Comparison of end-to-end and end-to-side venous anastomosis in free-tissue transfer following resection of head and neck tumors

Abstract Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

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Use of the Retrograde Recipient Vein for Additional Outflow in Free Tissue Transfer

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0039-1701031 ◽

2020 ◽

Vol 05 (01) ◽

pp. e1-e6

Author(s):

Tetsuji Uemura ◽

Mamoru Kikuchi ◽

Hidetaka Watanabe ◽

Tetsu Yanai

Keyword(s):

Head And Neck ◽

Free Tissue Transfer ◽

Blood Perfusion ◽

Free Flaps ◽

Successful Outcome ◽

Venous Anastomosis ◽

Venous Flow ◽

Flap Transfer ◽

Tissue Transfer ◽

Free Flap Transfer

Abstract Background The selection of appropriate recipient vessels is essential to the successful outcome of free flap transfer. To improve blood perfusion after reconstruction and reduce the risk of postoperative obstruction of flap vessels, multiple vessels should be chosen as candidate recipients. Methods For certainty of venous drainage, we have been performing venous anastomosis to the distal end of the recipient vein to utilize the reverse venous flow. Results A total of 48 cases of reconstruction of the head and neck or breast region with free flaps using retrograde venous anastomosis were performed. The method possibly improves flap circulation and the success rate of the free tissue transfer and reduces the need to extend surgery to search for multiple recipient veins. Conclusion We emphasized that retrograde limb of vein is useful as a second and/or rescued recipient in free tissue transfer. Retrograde venous anastomosis is a fine and reasonable option when appropriate recipient vessels cannot be found near the defect in the head and neck such as frozen neck or breast region.

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The microvascular coupler device for end-to-side venous anastomosis in free tissue transfer for head and neck reconstruction

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2014.07.013 ◽

2014 ◽

Vol 67 (12) ◽

pp. 1757-1758 ◽

Cited By ~ 5

Author(s):

J. Maraka ◽

O. Hausien ◽

N. Abreo ◽

N.G. Patel ◽

A.J. Durrani

Keyword(s):

Head And Neck ◽

Free Tissue Transfer ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Neck Reconstruction ◽

Tissue Transfer ◽

Coupler Device

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Feasible, effective and efficient; the microvascular coupler device for end-to-side venous anastomosis in free tissue transfer for head and neck reconstruction

International Journal of Surgery ◽

10.1016/j.ijsu.2014.08.094 ◽

2014 ◽

Vol 12 ◽

pp. S71

Author(s):

Jane Maraka ◽

Nigel Abreo ◽

Omar Hausien ◽

Nakul Patel ◽

Amer Durrani

Keyword(s):

Head And Neck ◽

Free Tissue Transfer ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Neck Reconstruction ◽

Tissue Transfer ◽

Coupler Device

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End-to-Side Venous Anastomosis With an Anastomotic Coupling Device for Microvascular Free-Tissue Transfer in Head and Neck Reconstruction

The Laryngoscope ◽

10.1097/mlg.0b013e3181839b75 ◽

2008 ◽

Vol 118 (12) ◽

pp. 2146-2150 ◽

Cited By ~ 18

Author(s):

Natalya Chernichenko ◽

Douglas A. Ross ◽

Joseph Shin ◽

Clarence T. Sasaki ◽

Stephen Ariyan

Keyword(s):

Head And Neck ◽

Free Tissue Transfer ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Neck Reconstruction ◽

Coupling Device ◽

Tissue Transfer

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Surgical Treatment of Head and Neck Tumors

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1975.tb95109.x ◽

1975 ◽

Vol 2 (2) ◽

pp. 66-66

Author(s):

NORMAN R. WYNDHAM

Keyword(s):

Surgical Treatment ◽

Head And Neck ◽

Head And Neck Tumors ◽

Neck Tumors

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Head and neck tumors in children and adolescents: Impact of a multidisciplinary tumor board

Oral Oncology ◽

10.1016/j.oraloncology.2020.105145 ◽

2021 ◽

Vol 114 ◽

pp. 105145

Author(s):

Charlotte Benoit ◽

Daniel Orbach ◽

Stacy Cyrille ◽

Kahina Belhous ◽

Véronique Minard-Colin ◽

...

Keyword(s):

Children And Adolescents ◽

Head And Neck ◽

Head And Neck Tumors ◽

Tumor Board ◽

Neck Tumors ◽

Multidisciplinary Tumor Board

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Effect of head and neck radiotherapy on the Eustachian tube functions

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-020-00038-w ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Ahmed Abdullah Hamd ◽

Essam Abd El-Wanes Behiry ◽

Adel Tharwat Atallah ◽

Sherif Maher Elaini ◽

Ahmed Hamdy Alshafai

Keyword(s):

Head And Neck ◽

Eustachian Tube ◽

Contralateral Side ◽

Head And Neck Tumors ◽

Eustachian Tube Dysfunction ◽

Middle Ear Effusion ◽

Neck Tumors ◽

Tube Dysfunction ◽

Ear Effusion

Abstract Background Nowadays, radiotherapy is widely used in management of many types of tumors including head and neck tumors; in this study, we concerned with its reverse effects on the Eustachian tube functions and if this effect is temporary or permanent. Results The whole (30) patients have tympanogram at both ears before starting radiotherapy; all patients (100%) were normal. In the immediate post radiotherapy tympanogram at the contralateral side, 6.7% of patients had effusion, and 20% had Eustachian tube dysfunction, while at the ipsilateral side, 20% of patients had effusion, and 33.3% had ET dysfunction. In the follow-up tympanogram 12 weeks post radiotherapy, we found that 6.7% of patients had effusion, and (10%) had Eustachian tube dysfunction at the contralateral side, while 6.7% of patients had effusion, and only 20% had Eustachian tube dysfunction at the ipsilateral side. Conclusion From this study, we concluded that patients with head and neck tumors treated by radiotherapy (apart from the nasopharynx) have a high incidence of affection of Eustachian tube function namely middle ear effusion and Eustachian tube dysfunction. The possibility for development of middle ear effusion and Eustachian tube dysfunction increases with increased tumor stage. Eustachian tube functions immediately post radiotherapy and after 12 weeks of the end of radiotherapy was affected by different effects according to the tumor site. The Eustachian tube functions significantly improved within 12 weeks after the last dose of radiotherapy, and we recommend audiological follow-up for patients with head and neck tumors treated with radiotherapy.

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