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Tonsbeek AM, Leidelmeijer R, Hundepool CA, Duraku LS, Van der Oest MJW, Sewnaik A, Mureau MAM. Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:1804. [PMID: 38791883 PMCID: PMC11119839 DOI: 10.3390/cancers16101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. METHODS A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. RESULTS Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23-47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. CONCLUSION Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.
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Affiliation(s)
- Anthony M. Tonsbeek
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.A.M.M.)
| | - Roxy Leidelmeijer
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.A.M.M.)
| | - Caroline A. Hundepool
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.A.M.M.)
| | - Liron S. Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Mark J. W. Van der Oest
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.A.M.M.)
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Marc A. M. Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.A.M.M.)
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Sittitrai P, Ruenmarkkaew D, Klibngern H. Pedicled Flaps versus Free Flaps for Oral Cavity Cancer Reconstruction: A Comparison of Complications, Hospital Costs, and Functional Outcomes. Int Arch Otorhinolaryngol 2022; 27:e32-e42. [PMID: 36714904 PMCID: PMC9879635 DOI: 10.1055/s-0042-1751001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 08/04/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Free flaps have been the preferred method for reconstruction after resection of oral cavity cancer. However, pedicled flaps remain valuable alternatives in appropriate settings. Objective The main objective of the present study was to compare surgical complications, hospital costs, and functional outcomes of oral cavity cancer patients who underwent soft tissue reconstruction with pedicled flaps or free flaps. Methods A total of 171 patients were included in the study. Ninety-eight underwent reconstruction with a pectoralis major, submental, temporalis, or supraclavicular pedicled flap, and in 73 patients, a radial forearm or anterolateral thigh free flap had been used. The cases were retrospectively reviewed, and a comparative analysis was carried out between the two groups. Results Recipient site and flap complications, speech, and swallowing functions did not differ between groups, but donor site complications, operative time, hospital stay, and costs were significantly reduced in the pedicled flap group compared with the free flap group. However, the pectoralis major flap reconstruction resulted in a more inferior swallowing function than the free flap reconstruction. Conclusions With comparable complications and functional outcomes, while decreasing in costs, pedicled flaps are a useful alternative to free flaps in oral cavity cancer reconstruction. However, in an extensive defect (> 70 cm 2 ), free flaps are the reconstruction of choice for the preservation of swallowing function.
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Affiliation(s)
- Pichit Sittitrai
- Department of Otolaryngology, Chiang Mai University hospital, Chiang Mai, Thailand
| | | | - Hanpon Klibngern
- Department of Otolaryngology, Chiang Mai University hospital, Chiang Mai, Thailand
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Comparison Between Radial Forearm Free Flap and Pectoralis Major Myocutaneous Flap for Reconstruction in Oral Cavity Cancer Patients: Assessment of the Quality of Life. J Craniofac Surg 2021; 33:906-909. [PMID: 34907949 DOI: 10.1097/scs.0000000000008423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT We aimed to evaluate the quality of life of Chinese patients after immediate reconstruction surgery on individuals with oral cavity cancer. In addition, we compared the differences between radial forearm free flap and pectoralis major myocutaneous flap. Using the University of Washington quality of life v4 questionnaire, 1:1 matched research was performed on patients received PMM or RFF flap. Chi-square test was used to analyze the variables. One hundred twenty four of 179 questionnaires were returned (69.3%). Age, N stage, and postoperative radiotherapy were similar for both groups. However, there were significant differences between two groups in gender, T stage, operation duration, and complication rate. Oral cavity cancer patients reconstructed with radial forearm free flap had better shoulder and speech functions but worse appearance domains. The results of our research provide important information for patients and physicians during their discussion of treatment programs for oral cavity cancers.
