Higher perioperative fluid administration is associated with increased rates of complications following head and neck microvascular reconstruction with fibular free flaps

Microsurgery ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Kyle S. Ettinger ◽  
Kevin Arce ◽  
Christine M. Lohse ◽  
Brandon W. Peck ◽  
Matthew D. Reiland ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flaps ◽  
Fluid Administration ◽  
Microvascular Reconstruction ◽  
Perioperative Fluid Administration

scholarly journals Transverse cervical vascular pedicle: It's extended use as ‘second-line’ recipient vessels in thoracic and upper arm reconstructions in addition to head-and-neck reconstructions

2018 ◽  
Vol 51 (02) ◽  
pp. 182-189
Author(s):  
Srijana Muppireddy ◽  
Parvathi Ravula ◽  
Srikanth Rangachari ◽  
Najma Shaik ◽  
Sushma Maaturu
Keyword(s):  
Head And Neck ◽  
Vascular Access ◽  
Free Flaps ◽  
External Jugular Vein ◽  
Superior Thyroid Artery ◽  
Microvascular Reconstruction ◽  
Second Line ◽  
Key Factors ◽  
Upper Arm ◽  
Arterial Anastomosis

ABSTRACT Background: Selection of recipient vessels is one of the key factors for a successful microvascular reconstruction. Non-availability of primary recipient vessels in the vicinity necessitates surgeon to approach a remote second-line vascular access. Transverse cervical vessels (TCV) have been described as second-line vascular access for head-and-neck reconstructions. Due to its location, their use can be extended to the proximal chest and upper arm reconstructions. Aim: The aim of the study is to analyse the reliability of TCV as second-line recipient vessels for the upper arm and chest reconstructions in addition to the head-and-neck reconstructions. Materials and Methods: During 2010–2017, 14 TCV were explored as the choice of second-line recipient pedicle for specific indications. Clinical experience with different reconstructions discussed. Results: Out of 14 transverse cervical arteries, 13 were of adequate size for anastomosis. About 12 successful reconstructions were performed involving the head and neck (7), proximal thorax (3) and upper arm (2) for indications such as scarring from different aetiology (8), previous free flaps (2) and sacrificed vessels (2). In one case, the arterial anastomosis was shifted to superior thyroid artery. All the chest and upper arm reconstructions needed a realignment of the pedicle without any kink. Transverse cervical vein (TCv) could be used only 5/14 times either alone or along with external jugular vein (EJV). In other cases, EJV alone was used. All the 12 flaps survived without any vascular event. Conclusions: Transverse cervical vessels are reliable second-line recipient vessels in the head and neck; in addition, they are of use in the upper arm and proximal chest defects.

S171 – Head and Neck Microvascular Reconstruction: Changing Trends

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P133-P133
Author(s):  
Rene M Pena ◽  
Paul Dae-Gwon Kim ◽  
Mark R Rowe
Keyword(s):  
Head And Neck ◽  
Plastic Surgery ◽  
Surgical Techniques ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Residency Programs ◽  
Neck Reconstruction ◽  
Case Number ◽  
Microvascular Free Flaps

Objectives The practice of head and neck reconstruction has been evolving over the past 15 years with the introduction of new surgical techniques, and increasing options for tissue harvest. We sought to investigate corresponding trends in the disciplines performing head and neck microvascular reconstruction. Methods 2 specialties for the proportion of head and neck microvascular reconstruction were compared: those performed by otolaryngologists and those done by plastics surgery. A 3-part study was performed to evaluate these trends: 1) Total case number of microvascular cases of otolaryngology residents and plastic surgery residents over the last 4 years was evaluated through the ACGME national data; 2) A poll of the percentage of otolaryngology residency programs that have their own microvascular reconstructive surgeon, and if that surgeon was hired within the last 5 years; and 3) The number of scientific articles published relating to microvascular head and neck reconstruction were systematically queried for 2 timeframes, (1995–2000) and (2002–2007). Results The national number of cases has steadily increased in the last 5 years. It has slowly increased compared to plastic surgery, but when all flaps are evaluated, it is not significant. We also found that the number of peer-reviewed articles relating to microvascular free flaps authored by otolaryngologists has increased. The data from the polls are still pending. Conclusions There is an increasing trend emerging in the practice of head and neck microvascular reconstruction, with an increase number of articles being authored and increased number of surgeries being performed by otolaryngolo-gists, compared to plastic surgeons.

