Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction

Head & Neck ◽  
2015 ◽  
Vol 38 (S1) ◽  
pp. E771-E775 ◽  
Author(s):  
Edward I. Chang ◽  
Hong Zhang ◽  
Jun Liu ◽  
Peirong Yu ◽  
Roman J. Skoracki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Flap Loss

Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis

2017 ◽  
Vol 34 (02) ◽  
pp. 087-094 ◽  
Author(s):  
Jinglong Liu ◽  
Quan Shi ◽  
Shuo Yang ◽  
Bo Liu ◽  
Bin Guo ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Meta Analysis ◽  
Anticoagulation Therapy ◽  
Head And Neck Reconstruction ◽  
Thromboembolic Events ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Flap Loss ◽  
Free Flap Surgery

Background Due to limited evidence, it is unclear whether postoperative anticoagulation therapy may lead to higher success rates for microvascular free-flap surgery in the head and neck. This review evaluated whether postoperative anticoagulation therapy can lead to a better result in head and neck reconstruction. Methods PubMed, Embase, and the Cochrane Library were used to search for articles on the efficacy of postoperative antithrombotic therapy in free-flap transfer during head and neck reconstruction without language restrictions in February of 2017. A random-effects model was used to estimate the relative risk ratio (RR) with 95% confidence intervals (CIs). The measured outcomes were flap loss, thromboembolic events, and hematoma formation. Results A total of 2,048 free-flap surgery procedures in the head and neck were analyzed. There was no significant difference in the occurrence of flap loss and thromboembolic events in the anticoagulation group compared with the nonanticoagulation group (RR = 1.25, 95% CI = 0.85–1.81, p = 0.26; and RR = 1.05, 95% CI = 0.74–1.48, p = 0.79, respectively). The risk of hematoma was twice as high in the anticoagulation group than the nonanticoagulation group, which was statistically significant (RR = 2.02, 95% CI = 1.08–3.76, p = 0.03). Conclusion The findings from our meta-analysis indicate that postoperative anticoagulation therapy barely decreases the risks of flap loss and thromboembolic events in free-flap surgery in the head and neck. However, it may significantly increase the risk of hematoma formation. Considering the limitations of this meta-analysis, additional high-quality, multicenter, prospective, randomized controlled studies are needed to confirm these findings.

scholarly journals Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting

2019 ◽  
Vol 12 (3) ◽  
pp. 183-192 ◽  
Author(s):  
Pieter-Jan Verhelst ◽  
Flore Dons ◽  
Pieter-Jan Van Bever ◽  
Joseph Schoenaers ◽  
Lloyd Nanhekhan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Flap Failure ◽  
Fibula Free Flap ◽  
Tertiary Center ◽  
Low Volume

The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. A retrospective analysis was conducted of all FFFs performed over a 20-year period at a low-volume single tertiary center to identify risk factors and postoperative complications. A total of 129 FFFs were included (122 mandible, 7 maxilla). Complete flap failure occurred in 12.4% and partial flap failure in 7.8% of patients. A significant relation was found between younger age and flap failure, and most failures were associated with venous thrombosis. In-hospital surgical complications occurred in 60.5%, in-hospital medical complications in 49.6%, and out-of-hospital complications in 77.5% of patients. The in-hospital reintervention rate was 27.1%, and including salvaged flaps, flap survival rate was 87.6%. Osteomyocutaneous FFF failure (complete 12.4%; partial 7.8%) is an important clinical reality in a low-volume head and neck reconstruction center resulting in an in-hospital reintervention rate of 27.1%. Postoperative complications are frequent, both surgical and out-hospital complications. These results provide a better understanding of the limitations of the FFF in a low-volume center and can be used to optimize care in this kind of setting.

Risk factors of free flap compromise in 247 cases of microvascular head and neck reconstruction: a single surgeon’s experience

2010 ◽  
Vol 267 (10) ◽  
pp. 1629-1633 ◽  
Author(s):  
Young-Hoon Joo ◽  
Dong-Il Sun ◽  
Jun-Ook Park ◽  
Kwang-Jae Cho ◽  
Min-Sik Kim
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction

The use of machine learning for predicating complications of free flap head and neck reconstruction.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18633-e18633
Author(s):  
Malke Asaad ◽  
Sheng-Chieh Lu ◽  
Praneeth Kambhampati ◽  
Jun Liu ◽  
Edward I Chang ◽  
...  
Keyword(s):  
Machine Learning ◽  
Head And Neck ◽  
Free Flap ◽  
Surgical Outcomes ◽  
Study Cohort ◽  
Head And Neck Reconstruction ◽  
Recipient Site ◽  
Neck Reconstruction ◽  
Routinely Collected Data ◽  
Flap Loss

e18633 Background: The use of machine learning (ML) in plastic and reconstructive surgery has increased over the last decade. However, its use to predict surgical outcomes in head and neck reconstruction has not been well studied. The goal of this study is to assess the performance of ML algorithms trained to predict surgical outcomes of head and neck free flap reconstruction. Methods: Our study cohort included routinely collected data from 4000 patients who underwent free flaps for reconstruction of head and neck defects between January 2005 and December 2018. We developed and tested nine supervised ML algorithms to predict three outcomes of a.) any complication, b.) any major recipient-site complication, and c.) total flap loss. Results: In our sample, 33.7% of patients experienced any complication, 26.5% experienced a major complication at the recipient site and 1.7% experienced total flap loss. The k-nearest neighbors algorithm demonstrated the best overall performance for predicting any complication (AUROC = .61, sensitivity = .60). Regularized regression had the best performance for predicting major recipient site complication (AUROC=.68, sensitivity = .66), and decision trees were the best predictors of total flap loss (AUROC = .66, sensitivity = .50). Conclusions: We demonstrated that ML models trained using routinely collected data can make clinical useful predictions about who will experience complications. Our models correctly identified between half and two-thirds of patients who experienced post-surgical complications including total flap loss. These models can be applied to readily available clinical and perioperative data to facilitate decision making. Further performance improvements are likely possible with the inclusion of additional variables related to patient health and behavior.

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

scholarly journals Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction—An Analysis of 1694 Venous Anastomoses

2021 ◽  
Vol 54 (02) ◽  
pp. 118-123
Author(s):  
Rajan Arora ◽  
Kripa Shanker Mishra ◽  
Hemant T. Bhoye ◽  
Ajay Kumar Dewan ◽  
Ravi K. Singh ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Head And Neck ◽  
Free Tissue Transfer ◽  
Effective Alternative ◽  
Head And Neck Reconstruction ◽  
Venous Anastomosis ◽  
Neck Reconstruction ◽  
Coupling Device ◽  
Tissue Transfer ◽  
Flap Loss

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.

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 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

Venous Anastomoses Using Microvascular Coupler in Free Flap Head and Neck Reconstruction

2012 ◽  
Vol 70 (4) ◽  
pp. 992-996 ◽  
Author(s):  
Tao Zhang ◽  
Joshua Lubek ◽  
Andrew Salama ◽  
John Caccamese ◽  
Domenick Coletti ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction
Sign in / Sign up

Export Citation Format

Share Document