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Evaluating the free radial forearm flap versus the pedicled pectoralis major myocutaneous flap for oesophago-pharyngeal reconstruction: decision making, outcome and literature review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tewfik K, Chiarelli P, Copelli C, Pederneschi N, Cassano L, Manfuso A, Covelli C, Longo F. Italian cost analysis of free flap surgery in head and neck reconstruction using the activity-based costing (ABC). J Plast Reconstr Aesthet Surg 2020; 74:1279-1285. [PMID: 33279430 DOI: 10.1016/j.bjps.2020.10.096] [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: 05/01/2020] [Revised: 09/10/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022]
Abstract
The aim of the study is to evaluate costs of free flap surgery for head and neck (H & N) reconstructions using the time-driven activity-based costing (ABC) method and to compare them with the refund provided by the Italian National Health System (NHS) amounting to 11,891€. We retrospectively selected 29 consecutive patients underwent free flap reconstruction in 2013 at IRCCS Casa Sollievo della Sofferenza. Patients were divided into three groups: Group 1 (n = 10) included patients receiving radial forearm free flap (RFFF), Group 2 (n = 10) receiving anterolateral thigh (ALT) free flap, and Group 3 (n = 9) composed of patients having fibular free flap. For each patient, costs were calculated using the ABC and divided into instay, surgical, and services costs. We observed an overall mean total cost of 27,802.40€. The mean costs related to hospital stay were 9,800.70€. The mean costs for surgery were 13,097.60€ and amounted to 4,904.10€ for services. RFFF appears to be less costing (25,175.40€) compared with ALT (29,191.60€) and fibula free flap (29,040.20€). ABC is an appropriate method to determine actual costs of free flap surgery by correctly allocating the resources used. The Italian NHS tariff seems to be inadequate to cover the real cost of this type of surgery.
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Affiliation(s)
- Karim Tewfik
- Head and Neck Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
| | - Pasquale Chiarelli
- Controller, Management Control Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Chiara Copelli
- Head and Neck Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Nicola Pederneschi
- Head and Neck Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Lazzaro Cassano
- Head and Neck Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Alfonso Manfuso
- Head and Neck Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Claudia Covelli
- Pathology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesco Longo
- Head and Neck Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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6
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Optimizing value in head and neck cancer free flap surgery. Curr Opin Otolaryngol Head Neck Surg 2019; 27:413-419. [DOI: 10.1097/moo.0000000000000570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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7
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Gabrysz-Forget F, Tabet P, Rahal A, Bissada E, Christopoulos A, Ayad T. Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review. J Otolaryngol Head Neck Surg 2019; 48:13. [PMID: 30871637 PMCID: PMC6417188 DOI: 10.1186/s40463-019-0334-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The present review focuses on comparative studies of reconstruction with free flaps (FF) versus pedicled flaps (PF) after oncologic resection. Method A systematic review was developed in compliance with PRISMA guidelines and performed using the Pubmed, Medline, EMBASE, Amed and Biosis databases. Results A total of 30 articles were included. FF are associated with a longer operative time, a higher cost and a higher incidence of postoperative revisions compared to PF. FF are associated with a longer stay at the intensive care unit than the supraclavicular artery island flap (SCAIF) and with a more extended hospital stay compared to the submental island flap (SMIF). FF are associated with fewer infections and necrosis compared to the pectoralis major myocutaneous flap (PMMF). Conclusion The comparison of both type of flaps is limited by the inherent design of the studies included. In sum, FF seem superior to the PMMF for several outcomes. SMIF and SCAIF compare favorably to FF for some specific indications achieving similar outcomes at a lower cost.
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Affiliation(s)
| | - Paul Tabet
- Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
| | - Akram Rahal
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada
| | - Eric Bissada
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada. .,Department of Surgery, Centre Hospitalier de l'Université de Montréal, 900, Saint-Denis St. pavillon R, H2X 0A9, Montreal, Canada.
