Intraoral Hirudotherapy for Venous Congestion following Free Flap Head and Neck Reconstruction: Novel Intraoral Technique

ORL ◽  
2021 ◽  
pp. 1-4
Author(s):  
Ameen Amanian ◽  
Oleksandr Butskiy ◽  
Kevin Zhao ◽  
Donald W. Anderson
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Venous Congestion ◽  
Healthcare Team ◽  
Head And Neck Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Healthcare Teams ◽  
Neck Reconstruction ◽  
Novel Technique

Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free flap reconstruction. Many institutions and healthcare teams have been reluctant to use intraoral leech therapy due to risks such as migration into the airway, increased infection from intraoral manipulation, and patient discomfort. Several protocols recommend blocking the path to the oropharynx via gauze or leaving a tracheotomy in place to protect the airway. This report pre­sents a novel technique for intraoral hirudotherapy that is safe and simple for treatment of free flap venous congestion. The base of a clear cup or a plastic lid is utilized, and the leech is attached onto the inside of the lid with 2 sutures near each end. Several cups with leeches attached are made at a time to reduce delay and difficulty of application by less experienced clinical staff. The leech is then applied onto the compromised flap and then simply removed once it has unlatched from the flap. This method allows the leech to be applied with ease by multiple members of the healthcare team, decreases the need for intraoral manipulation, and reduces the risk of migration into the aerodigestive tract. Future prospective studies are warranted to assess the efficacy of this technique.

S147 – Pectoralis Major Flaps: A Workhorse in Today's Free Flap Era

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P125-P126
Author(s):  
Barrie Yau-Boon Tan ◽  
Mark Khoo
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Wound Dehiscence ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Recipient Site ◽  
Neck Reconstruction ◽  
Flap Failure

Objectives To study the use, complication rate, and efficacy of pedicled local regional flaps for head and neck reconstruction, and to compare these results with those of microvascular free flap reconstruction. Methods Retrospective analysis of all head and neck oncologic resections requiring flap reconstruction in a tertiary head and neck surgery centre over a 6-year period from 2001–2007. Results In total, 77 operations with flap reconstruction were performed. 44 resections employed pedicled locoregional flaps, comprising 33 pectoralis major, 3 trapezius, 3 cervical rotation, 1 deltopectoral, 1 temporalis muscle, 2 nasolabial, 1 cheek rotation, and 2 bilobed rotation flaps. 2 patients had a combination of 2 regional flaps. There was 1 flap failure. Minor complications occurred in 25% of patients comprising wound seromas (3), wound dehiscence (6), fibrotic band formation (1) and pharyngocutaneous fistula (1). 33 resections employed free flap microvascular reconstructions, comprising 22 free radial forearm, 7 free rectus abdominis, 1 free jejunal, 1 free fibular, and 2 anterolateral thigh flaps. There was 1 flap failure. Minor complications occurred in 33% of patients, comprising donor site wound dehiscence (4), recipient site wound dehiscence or seroma (4), plate extrusion (1), abscess and wound breakdown (2). Conclusions Despite the ready access to free flap reconstruction today, pedicled flaps, especially the pectoralis major flap, remain a major workhorse in head and neck reconstruction. They are hardy, reliable, cost-effective, and can be done in a short operative time. Moreover, for several regions, the functional outcome is no worse than free flap reconstruction.

Octogenarian Free Flap Reconstruction: Complications and Cost of Therapy

2002 ◽  
Vol 126 (3) ◽  
pp. 301-306 ◽  
Author(s):  
Keith E. Blackwell ◽  
Babak Azizzadeh ◽  
Carlos Ayala ◽  
Jeffrey D. Rawnsley
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Tertiary Care ◽  
Medical Complications ◽  
Head And Neck Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Younger Patients ◽  
Neck Reconstruction ◽  
The Cost

OBJECTIVE: The study goal was to document the reliability, incidence of complications, and cost of therapy for patients older than 80 years who undergo microvascular head and neck reconstruction. PATIENTS AND METHODS: Thirteen octogenarians underwent free flap reconstruction of defects resulting from the treatment of head and neck cancer at an academic tertiary care medical center. The incidence of medical and reconstructive complications and the cost of hospitalization were compared with those for 99 younger patients who were treated during the same time period. RESULTS: There were no cases of free flap failure or significant reconstructive complications in the octogenarians. The incidence of medical complications was 62% in the octogenarians and 15% in the younger patients. The average cost of therapy was $54,702 per octogenarian patient compared with $30,397 per younger patient. The increased incidence of medical complications and increased cost arose primarily from an increased severity of preoperative systemic illness in the octogenarians. However, controlling for comorbidity did not eliminate the discrepancy in medical complications between the octogenarians and the younger patients. CONCLUSIONS: Although microvascular head and neck reconstruction in the elderly is very reliable, the incidence of medical complications and the cost of therapy are significantly increased in octogenarians.

Recipient vessel selection for multiple free flap transfers in head and neck reconstruction at different periods

Microsurgery ◽  
2021 ◽  
Author(s):  
Chih‐Sheng Lai ◽  
Ching‐Hui Shen ◽  
Yi‐Ting Chang ◽  
Shih‐An Liu ◽  
Chen‐Te Lu ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Recipient Vessel ◽  
Neck Reconstruction ◽  
Selection For

Fatty tissue atrophy of free flap used for head and neck reconstruction

Microsurgery ◽  
2010 ◽  
Vol 31 (1) ◽  
pp. 32-35 ◽  
Author(s):  
Masaki Fujioka ◽  
Kana Masuda ◽  
Yoshinobu Imamura
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Fatty Tissue ◽  
Neck Reconstruction

Free Flap Reconstruction in the Head and Neck. Indications, Technical Aspects and Outcomes

2014 ◽  
Vol 65 (1) ◽  
pp. 33-42
Author(s):  
José Luis Llorente ◽  
Fernando López ◽  
Vanessa Suárez ◽  
Ángel Fueyo ◽  
Susana Carnero ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Technical Aspects

Free flap head and neck reconstruction: Feasibility in older patients

2019 ◽  
Vol 10 (4) ◽  
pp. 577-583 ◽  
Author(s):  
Aurélie Parsemain ◽  
Pierre Philouze ◽  
Pierre Pradat ◽  
Philippe Ceruse ◽  
Carine Fuchsmann
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Older Patients ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction
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