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Krishna D, Khan MM, Dubepuria R, Chaturvedi G, Cheruvu VPR. Reconstruction of Scalp and Forehead Defects: Options and Strategies. Cureus 2023; 15:e41479. [PMID: 37551215 PMCID: PMC10404163 DOI: 10.7759/cureus.41479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Background Aesthetic reconstruction of scalp and forehead defects with local flaps and minimal donor site morbidity is the primary goal of coverage. While selecting the coverage technique, essential factors such as size, location, and components of a defect, hair-bearing or non-hair-bearing nature of skin, status of the exposed skull, need for radiation, patient condition, availability of local tissue, and the potential for hairline distortion should be kept in mind. Materials and methods This is a retrospective analysis in which 54 patients who underwent soft tissue reconstruction of the scalp and forehead defects were included. The defect size was categorized into four groups: small: <4 cm2, medium: 4-50 cm2, large: 50-200 cm2, and very large: >200 cm2. Reconstruction of all defects was done according to the defect's size, location, and depth. All patients were regularly followed at intervals of two weeks, six weeks, and three months, respectively. The outcome was evaluated in terms of flap survival, flap coverage scale, the requirement of secondary treatment, postoperative complications, and final aesthetic appearance. Results In 54 consecutively treated patients with scalp and forehead defects, the male-to-female ratio was 2:1, and the overall mean age of participants was 34.8 years, ranging from 0.5 to 66 years. The most common etiology of the defect was trauma (16; 29.6%), and the most common location of the defect was combined (16; 29.6%). Rotation flap and primary closure were the most commonly performed procedure, each 12 (22.2%) in number. Out of 12 primary closure cases, two patients developed wound dehiscence because of infection. All cases of skin grafting healed well. All cases of transposition flap with skin grafting at the donor site went uneventful, and the dog ear at the base was revised later. One case of the bipedicle flap in which partial graft loss occurred at the donor area was managed with regrafting. Two cases of single rotation flap, one double rotation flap, and one free latissimus dorsi muscle flap developed distal necrosis. The excellent aesthetic outcome was found in all cases of primary closure and single and double rotation flaps. Conclusions Local flaps have an architecture similar to the recipient site, and low donor site morbidity results in an aesthetically more pleasant outcome. In our experience, scalp defects up to 50 cm2 were covered with the local scalp flaps with primary closure of the donor area. Defects ranging from 50 to 200 cm2 required local scalp flap with skin grafting at the donor area. Free tissue transfers are usually needed when the defect is very large, devoid of the periosteum, or with the calvarial defect.
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Affiliation(s)
- Deepak Krishna
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Manal M Khan
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Rahul Dubepuria
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Gaurav Chaturvedi
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ved Prakash Rao Cheruvu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Nieminen T, Tolvi M, Lassus P, Wilkman T, Lehtonen L, Mäkitie A. Risk factors for evaluating early mortality after microvascular reconstruction of head and neck cancers. Scand J Surg 2022; 111:83-91. [PMID: 36000730 DOI: 10.1177/14574969221117010] [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
BACKGROUND Free tissue transfer reconstruction carries significant complication rates in surgical head and neck oncology. A registry-based approach offers a possibility to investigate the factors affecting increased morbidity and early mortality, that is, death within 6 months of treatment. METHODS A retrospective registry review was conducted on a series of 317 consecutive microvascular free tissue transfers in head and neck cancer patients performed during 2013-2017 at the Helsinki University Hospital (Helsinki, Finland). All surviving patients had a minimum follow-up of 2 years (range 24-84 months). RESULTS Overall, 36 (11.4%) early deaths occurred in this series. In multivariable logistic regression analysis, patients aged 75 years and older (p = 0.019), Adult Comorbidity Evaluation-27 (ACE-27) score of 3 (p = 0.048), tumor class T3 (p = 0.005), lymph node class N2 (p = 0.014), or thrombocyte count of 360 (× 109 L) or more (p = 0.001) were more likely to die within 6 months of surgery. Of these 36 patients, 27 (75%) had a complication warranting hospital care and most (n = 22, 61%) had several complications. CONCLUSIONS Early postoperative mortality most frequently affects patients aged 75 years and above, with a high ACE-27 score, advanced tumor stage, or high thrombocyte count. Therefore, preoperative assessment and patient selection should have a crucial role in this patient population.