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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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9
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Gao LL, Basta M, Kanchwala SK, Serletti JM, Low DW, Wu LC. Cost‐effectiveness of microsurgical reconstruction for head and neck defects after oncologic resection. Head Neck 2016; 39:541-547. [DOI: 10.1002/hed.24644] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/21/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lin Lin Gao
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - Marten Basta
- Department of Plastic and Reconstructive SurgeryBrown UniversityProvidence Rhode Island
| | - Suhail K. Kanchwala
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - Joseph M. Serletti
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - David W. Low
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - Liza C. Wu
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
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Multicenter prospective micro-costing study evaluating mandibular free-flap reconstruction. Eur Arch Otorhinolaryngol 2016; 274:1103-1111. [DOI: 10.1007/s00405-016-4360-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/25/2016] [Indexed: 01/07/2023]
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Fang Z, Tian Z, Zhang C, Sun J, Hu J, He Y. Risk Factors for Pedicle Flap Complications in 251 Elderly Chinese Patients Who Underwent Oral and Maxillofacial Reconstruction. J Oral Maxillofac Surg 2016; 74:2073-80. [DOI: 10.1016/j.joms.2016.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 02/15/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
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12
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Refos JWJ, Witte BI, de Goede CJT, de Bree R. Shoulder morbidity after pectoralis major flap reconstruction. Head Neck 2016; 38:1221-8. [DOI: 10.1002/hed.24404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Joel W. J. Refos
- Department of Otolaryngology - Head and Neck Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Birgit I. Witte
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam The Netherlands
| | - Cees J. T. de Goede
- Department of Physical Therapy; VU University Medical Center; Amsterdam The Netherlands
| | - Remco de Bree
- Department of Otolaryngology - Head and Neck Surgery; VU University Medical Center; Amsterdam The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center; University Medical Center Utrecht; Utrecht The Netherlands
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Li P, Fang Q, Luo R, Zhao M, Liu S, Du W, Qi J, Lou W. Infrahyoid Myocutaneous Flap Versus Radial Forearm Free Flap in Treating Patients with cT1-2 Tongue Carcinoma. J HARD TISSUE BIOL 2015. [DOI: 10.2485/jhtb.24.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Peng Li
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Qigen Fang
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Ruihua Luo
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Ming Zhao
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Shantin Liu
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Wei Du
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Jinxing Qi
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Weihua Lou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University
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Lotter O, Townley WA, Gonser P, Schaller HE, Hoefert S. Reimbursement for reconstruction by tissue transfer-a European comparison. BMC Health Serv Res 2014; 14:427. [PMID: 25248968 PMCID: PMC4263045 DOI: 10.1186/1472-6963-14-427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 08/14/2014] [Indexed: 11/17/2022] Open
Abstract
Background Case payment mechanisms have become the principal means of remunerating hospitals in most developed countries. Our purpose was to analyse the reimbursement for different types of tissue transfer in five European countries. Methods We looked at common surgical options for pedicled and free flaps. The recipient site of a flap and the principal diagnosis were systematically modified and processed with national grouper software in order to identify Diagnosis-Related Groups from which the proceeds were derived. The primary data originated from the database of the German Institute for the Hospital Remuneration System as aggregate information. We conducted eight specialist interviews to transfer the available data into clinical practice. Data of real patients were not available and we rather simulated standard patients to avoid dilution of results. Results Altogether, payment for pedicled flaps averaged 5933€ and was 8517€ for free flaps. The comparison of both flap types within a country revealed significant differences in Germany, Austria and Sweden only (p < 0.001). Italy has the highest mean proceeds for pedicled flaps, followed by Sweden, Germany, Austria and the UK. This relationship changes for free flaps with Sweden achieving the highest payments. Overall, reimbursement conformity is higher for free flaps. Conclusions Most countries have procedure-driven payment systems for flap surgery, which additionally can strongly depend on the diagnosis. Nevertheless the latter does not always justify existing price differences. For the first time, clinical cases in tissue transfer were compared internationally. In today`s dynamic world of health care, we should observe other countries` compensation systems to identify ways of improving our own.
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Affiliation(s)
- Oliver Lotter
- Clinic for Plastic, Hand and Reconstructive Surgery, Burn and Trauma Center, Eberhard-Karls-University, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany.
