scholarly journals Use of free microvascular flaps in the management of the head and neck defects

2006 ◽  
Vol 63 (8) ◽  
pp. 713-720 ◽  
Author(s):  
Zivorad Nikolic ◽  
Jelena Jeremic ◽  
Radoje Milosavljevic
Keyword(s):  
Head And Neck ◽  
Gold Standard ◽  
Clinical Observation ◽  
Clinical Results ◽  
Test Results ◽  
Flap Necrosis ◽  
Free Flap Reconstruction ◽  
Microsurgical Reconstruction ◽  
Flap Viability ◽  
Patient Series

Background/aim: In the field of contemporary head and neck reconstructive surgery, free vascularized tissue transfer is becoming a gold standard. The aim of this study was to review our clinical results and experience, with use of free microvascular flaps and compare them with the recently published patient series. Methods. During the period from 2001 to 2005, 37 patients underwent microsurgical reconstruction after the tumor ablation in the region of head and neck. Flap viability was monitored intraoperatively with the Ackland test and postoperatively by the clinical observation and mini-Doppler test. Results. The overall success rate was 83.8%. The complications that appeared were: one complete flap necrosis due to venous thrombosis, and five late flap ischemic necroses, in the period from the 10th to 14th postoperative day. Conclusion. Free flap reconstruction of the head and neck is a surgical technique that provides the reconstruction of complex and extensive defects, that could not be performed by using local or regional flaps.

Cutaneous Vascular Anatomy of Pectoral Skin Flaps

1973 ◽  
Vol 82 (5) ◽  
pp. 691-695
Author(s):  
Thomas C. Calcaterra ◽  
Edward F. Cherney ◽  
Mohammed Saffouri
Keyword(s):  
Head And Neck ◽  
Blood Supply ◽  
Surgical Therapy ◽  
Vascular Anatomy ◽  
Skin Flaps ◽  
Flap Necrosis ◽  
Arterial Blood Supply ◽  
Pedicled Flaps ◽  
Arterial Blood ◽  
Flap Viability

The need for nondelayed skin flaps from the chest for postoperative reconstruction and repair has increased considerably since the advent of combined irradiation and surgical therapy for treatment of cancer of the head and neck. Survival of these pedicled flaps is of paramount concern to the surgeon, as flap necrosis can be catastrophic for the patient. Many parameters have been evaluated to predict flap viability, but recent studies strongly suggest that the arterial blood supply of the pedicle is the most important factor in the success of immediate transposition. A study was performed in 19 cadavers to delineate the cutaneous vascular anatomy of the chest in order to determine precisely where the perforating vessels of the thorax and shoulders supply the pedicle region of medially-based and laterally-based pectoral flaps. On the basis of this study, modification of the design of these flaps is recommended.

scholarly journals Impact of Goal Directed Therapy in Head and Neck Oncological Surgery with Microsurgical Reconstruction: Free Flap Viability and Complications

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1545
Author(s):  
Blanca Tapia ◽  
Elena Garrido ◽  
Jose Luis Cebrian ◽  
Jose Luis Del Castillo ◽  
Javier Gonzalez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Fluid Management ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Goal Directed Therapy ◽  
Flap Viability

(1) Background: Surgical outcomes in free flap reconstruction of head and neck defects in cancer patients have improved steadily in recent years; however, correct anaesthesia management is also important. The aim of this study has been to show whether goal directed therapy can improve flap viability and morbidity and mortality in surgical patients. (2) Methods: we performed an observational case control study to analyse the impact of introducing a semi invasive device (Flo Trac®) during anaesthesia management to optimize fluid management. Patients were divided into two groups: one received goal directed therapy (GDT group) and the other conventional fluid management (CFM group). Our objective was to compare surgical outcomes, complications, fluid management, and length of stay between groups. (3) Results: We recruited 140 patients. There were no differences between groups in terms of demographic data. Statistically significant differences were observed in colloid infusion (GDT 53.1% vs. CFM 74.1%, p = 0.023) and also in intraoperative and postoperative infusion of crystalloids (CFM 5.72 (4.2, 6.98) vs. GDT 3.04 (2.29, 4.11), p < 0.001), which reached statistical significance. Vasopressor infusion in the operating room (CFM 25.5% vs. GDT 74.5%, p < 0.001) and during the first postoperative 24h (CFM 40.6% vs. GDT 75%, p > 0.001) also differed. Differences were also found in length of stay in the intensive care unit (hours: CFM 58.5 (40, 110) vs. GDT 40.5 (36, 64.5), p = 0.005) and in the hospital (days: CFM 15.5 (12, 26) vs. GDT 12 (10, 19), p = 0.009). We found differences in free flap necrosis rate (CMF 37.1% vs. GDT 13.6%, p = 0.003). One-year survival did not differ between groups (CFM 95.6% vs. GDT 86.8%, p = 0.08). (4) Conclusions: Goal directed therapy in oncological head and neck surgery improves outcomes in free flap reconstruction and also reduces length of stay in the hospital and intensive care unit, with their corresponding costs. It also appears to reduce morbidity, although these differences were not significant. Our results have shown that optimizing intraoperative fluid therapy improves postoperative morbidity and mortality.

scholarly journals Factors Predicting Total Free Flap Loss after Microsurgical Reconstruction Following the Radical Ablation of Head and Neck Cancers