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Affiliation(s)
- Teija Nieminen
- Division of Anaesthesiology, Department of Anaesthesiology Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, P.O. Box 340, 00029 HUS Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine,University of Helsinki, Helsinki, Finland
| | - Morag Tolvi
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Patrik Lassus
- Patrik Lassus Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tommy Wilkman
- Tommy Wilkman Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland Department of Oral and Maxillofacial Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lasse Lehtonen
- HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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de Berker HT, Čebron U, Bradley D, Patel V, Berhane M, Almas F, Walton G, Eshete M, McGurk M, Martin D, Honeyman C. Outcomes of microsurgical free tissue transfer performed on international surgical collaborations in low-income and middle-income countries: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2049-2063. [PMID: 35490120 DOI: 10.1016/j.bjps.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/19/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Microsurgical free tissue transfer is the gold standard for reconstruction of significant soft tissue and bony defects following cancer resection and trauma. Many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources or training required to perform microsurgical procedures. Long-term international collaborations have been formed with annual reconstructive programmes conducting microsurgery. AIMS To critically analyze outcomes of microsurgical free tissue transfer performed on international reconstructive collaborations in LMICs. METHODS PRISMA-compliant systematic review and meta-analysis of outcomes for free tissue transfer performed during international collaborations in LMICs using an inverse variance model. The study protocol was published prospectively and registered with PROSPERO (ID: CRD42021225613). RESULTS Seven studies, included 290 flaps on 284 patients. The most common sites requiring reconstruction were Head and neck (53% (n = 153)) and lower limb (7.9% (n = 23)) were lower limb reconstruction. The most common free flaps were radial forearm (22%; n = 64) and anterolateral thigh (18%; n = 51). Total Flap Failure rate was 3.8% (n = 13; 95% confidence interval (CI) = 1.9-6.3%) Overall complication rate was 38% (95% CI =27-48%), with 19% of flaps requiring emergency return to theatre (95% CI =14-26%). Flap salvage was successful in 52% of take-backs (95% CI =15% - 88%). CONCLUSIONS Free flaps performed during international surgical collaborations in LMICs have comparable failure rates to those performed in higher-income settings. However, there are higher complication and take-back rates. This should be taken into account when planning international collaborations. These results should help preoperative counselling and the consent process.
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Affiliation(s)
- Henry T de Berker
- Department of Plastic Surgery, Royal Preston Hospital, Preston, United Kingdom.