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A Comparison Between the Pectoralis Major Myocutaneous Flap and the Free Anterolateral Thigh Perforator Flap for Reconstruction in Head and Neck Cancer Patients. J Craniofac Surg 2014; 25:868-71. [DOI: 10.1097/scs.0000000000000443] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Myers LL, Ahn C. Does increased free flap size in the head and neck region impact clinical outcome? J Oral Maxillofac Surg 2014; 72:1832-40. [PMID: 24768422 DOI: 10.1016/j.joms.2014.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/02/2014] [Accepted: 03/02/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE There are few studies analyzing the long-term clinical effects related to increasing the size of head and neck free tissue reconstructions. The purpose of this study was to compare long-term clinical outcomes of patients undergoing very large area (≥200 cm(2)) and large area (100 to 199 cm(2)) free tissue reconstructions of head and neck defects. PATIENTS AND METHODS Institutional review board approval was obtained before conducting this retrospective cohort study at the authors' university-based tertiary care hospitals. The authors analyzed the charts of consecutive patients with free flaps of at least 100 cm(2) treated from July 2000 to December 2011. Very large area flaps were arbitrarily defined as larger than 200 cm(2). Intraoperative variables, flap success rates, overall survival, and total hospital and intensive care unit (ICU) stays for the 2 groups were analyzed. Fisher exact tests or χ(2) tests were used for categorical variables and Student t tests were used for continuous variables. Log-rank tests were conducted to investigate whether overall survival was significantly different between the 2 groups. Statistical significance was defined as a P value less than .05. RESULTS The charts of 121 consecutive patients were analyzed. Thirty-eight patients (31%) had very large area flaps (277.1 ± 79.4 cm(2); range, 200 to 576 cm(2)) and 83 patients (69%) had large area flaps (140.1 ± 25.5 cm(2)). There was no difference between flap groups in presenting T4 stage disease (P = .448). Ninety-eight percent of the very large area flaps and 93% of the large area flaps survived. Total hospital stays for the very large area and large area flap groups were 12.8 ± 8.2 and 12.3 ± 8.3 days, respectively (P = not significant). In contrast, ICU stays were increased for the very large area flap group at 7.1 ± 7.5 versus 4.0 ± 4.0 days for the large area flap group (P = .022). The overall median patient survival for the very large area flap group was 7.6 months (95% confidence interval, 5.7-10.0) and that for the large area flap group was 8.4 months (95% confidence interval, 5.4-12.9; P = .376). CONCLUSION Performing very large area flaps for head and neck reconstruction did not negatively affect clinical outcome. Comparable success rates, total hospital stays, and overall survival can be safely achieved in this difficult patient population. More studies need to be conducted on resource usage.
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Affiliation(s)
- Larry L Myers
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Chul Ahn
- Professor, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
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Fang QG, Shi S, Li M, Zhang X, Liu FY, Sun CF. Free flap reconstruction versus non-free flap reconstruction in treating elderly patients with advanced oral cancer. J Oral Maxillofac Surg 2014; 72:1420-4. [PMID: 24613030 DOI: 10.1016/j.joms.2014.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/09/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Our goal was to evaluate whether elderly patients can benefit from free flaps. MATERIALS AND METHODS The clinical information from the included patients was reviewed, and these patients were asked to complete the University of Washington Quality of Life, version 4, questionnaire. Comparisons of the different scales between the 2 groups were performed. RESULTS The difference in the mouth-opening width before and after surgery did not differ significantly (P = .621) in the patients with and without free flap reconstruction. However, free flap placement tended to preserve the original mouth-opening width. No significant differences were found in recurrence-free survival or disease-specific survival between the 2 groups. The mean quality of life score of the 2 groups was 77.5 ± 10.4 and 72.1 ± 10.8. Significant differences were found in the chewing domain scores between the 2 groups (P = .039). Patients with free flap reconstruction tended to score better in the appearance and taste domains (P = .073 and P = .053, respectively); however, they required longer operative times, and longer postoperative hospital stays and incurred hospital costs. CONCLUSIONS Free flap reconstruction did not benefit elderly patients in mouth-opening width or survival analyses; the only quality of life domain that was significantly improved in patients undergoing free flap reconstruction was chewing. Free tissue transfer should be cautiously suggested for elderly patients with advanced oral cancer.
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Affiliation(s)
- Qi-Gen Fang
- Resident, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Shuang Shi
- Resident, Department of Pediatric Dentistry, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Mengjie Li
- Resident, Department of Endodontic Dentistry, Jilin University School of Stomatology, Dongchang District, Changchun, Jilin, People's Republic of China
| | - Xu Zhang
- Resident, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Fa-Yu Liu
- Professor, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Chang-Fu Sun
- Professor, Department Head, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China.
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Avery C. A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. Avery
- University Hospitals of Leicester; Leicester UK
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19
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Avery CME, Gandhi N, Peel D, Neal CP. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit. Int J Oral Maxillofac Surg 2013; 43:546-54. [PMID: 24220666 DOI: 10.1016/j.ijom.2013.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/04/2013] [Accepted: 10/09/2013] [Indexed: 11/26/2022]
Abstract
There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P=0.028), diabetes mellitus (P=0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P=0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P=0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005-2012) of the study period (22.2% vs. 79.8%, P=0.002, and 0% vs. 55.7%, P=0.064, respectively). There were also declines in recurrent disease (P=0.008), MRSA (P<0.001), and duration of admission (P=0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.
