scholarly journals Head and neck oncological reconstruction with 114 free flaps in a Portuguese tertiary cancer center

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Andreia Silva ◽  
Patrícia Caixeirinho ◽  
Miguel Vilares ◽  
Carina Semedo ◽  
Mariluz Martins ◽  
...  
Keyword(s):  
Head And Neck ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
Functional Results ◽  
Cancer Center ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Oncological Surgery ◽  
Microsurgical Reconstruction ◽  
Neck Reconstruction

Introduction: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted.Results: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived.Discussion: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world.Conclusion: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.

Anatomy, Exposure, and Preparation of Recipient Vessels in Microsurgical Head and Neck Reconstruction

2020 ◽  
Author(s):  
Hope Xu ◽  
Leila Jazayeri ◽  
Evan Matros ◽  
Peter W. Henderson
Keyword(s):  
Head And Neck ◽  
Clinical Anatomy ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Submandibular Region ◽  
Comprehensive Review ◽  
Neck Reconstruction ◽  
Posterior Triangle

AbstractSuccessful microvascular reconstruction of head and neck defects requires the ability to safely identify, isolate, and utilize recipient vessels. To date, however, a comprehensive review of the anatomy and techniques relevant to the available anatomic regions has not been undertaken. This review covers the relevant clinical anatomy of the anterior triangle, posterior triangle, submandibular region, intraoral region, preauricular region, chest, and arm, taking particular care to highlight the structures that are crucial to identify while performing each dissection. Finally, a step-by-step technique for safely dissecting the recipient vessels at each site is provided.

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.

Outcomes of Head and Neck Microvascular Reconstruction in Hypercoagulable Patients

2019 ◽  
Vol 36 (04) ◽  
pp. 271-275
Author(s):  
Trang T. Nguyen ◽  
Katie G. Egan ◽  
Danielle L. Crowe ◽  
Niaman Nazir ◽  
Wojciech H. Przylecki ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Head And Neck ◽  
Thrombotic Event ◽  
Vena Cava ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Neck Reconstruction ◽  
Flap Loss

Abstract Background Inherited coagulopathies and previous thrombotic events are often considered relative contraindications to microvascular reconstruction. We hypothesize that with planning, head and neck microvascular reconstruction can be successfully performed in hypercoagulable individuals. Methods A retrospective review was conducted of subjects with coagulopathies or previous thrombotic events who underwent microvascular head and neck reconstruction. Outcomes studied were “flap-related complications” (arterial/venous compromise or flap loss) and “patient-related complications” (hematoma, deep venous thrombosis, pulmonary embolism, infection, stroke, or death). Results One hundred thirty-four microvascular flaps were performed in 117 subjects. Twenty-four subjects (20.5%) had a preoperative hypercoagulable condition and underwent 28 microvascular reconstructions. Twenty-three of 24 subjects had a previous thrombotic event, with five subjects identified with an inherited or acquired coagulopathy. All microvascular reconstructions were successful; however, complications occurred in 12 of 28 reconstructions (42.9%). Complications were “flap related” in four reconstructions (14.3%), “patient related” in nine reconstructions (32.1%), and both in one reconstruction (3.6%). Flap-related complications included small partial flap loss (n = 2), arterial compromise (n = 1), and venous compromise (n = 1), with all undergoing successful salvage. Patient-related complications included hematoma (n = 3), pulmonary embolism (n = 2), infection (n = 2), deep venous thrombosis (n = 1), and death (n = 1). Statistical analysis demonstrated that complications were more common in subjects with inferior vena cava filters (p = 0.06) and hematomas were associated with the use of therapeutic heparin infusion (p = 0.04). Conclusion Microvascular head and neck reconstruction can be successfully performed in hypercoagulable subjects. However, patient-related complications remain a concern in these subjects.

scholarly journals AN ANALYSIS OF OUTCOME AND COMPLICATIONS OF MICROVASCULAR FREE FLAP HEAD AND NECK RECONSTRUCTION

2020 ◽  
pp. 1-3
Author(s):  
Nitin Tomar ◽  
Ayush Naik ◽  
Ashish Malviya ◽  
Abhishek Pratap Singh
Keyword(s):  
Head And Neck ◽  
Perioperative Complications ◽  
Donor Site ◽  
Wound Dehiscence ◽  
Neck Surgery ◽  
Tumor Stage ◽  
External Jugular Vein ◽  
Superior Thyroid Artery ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction

Background: Microvascular free ap transfers have become a preferred reconstructive technique; however, rare complica-tions may still prove devastating. Aim: The objective of this study was to evaluate the clinical outcomes in Head and neck cancer patients undergoing different microvascular free ap reconstructions . Materials and Methods: his study analyzed the surgical out-come and complications of 200 microvascular free aps head and neck reconstruction. In most cases, after resection of the malignant tumor, reconstruction was undertaken . Four types of free ap were performed as follows: Anterolateral thigh (80%), radial forearm (15%), bula (4%), and jejunum (1%). The most commonly used as recipient vessels for anastomosis were superior thyroid artery and the external jugular vein. The incidence of perioperative complications and Patient-related characteristics (age, sex, diagnosis, comorbidity, level, tumor stage, defect site, primary versus secondary reconstruction, and history of surgery, radiation therapy, or chemotherapy) were recorded prospectively. Observations and results: Emergency surgical re-exploration was required in nine patients and the overall ap success rate was 95.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (12.5%), wound dehiscence (15%), partial ap necrosis (2.5%), stula formation (9.5%), and bleeding (1.5%). Recipient and donor site morbidity was limited and considered acceptable. Conclusions: Micro surgical free ap is shown to be a valuable and reliable method in head and neck surgery which can be used effectively and safely with minimal morbidity in selected patients. When performed by skilled surgeon, reconstruction can be performed with acceptable outcomes and early re-exploration should be the rst choice for the management of vascular compromised aps.

Systematic Review of Supraclavicular Artery Island Flap vs Free Flap in Head and Neck Reconstruction

2018 ◽  
Vol 160 (2) ◽  
pp. 215-222 ◽  
Author(s):  
Daniel C. Sukato ◽  
Alisa Timashpolsky ◽  
George Ferzli ◽  
Richard M. Rosenfeld ◽  
Eli A. Gordin
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Operative Time ◽  
Perioperative Complications ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Island Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Supraclavicular Artery Island Flap

Objective The aim of this systematic review is to compare the surgical outcomes of supraclavicular artery island flap (SCAIF) and free tissue transfer (FTT) in head and neck reconstruction. Data Sources PubMed, Web of Science, and EMBASE databases. Review Methods Independent screening and data extraction were performed by 2 authors. Only studies that directly compared SCAIF and FTT were included. Data were pooled with random-effects meta-analysis to determine the standardized mean differences (SMDs), risk differences, and 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistics. The Methodological Index for Non-Randomized Studies tool was used to evaluate extent of bias in studies. Results The initial query yielded 661 results, of which 4 comparative studies remained for final analysis. The pooled sample sizes for the SCAIF and FTT cohorts were 100 and 84, respectively. SCAIF was associated with reduction of operative time by a large effect size (SMD, 1.65; 95% confidence interval, 0.78-2.52). The harvested flap areas and perioperative complications, including rates of total flap loss, partial flap necrosis, and recipient/donor site dehiscences, were comparable between the 2 procedures with low to high heterogeneity among studies. Conclusion SCAIF requires less operative time and has comparable short-term perioperative results to FTT. The findings of this study support the viability of SCAIF as an alternative to FTT and provide evidence for its inclusion in the reconstructive armamentarium of major head and neck ablation and trauma.

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