| | - Urška Čebron
- Department of Hand, Plastic, Reconstructive and Burn Surgery, University of Tübingen, Tübingen, Germany
| | - Daniel Bradley
- King's College London, Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Tower, Guy's Hospital, London, United Kingdom
| | - Vinod Patel
- Oral Surgery Department, Guy's Dental Institute, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Meklit Berhane
- Department of Plastic and Reconstructive Surgery, ALERT Hospital, Addis Ababa, Ethiopia
| | - Fernando Almas
- Department of Cranio-Maxillofacial and Reconstructive Surgery, Saint Judes General Hospital, Federal Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gary Walton
- Department of Head and Neck Surgery, University Hospitals Coventry and Warwickshire, United Kingdom
| | - Mekonen Eshete
- Department of Surgery, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Mark McGurk
- Department of Head and Neck Surgery, University College London Hospital, London, United Kingdom
| | | | - Calum Honeyman
- Canniesburn Plastic Surgery and Burns Unit, Glasgow, Scotland, United Kingdom
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Malahias M, Ackling E, Zubair O, Harper N, Al-Rawi H, Khalil H. Extended Scalp Flaps for Extensive Soft Tissue Scalp Defects as a Day Surgery Procedure Under Local Anesthetic: A Single Centre Experience. J Neurol Surg B Skull Base 2021; 82:689-694. [PMID: 34745838 DOI: 10.1055/s-0040-1715560] [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: 12/04/2019] [Accepted: 06/22/2020] [Indexed: 10/22/2022] Open
Abstract
Background Cutaneous malignancies are on the rise, associated with an increased number in scalp cancers that require wide local excision (WLE) to ensure clearance; the inelastic nature of the scalp poses a particular challenge when dealing with such large defects. Case presentation A series of 68 cases with large scalp defects following WLE for the clearance of squamous cell carcinoma, atypical fibroxanthoma, dermatofibrosarcoma protuberans, and melanoma skin cancers are presented. These cases were treated in one center under local anesthesia and underwent extended scalp flaps to close the resulting defect primarily without the use of skin grafts for the flap donor site on the scalp. Conclusion Extended scalp flap is a safe and reproducible solution for extensive scalp defects, which results in quicker wound healing with cosmetically superior results, and can be performed safely and comfortably under local anesthesia in the day case setting.
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Affiliation(s)
- Marco Malahias
- Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Edward Ackling
- Department of Trauma & Orthopaedic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Omer Zubair
- Department of Trauma & Orthopaedic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Natasha Harper
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Haytham Al-Rawi
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Haitham Khalil
- Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Mortality Within 30 Days After Head and Neck Free Flap Reconstruction: A Systematic Review. J Craniofac Surg 2021; 32:1738-1741. [PMID: 34081420 DOI: 10.1097/scs.0000000000007548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of this systematic review is to analyze the 30-day postoperative mortality in patients undergoing free flap reconstruction for head and neck cancer published in literature and to identify associated factors. METHODS The authors performed a literature search between January 1950 and February 2020 in PubMed, EMBASE, and Scopus, using a combination of Medical Subject Headings headings and text keywords related to head and neck cancer; microsurgery or free flap reconstruction; and 30-day mortality. Inclusion criteria were: original studies in English reporting on 30-day mortality after head and neck free flap reconstruction in adult population. RESULTS Thirty-one publications reported on a total of 13,447 patients who underwent head and neck free flap reconstruction. The published 30-day postoperative mortality ranged from 0% to 6.3%, with an average of 1.21%. A number of studies examined the association between mortality and body mass index, American Society of Anesthesiologists, and comorbidity score and age. One study found that underweight patients had significantly higher mortality. Two studies found no association between the American Society of Anesthesiologists score and 30-day postoperative mortality; however, 1 study reported significantly higher mortality with increased comorbidity score. Regarding association with age, 3 studies found significant higher mortality in older patients, while 5 studies found no difference. CONCLUSIONS The average 30-day postoperative mortality in patients undergoing head and neck free flap reconstruction is 1.21% and is; therefore, not negligible. Careful patient selection and preoperative optimization are essential in order to reduce mortality in head neck free flap reconstruction.
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Ali B, Choi EE, Barlas V, Petersen TR, Menon NG, Morrell NT. Risk Factors for 30-Day Mortality After Head and Neck Microsurgical Reconstruction for Cancer: NSQIP Analysis. OTO Open 2021; 5:2473974X211037257. [PMID: 34616994 PMCID: PMC8489772 DOI: 10.1177/2473974x211037257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To identify the incidence and risk factors for 30-day postoperative mortality after microsurgical head and neck reconstruction following oncological resection. STUDY DESIGN Retrospective case-control study. SETTING American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. METHODS Microsurgical head and neck reconstructive cases were identified from 2005 to 2018 using Current Procedural Terminology codes and oncologic procedures using the International Classification of Disease 9 and 10 codes. The outcome of interest was 30-day mortality. RESULTS The 30-day postoperative mortality rate was 1.2%. Univariate logistic regression analysis identified the following associations: age >80 years, hypertension, poor functional status, preoperative wound infection, renal insufficiency, malnutrition, anemia, and prolonged operating time. Multivariable logistic regression models were used to stratify further by the degree of malnutrition and anemia. Hematocrit <30% was found to be an independent risk factor for 30-day postoperative mortality (odds ratio [OR] = 9.59, confidence interval [CI] 2.32-39.65, P < .1) with albumin <3.5 g/dL. This association was even stronger with albumin <2.5 g/dL (OR = 11.64, CI 3.06-44.25, P < .01). One-third of patients (36.6%) had preoperative anemia, of which less than 1% required preoperative transfusion, although one-quarter (24.6%) required intraoperative or 72 hours postoperative transfusion. CONCLUSIONS Preoperative anemia is a risk factor for 30-day postoperative mortality. This association seems to get stronger with worsening anemia. Identification and optimization of such patients preoperatively may mitigate the incidence of 30-day postoperative mortality.