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Affiliation(s)
- C M E Avery
- Department of Maxillofacial Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
| | - N Gandhi
- University of Birmingham, Birmingham, UK
| | - D Peel
- Department of Clinical Oncology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - C P Neal
- Department of Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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Granzow JW, Suliman A, Roostaeian J, Perry A, Boyd JB. Supraclavicular artery island flap (SCAIF) vs free fasciocutaneous flaps for head and neck reconstruction. Otolaryngol Head Neck Surg 2013; 148:941-8. [PMID: 23554114 DOI: 10.1177/0194599813476670] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE At our institution, the supraclavicular artery island flap (SCAIF) has become a reliable option for fasciocutaneous coverage of complex head and neck (H&N) defects. We directly compare the outcomes of reconstructions performed with SCAIFs and free fasciocutaneous flaps (FFFs), which have not been reported previously. STUDY DESIGN Retrospective chart review. SETTING Tertiary academic medical center. SUBJECTS AND METHODS Retrospective review of consecutive single-surgeon H&N reconstructions using fasciocutaneous flaps over 5 years. Reconstructions were divided into 2 groups: SCAIFs and FFFs. Patient demographics, surgical parameters, and outcomes were compared statistically between groups. RESULTS Thirty-four flaps were used in H&N reconstruction (18 SCAIFs and 16 FFFs). There was no difference in patient demographics, distribution of defects, or follow-up (SCAIF 9.2 vs FFF 15.13 months, P = .65) between the 2 groups. The SCAIFs were larger than the FFFs (164.6 ± 60 vs 111 ± 68 cm(2), P < .05) and had shorter total operative times (588 ± 131 vs 816 ± 149 minutes, P < .05). Intensive care unit (ICU) length of stay was shorter for the SCAIF vs the FFF group (1.8 vs 5.6 days, P < .05). Overall morbidity was not significantly different (SCAIF 39% vs FFF 44%, P = NS). CONCLUSION The SCAIF is a technically simpler and equally reliable sensate fasciocutaneous flap for H&N reconstruction with comparable outcomes, shorter operative time, less ICU stay, and no need for postoperative monitoring when compared with using FFFs. It should be considered a first-choice reconstructive option for complex H&N defects.
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Affiliation(s)
- Jay W Granzow
- Division of Plastic & Reconstructive Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
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Tang CL, Wu YC, Lai CH, Lai CS, Lin CL, Lin SD, Chang KP. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap. J Plast Surg Hand Surg 2012; 46:335-8. [PMID: 22998147 DOI: 10.3109/2000656x.2012.718281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The pectoralis major myocutaneous pedicled flap (PMMPF) - the "workhorse" for head and neck reconstruction - is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.
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Affiliation(s)
- Chen-Ling Tang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Nguyen JT, Ashitate Y, Buchanan IA, Ibrahim AMS, Gioux S, Patel PP, Frangioni JV, Lee BT. Bone flap perfusion assessment using near-infrared fluorescence imaging. J Surg Res 2012; 178:e43-50. [PMID: 22664132 DOI: 10.1016/j.jss.2012.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/18/2012] [Accepted: 05/03/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Microsurgical vascularized bone flaps are a versatile technique for reconstructing large bone defects. However, the assessment of perfusion is challenging, because clinical examination is difficult intraoperatively and often not possible postoperatively. Therefore, it is important to develop techniques to assess the perfusion of vascularized bone flaps and potentially improve the surgical outcomes. Near-infrared (NIR) fluorescence imaging has previously been shown to provide real-time, intraoperative evaluation of vascular perfusion. The present pilot study investigated the ability of NIR imaging to assess the perfusion of vascularized bone flaps. METHODS Vascularized bone flaps were created in female Yorkshire pigs using well-established models for porcine forelimb osteomyocutaneous flap allotransplantation (n = 8) and hindlimb fibula flaps (n = 8). Imaging of the bone flaps was performed during harvest using the FLARE intraoperative fluorescence imaging system after systemic injection of indocyanine green. Perfusion was also assessed using the standard of care by clinical observation and Doppler ultrasonography. NIR fluorescence perfusion assessment was confirmed by intermittent clamping of the vascular pedicle. RESULTS NIR fluorescence imaging could identify bone perfusion at the cut end of the osteotomy site. When the vascular pedicle was clamped or ligated, NIR imaging demonstrated no fluorescence when injected with indocyanine green. With clamp removal, the osteotomy site emitted fluorescence, indicating bone perfusion. The results using fluorescence imaging showed 100% agreement with the clinical observation and Doppler findings. CONCLUSIONS Vascularized bone transfers have become an important tool in reconstructive surgery; however, no established techniques are available to adequately assess perfusion. The results of our pilot study have indicated that NIR imaging can provide real-time, intraoperative assessment of bone perfusion.
