbert RW. Circumferential pharyngeal reconstruction: history, critical analysis of techniques, and current therapeutic recommendations. Head Neck 2010; 32:109-20. [PMID: 19565471 DOI: 10.1002/hed.21169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Reconstruction of circumferential pharyngeal defects following total pharyngolaryngectomy presents major challenges with respect to surgical morbidity and restoration of functional deficits, which are often made more demanding by the increasing trend to utilize primary chemoradiation protocols with surgery reserved for salvage cases. The present review evaluates the reconstructive techniques described in the literature, including historical techniques as well as more recent innovative methods. Each technique is critically appraised with particular reference to postoperative morbidity and functional rehabilitation. Treatment recommendations are made based on the available evidence.
Collapse
Affiliation(s)
- Rajan S Patel
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
23
|
Patel RS, Gilbert RW. Utility of the gastro-omental free flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2009; 17:258-62. [PMID: 19444111 DOI: 10.1097/moo.0b013e32832cba42] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the current era of organ-preservation therapies, surgical salvage and reconstruction of defects following ablation of mucosa and soft tissue in the head and neck is extremely challenging because of the toxic effects of chemoradiation and intensive radiotherapy on wounds. The anatomical, physiological and immunological properties of the gastro-omental flap make it an ideal reconstructive technique in head and neck surgery. RECENT FINDINGS Several case series published in the past 12 months highlight the utility of this flap in inhospitable wounds and particularly in restoration of circumferential pharyngeal defects. The gastro-omental flap produces satisfactory functional results and morbidity in this group of high-risk patients. SUMMARY The gastro-omental free flap provides an alternative to traditional reconstructive techniques that is ideally suited to high-risk complex wounds in the head and neck.
Collapse
Affiliation(s)
- Rajan S Patel
- Department of Otolaryngology-Head and Neck Surgery, Auckland City Hospital, University of Auckland, New Zealand.
| | | |
Collapse
|