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Affiliation(s)
- Barkat Ali
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - EunHo Eunice Choi
- Biostatistics, Epidemiology, and Research Designs, Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Venus Barlas
- University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
| | - Timothy R. Petersen
- Department of Anesthesia and Critical Care, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Nathan G. Menon
- Department of Orthopedics, Hand, and Microsurgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Nathan T. Morrell
- Department of Orthopedics, Hand, and Microsurgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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7
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Shinde A, Jones B, Luu M, Li R, Glaser S, Massarelli E, Freeman M, Gernon T, Maghami E, Kang R, Zumsteg Z, Karam SD, Amini A. Factors predictive of 90-day mortality after surgical resection for oral cavity cancer: Development of a recursive partitioning analysis for risk stratification. Head Neck 2021; 43:2731-2739. [PMID: 34013577 DOI: 10.1002/hed.26740] [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: 11/05/2020] [Revised: 02/08/2021] [Accepted: 05/04/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Factors that influence postoperative mortality (POM) have been identified, but a predictive model to guide clinicians treating oral cavity cancer (OCC) has not been well established. METHODS Patients with OCC undergoing upfront surgical resection were included. Primary outcome was 90-day POM (90dPOM). RESULTS 33 845 were identified using the National Cancer Database. Rate of 90dPOM was 3.2%. Predictors of higher 90dPOM include older age, higher comorbidity scores, nonprivate insurance, lower income, treatment in an academic facility, higher T- and N-classification, radical excision, and presence of positive margins. On RPA, two high-risk (90dPOM > 10%) patient subsets were identified: patients ≥80 years of age with T3-4 disease and patients <80 years, with any comorbidity and T3-4, N2-3 disease. CONCLUSIONS We identified a subset of patients in this cohort who are at high risk for 90dPOM. These patients may warrant additional perioperative and postoperative monitoring in addition to better preoperative assessment and screening.
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Affiliation(s)
- Ashwin Shinde
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Michael Luu
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Erminia Massarelli
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Morganna Freeman
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Thomas Gernon
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Ellie Maghami
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Robert Kang
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Zachary Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
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8
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Kainulainen S, Aro K, Koivusalo AM, Wilkman T, Roine RP, Aronen P, Törnwall J, Lassus P. Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery. J Oral Maxillofac Surg 2020; 78:1835-1845. [DOI: 10.1016/j.joms.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 12/15/2022]
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Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3018. [PMID: 32983776 PMCID: PMC7489632 DOI: 10.1097/gox.0000000000003018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated.
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10
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Imai T, Asada Y, Morita S, Saijo S, Fujii K, Kishimoto K, Yamazaki T, Goto T, Matsuura K. Preoperative prognostic nutritional index as a method to predict postoperative complications after major head and neck surgery with free tissue transfer reconstruction. Jpn J Clin Oncol 2019; 50:29-35. [DOI: 10.1093/jjco/hyz133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/03/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Head and neck (H&N) cancer patients are often malnourished and have diminished immunity. H&N surgery with free tissue transfer reconstruction (HNS-FTTR) is associated with a relatively high incidence of postoperative complications.