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Affiliation(s)
- John T Nguyen
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Hsing CY, Wong YK, Wang CP, Wang CC, Jiang RS, Chen FJ, Liu SA. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients – A quality of life analysis. Oral Oncol 2011; 47:522-7. [DOI: 10.1016/j.oraloncology.2011.03.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
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The Use of AlloDerm in Postmastectomy Alloplastic Breast Reconstruction: Part II. A Cost Analysis. Plast Reconstr Surg 2011; 127:2245-2254. [DOI: 10.1097/prs.0b013e3182131c6b] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinical Reliability of Radial Forearm Free-Flap Procedure in Reconstructive Head and Neck Surgery. J Craniofac Surg 2011; 22:822-5. [DOI: 10.1097/scs.0b013e31820f36aa] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kruse AL, Luebbers HT, Obwegeser JA, Bredell M, Grätz KW. Evaluation of the pectoralis major flap for reconstructive head and neck surgery. HEAD & NECK ONCOLOGY 2011; 3:12. [PMID: 21352590 PMCID: PMC3056835 DOI: 10.1186/1758-3284-3-12] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/27/2011] [Indexed: 11/29/2022]
Abstract
Purpose The pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery. Patients and methods The records of all patients treated with a PMMF between 1998 and 2009 were systematically reviewed. Data of recipient localization, main indication, and postoperative complications were analyzed. Results The male to female ratio was 17:3, with a mean age of 60 years (45-85). Indications in 7 patients were recurrence of a squamous cell carcinoma, in one case an osteoradionecrosis and in 12 cases an untreated squamous cell carcinoma. In 6 male patients (30%), a complication appeared leading to another surgery. Conclusion The PMMF is a flap for huge defects in head and neck reconstructive surgery, in particular when a bulky flap is needed in order to cover the carotid artery or reconstructive surgery, but the complication rate should not be underestimated in particular after radiotherapy.
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Affiliation(s)
- Astrid L Kruse
- Department of Craniomaxillofacial and Oral Surgery, University of Zurich, Switzerland.
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Avery C, Crank S, Neal C, Hayter J, Elton C. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol 2010; 46:829-33. [DOI: 10.1016/j.oraloncology.2010.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 11/15/2022]
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The changing role of pectoralis major flap in head and neck reconstruction. Eur Arch Otorhinolaryngol 2010; 267:1759-63. [DOI: 10.1007/s00405-010-1271-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
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Suzuki H, Matsuura K, Hiraki N, Kadokawa Y, Hashida K, Udaka T, Nagatani G. Digastric muscle sew-up procedure for the repair of the floor of the mouth following pull-through operation for oral cancers. Ann Otol Rhinol Laryngol 2008; 117:745-8. [PMID: 18998502 DOI: 10.1177/000348940811701007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We report the digastric muscle sew-up procedure for the repair of the floor of the mouth following the pull-through operation for advanced oral cancers. METHODS Eleven patients with advanced oral cancers (of the tongue in 8 cases and of the floor of the mouth in 3 cases) were retrospectively analyzed. One-third glossectomy and hemiglossectomy were performed in 4 patients each; the other 3 patients underwent tumor resection on the floor of the mouth. After neck dissection and tumor resection via the pull-through approach, the floor of the mouth was repaired simply by sewing the digastric muscle to the mandibular base. The surfaces of the transected musculature of the tongue and the floor of the mouth were left uncovered and exposed to the oral cavity. RESULTS The postoperative wound healing was fairly good in all of the patients. Neck infection or the formation of a fistula on the floor of the mouth was not seen. The patients started transoral ingestion by the 10th postoperative day. Temporary difficulty in swallowing occurred in all patients, but was totally alleviated within 1 month. Their clarity of speech recovered to a tolerable level. CONCLUSIONS We believe that the digastric muscle sew-up procedure is a simple, safe, and timesaving method for the repair of small to medium-sized defects of the floor of the mouth created by ablative surgery in patients with advanced oral cancers.
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Affiliation(s)
- Hideaki Suzuki
- Dept of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2008; 16:394-7. [PMID: 18626261 DOI: 10.1097/moo.0b013e32830c1edc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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