scholarly journals Consideration in Microvascular Reconstruction during Times of Social Crises: Perspectives on Resource Utilization

2020 ◽  
Vol 36 (06) ◽  
pp. 768-772
Author(s):  
Sean Lloyd Kent ◽  
Yohanan Kim ◽  
Hector Perez ◽  
Ethan Frank ◽  
Vance Gentry ◽  
...  
Keyword(s):  
Head And Neck ◽  
Resource Utilization ◽  
Free Flap ◽  
Cost Savings ◽  
Free Flaps ◽  
Cost Effective ◽  
Microvascular Reconstruction ◽  
Global Pandemic ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit

AbstractReconstruction of head and neck surgical defects can be a complicated, costly process. While the era of cost-effective medicine has begun to broadly question the necessity of high-cost care, times of extraordinary sociomedical demand bring increased scrutiny to even routine costs and resource utilization. Within this context, we reviewed the advantages, drawbacks, and financial costs of both regional and free flap reconstructions, namely the decreased costs and hospital resource utilization that may be associated with reconstruction using regional flaps. Although beset by reports of partial necrosis in certain regional flaps—particularly the submental island, cervicofacial advancement, and supraclavicular artery island flaps—many reports have demonstrated complication and flap failure rates equivalent to those of free flaps. Additionally, regional flaps have been associated with decreased costs for hospital stay, most notably in cases of postoperative complications. In cases necessitating free flap reconstruction, cost-savings strategies such as bypassing postoperative intensive care unit admissions have been shown to provide satisfactory, safe outcomes. As the head and neck surgeon continues to adapt to the medical pressures of a global pandemic, resource-sparing approaches to oncologic care will persist in their newfound importance.

scholarly journals Bioelectrical Impedance Analysis in Patients Undergoing Major Head and Neck Surgery: A Prospective Observational Pilot Study

2021 ◽  
Vol 10 (3) ◽  
pp. 539
Author(s):  
Sharon Tzelnick ◽  
Pierre Singer ◽  
Yoni Shopen ◽  
Limor Moshkovitz ◽  
Shlomo Fireman ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Head And Neck ◽  
Phase Angle ◽  
Bioelectrical Impedance ◽  
High Volume ◽  
Impedance Analysis ◽  
Neck Surgery ◽  
Fluid Administration ◽  
Perioperative Fluids ◽  
Perioperative Fluid Administration

Background: Head and neck patients are prone to malnutrition. Perioperative fluids administration in this patient group may influence nutritional status. We aimed to investigate perioperative changes in patients undergoing major head and neck surgery and to examine the impact of perioperative fluid administration on body composition and metabolic changes using bioelectrical impedance. Furthermore, we sought to correlate these metabolic changes with postoperative complication rate. In this prospective observational pilot study, bioelectrical impedance analysis (BIA) was performed preoperatively and on postoperative days (POD) 2 and 10 on patients who underwent major head and neck surgeries. BIA was completed in 34/37 patients; mean total intraoperative and post-anesthesia fluid administration was 3682 ± 1910 mL and 1802 ± 1466 mL, respectively. Total perioperative fluid administration was associated with postoperative high extra-cellular water percentages (p = 0.038) and a low phase-angle score (p < 0.005), which indicates low nutritional status. Patients with phase angle below the 5th percentile at POD 2 had higher local complication rates (p = 0.035) and longer hospital length of stay (LOS) (p = 0.029). Multivariate analysis failed to demonstrate that high-volume fluid administration and phase angle are independent factors for postoperative complications. High-volume perioperative fluids administration impacts postoperative nutritional status with fluid shift toward the extra-cellular space and is associated with factors that increase the risk of postoperative complications and longer LOS. An adjusted, low-volume perioperative fluid regimen should be considered in patients with comorbidities in order to minimize postoperative morbidity.

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