Methods
Associations between possible risk factors and postoperative Clavien–Dindo (C–D) grades ≥ II and ≥ IIIa wound healing- or infection-related complications, postoperative overall complications and prolonged hospital stay were investigated in 188 patients who underwent HNS-FTTR during 2014–2018. The preoperative prognostic nutritional index (PNI) was calculated using the serum albumin level and total lymphocyte count.
Results
C–D ≥ II and ≥ IIIa complications were seen in 66 (35.1%) and 37 (19.7%) patients, respectively. Multivariate analysis showed that (i) previous irradiation was significantly associated with C–D ≥ II wound healing- or infection-related complications and prolonged hospital stays [odds ratio (OR) 3.096 and 3.328; P = 0.007 and 0.008, respectively]; and (ii) operation time of ≥9 h 20 min was a significant risk factor for C–D ≥ IIIa wound healing- or infection-related complications, and C–D ≥ IIIa overall complications (OR 2.987 and 2.257; P = 0.021 and 0.047, respectively). (3) Only preoperative PNI ≤ 40 was associated with all occurrences of C–D ≥ II and ≥ IIIa wound healing- or infection-related complications, C–D ≥ II and ≥ IIIa overall complications, and prolonged hospital stays (OR 3.078, 2.918, 2.627, 3.132 and 3.116; P = 0.020, 0.046, 0.036, 0.023 and 0.025, respectively).
Conclusions
PNI, easily calculated, was the lone risk factor significantly predicting all C–D ≥ II and ≥ IIIa postoperative wound healing- or infection-related complications, C–D ≥ II and ≥ IIIa postoperative overall complications and prolonged hospital stay after HNS-FTTR.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Sinkichi Morita
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Satoshi Saijo
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Keitaro Fujii
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kazuhiro Kishimoto
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Tomoko Yamazaki
- Department of Head and Neck Medical Oncology, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Takahiro Goto
- Department of Plastic and Reconstructive Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center East, Kashiwa, Chiba, Japan
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11
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Lahtinen S, Koivunen P, Ala-Kokko T, Kaarela O, Ohtonen P, Laurila P, Liisanantti J. Short- and long-term mortality and causes of death after reconstruction of cancers of the head and neck with free flaps. Br J Oral Maxillofac Surg 2019; 57:21-28. [DOI: 10.1016/j.bjoms.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
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12
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Imai T, Kurosawa K, Yamaguchi K, Satake N, Asada Y, Matsumoto K, Morita S, Saijo S, Aoi J, Fujii K, Kishimoto K, Goto T, Matsuura K. Enhanced Recovery After Surgery program with dexamethasone administration for major head and neck surgery with free tissue transfer reconstruction: initial institutional experience. Acta Otolaryngol 2018; 138:664-669. [PMID: 29385889 DOI: 10.1080/00016489.2018.1429651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Enhanced Recovery After Surgery (ERAS) protocols promote recovery after various invasive surgeries. Likewise, preoperative glucocorticoid administration can reduce complications after some surgeries. However, the effects of ERAS protocols and glucocorticoid administration in patients undergoing major surgery for head and neck cancer have not been well described. The aim of this study was to evaluate the effect of an ERAS protocol with preoperative glucocorticoid administration in major surgery for head and neck cancer. METHODS This retrospective study included 28 patients who underwent major head and neck surgery with free tissue transfer reconstruction at our institution from September 2016 to May 2017, after implementation of an ERAS protocol with preoperative glucocorticoid administration. Outcomes in that group were compared with those in a control group that underwent surgery from January 2015 to September 2016, before implementation of the protocol. RESULTS Analysis revealed significantly less body weight fluctuation, lower C-reactive protein levels, higher albumin levels, and lower body temperature in the ERAS group than in the control group postoperatively. CONCLUSIONS Patients undergoing major surgery for head and neck cancer who were treated with the ERAS protocol and preoperative glucocorticoid administration had evidence of better hemodynamic stability and less inflammatory response than control patients.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Koreyuki Kurosawa
- Department of Plastic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kayo Yamaguchi
- Department of Nursing, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Naoko Satake
- Department of Nursing, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Ko Matsumoto
- Department of Diagnostic Radiology, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Sinkichi Morita
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Satoshi Saijo