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Masaki Fujioka
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Radiation Treatment ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Tumor Type ◽  
Flap Necrosis ◽  
Microsurgical Reconstruction ◽  
Flap Failure ◽  
Flap Loss

Background. With greater experience in microsurgical reconstruction, free tissue transfer has become common and reliable. However, total flap necrosis after microsurgical reconstruction is sometimes seen in patients who have undergone radical ablation of head and neck malignancies. We investigated factors predicting free flap loss in head and neck reconstruction. Methods. We reviewed the records of 111 free flap reconstructions carried out among 107 patients with head and neck cancer who required radical resection and microsurgical reconstruction in our unit from 2004 through 2010. Among these patients, 6 showed total flap necrosis postoperatively. We investigated the associations between primary or recurrent tumor, type of flaps, chemotherapy, and radiotherapy and flap loss. Results. Five of 20 (25.0%) patients who underwent radiotherapy developed flap necrosis: among the 91 patient who did not undergo radiotherapy, only one (1.1%) developed. Preoperative radiotherapy was statistically identified as the most important risk factor for postoperative flap failure. Conclusions. Patients receiving radiation treatment are more likely to develop total flap failure when they undergo reconstructive surgery with free flaps after tumor ablation, because the combination of endarteritis and chronic ischemia caused by radiation damaged endothelial membrane in the recipient vessels, consequently, thrombosis tends to develop.

Behavior of anastomozed vessels and transferred flaps after anastomosed site infection in head and neck microsurgical reconstruction

Microsurgery ◽  
2016 ◽  
Vol 36 (8) ◽  
pp. 658-663 ◽  
Author(s):  
Tateki Kubo ◽  
Ken Matsuda ◽  
Koichiro Kiya ◽  
Ko Hosokawa
Keyword(s):  
Head And Neck ◽  
Site Infection ◽  
Microsurgical 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

Accuracy of Computed Tomography for Detection of COVID-19 among Suspected Patients

2021 ◽  
Vol 15 (9) ◽  
pp. 2474-2476
Author(s):  
Maham Munir Awan ◽  
Afshan Noreen ◽  
Farah Kalsoom ◽  
Muhammad Tahir ◽  
Umaima Majeed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Predictive Value ◽  
Gold Standard ◽  
Radiology Department ◽  
True Positive ◽  
Test Results ◽  
Rt Pcr ◽  
Radiological Society ◽  
Medical University ◽  
Pcr Test

Objective: To determine the accuracy of CT chest in diagnosis of COVID-19 taking RT-PCR-testing as gold standard. Materials and Methods: A total of 150 patients of suspicion of COVID-19 who were referred for CT Chest in Radiology Department of Nishtar Medical University Multan from June-2020 to May-2021 were included. In all patients, two RT-PCR test results were obtained with 7 days of admission in hospital. Presence of any of these positive was labelled as COVID-19 infection. CT chest was performed in all patients within 2 days of admission in hospital using 128 slices CT scan machine. The diagnosis of COVID-19 infection was made according to the recommendations by Radiological Society of North America (RSNA) protocol. Results: Mean age was 51.3±14.7 years. 78 (52%) patients were male and 72 (48%) patients were female. RTPCR test was positive in 89 (59.3%) patients. While the CT chest findings were suggestive of COVID-19 infection in 130 (86.7%) patients. The sensitivity of CT chest was 95.5%, specificity 26.2%, PPV wad 65.4% and NPV was 80.0%. Conclusion: CT chest has a very good sensitivity for detection of COVID-19, it can be used as a rapid diagnostic tool especially in areas of pandemic. However, the specificity of CT chest is low, that can limit its use in low COVID-19 affected areas. Keywords: COVID-19, Computed tomography, False Positive, True Positive, Positive Predictive Value, Negative Predictive Value.

scholarly journals Urinary incontinence: Clinical observation on 30 patients undergoing treatment with F.R.E.M.S (Frequency Rhythmic Electrical Modulation System)

2015 ◽  
Vol 87 (3) ◽  
pp. 243
Author(s):  
Massimo Massari ◽  
Patrizia Desideri ◽  
Paolo Menchinelli ◽  
Lucia Cerrito ◽  
Luciano De Giovanni
Keyword(s):  
Electric Fields ◽  
Clinical Observation ◽  
Clinical Results ◽  
Diagnostic Techniques ◽  
Pharmacological Therapy ◽  
Non Invasive ◽  
Impulse Duration ◽  
Electrical Modulation ◽  
Immunohistochemical Studies

Aim of the study: Urge incontinence is considered to be a dysfunctional pathology of social interest due to the psychological and relational implications of such disability, the elevated number of affected patients and the consequent treatment costs. We propose an innovative non-pharmacological and non-invasive care methodology: Frequency rhythmic electrical modulation system (F.R.E.M.S.) therapy (FT), based on the administration of electric fields of monophasic pulsed, negative, asymmetric current, generated by a neurostimulator with the characteristics of low variable frequency, high voltage and very low impulse duration. Material and Methods: 30 patients were studied with urodynamic evaluation and radiological diagnostic techniques, and underwent 2 cycles of 15 days therapy, with a 12 months follow-up. Results: In 93% of cases, we obtained a positive result, with either disappearance or improvement of symptoms. Conclusion: Although the Authors believe that clinical results deserve further neurohistological and immunohistochemical studies, in order to define the anathomophysiological and biochemical changes induced by FT, they propose it as a possible alternative to traditional pharmacological therapy and electrical stimulation.

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