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Jiro Aoi
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Keitaro Fujii
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kazuhiro Kishimoto
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Takahiro Goto
- Department of Plastic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
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13
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Miyamoto S, Higashino T, Sakuraba M. Mandibular reconstruction in elderly patients. J Surg Oncol 2018; 117:1744-1751. [PMID: 29761514 DOI: 10.1002/jso.25059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/08/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The choice of reconstructive technique for a segmental mandibular defect in elderly patients is controversial. The aim of this study was to establish an algorithm for selecting a method of mandibular reconstruction in elderly patients. METHODS We retrospectively evaluated 121 patients aged ≥65 years who underwent immediate microvascular mandibular reconstruction after oncologic resection. Patients were divided into three groups based on method of reconstruction: vascularized bone graft (n = 49), mandibular reconstruction plate and soft tissue flap (n = 22), and soft-tissue flap (n = 50). We compared perioperative outcomes among groups and investigated factors affecting the choice of reconstructive technique. RESULTS Rates of postoperative complications did not differ significantly among groups. Mandibular reconstruction plate was indicated only for anterior mandibular defects. Soft-tissue flap was indicated for posterior mandibular defects in patients aged ≥75 years or with a poor postoperative Eichner index. CONCLUSIONS Mandibular reconstruction plate and soft-tissue flap can be good alternatives to vascularized bone graft in the elderly. Our algorithm uses defect type, patient age, and postoperative Eichner index to determine reconstructive technique.
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Affiliation(s)
- Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takuya Higashino
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Minoru Sakuraba
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan
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Iida T, Yoshimatsu H, Yamamoto T, Koshima I. A pilot study demonstrating the feasibility of supermicrosurgical end-to-side anastomosis onto large recipient vessels in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2016; 69:1662-1668. [DOI: 10.1016/j.bjps.2016.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 12/26/2022]
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15
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Costa DJ, Walen S, Varvares M, Walker R. Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects. J Neurol Surg B Skull Base 2015; 77:32-7. [PMID: 26949586 DOI: 10.1055/s-0035-1556874] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 05/14/2015] [Indexed: 10/23/2022] Open
Abstract
Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent anatomy of the scalp presents challenges and may limit reconstructive options. Objective To describe and investigate the scalp rotation flap as a reconstructive technique for complex soft tissue defects. Design Retrospective case series with a mean follow-up of 13 months. Setting Tertiary academic center. Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation flap reconstruction. Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane. The flap is rotated into the defect, and a split-thickness skin graft is placed over the donor site periosteum. Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient satisfaction with cosmetic outcome. Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification was 2.8. Mean defect size was 41 cm(2) (range: 7.8-120 cm(2)), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was 181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications. Three patients with previous radiation therapy had distal flap necrosis. Twenty-one patients (95%) reported an acceptable cosmetic result. Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex soft tissue defects. This can be particularly important in patients with significant medical comorbidities who cannot tolerate a lengthy operative procedure.
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Affiliation(s)
- Dary J Costa
- Department of Otolaryngology, Saint Louis University School of Medicine, St. Louis, Missouri, United States; Department of Otolaryngology, Cardinal Glennon Children's Medical Center, St. Louis, Missouri, United States
| | - Scott Walen
- Department of Otolaryngology, Saint Louis University School of Medicine, St. Louis, Missouri, United States
| | - Mark Varvares
- Department of Otolaryngology, Saint Louis University School of Medicine, St. Louis, Missouri, United States
| | - Ronald Walker
- Department of Otolaryngology, Saint Louis University School of Medicine, St. Louis, Missouri, United States
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