Cardiovascular complications in head & neck microvascular flap reconstruction: A retrospective risk stratification and outcomes assessment

For patients whose vasculitis is managed with biologic medications, no reports or evidence-based guidance exists regarding the perioperative management of microvascular flaps. We present a case of a 78-year-old patient with Takayasu’s arteritis (TA) and diabetes mellitus who was taking infliximab and underwent wide local excision of squamous cell carcinoma, craniectomy and reconstruction with a latissimus dorsi flap. TA, an immune-mediated large cell vasculitis characterised by granuloma formation, tends to affect larger vessels and aortic branches. The typical localisation of this condition raises concerns about potentially compromised pedicle and recipient vessels (ie, superficial temporal arteries), which could hinder postoperative flap success. Discontinuation of infliximab 4 weeks before surgery and resumption 6 weeks after led to favourable results. This case addresses the gap in the literature concerning stopping and restarting biologic drugs in the perioperative setting and documents a successful course of a microvascular procedure in a patient with vasculitis.

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ST-Elevation Myocardial Infarction and COVID-19 Pneumonia: The Importance of Risk-Stratification of Myocardial Injury in COVID-19 Era

Indian Journal of Clinical Cardiology ◽

10.1177/2632463621992389 ◽

2021 ◽

pp. 263246362199238

Author(s):

Julio C. Sauza-Sosa ◽

Oscar Millan-Iturbe ◽

Jorge Mendoza-Ramirez ◽

Carlos N. Velazquez-Gutierrez ◽

Erika Lizeth De la Cruz Reyna ◽

...

Keyword(s):

Risk Stratification ◽

Injury Risk ◽

Myocardial Injury ◽

Cardiovascular Complications ◽

Adverse Outcomes ◽

St Elevation ◽

Diagnostic Coronary Angiography ◽

Serial Measurements ◽

Initial Classification

Background: Myocardial injury is a common manifestation in patients with coronavirus disease (COVID-19), and the correlation with adverse outcomes has been demonstrated; therefore, adequate monitoring of myocardial injury markers is very important. Case Summary: A patient with COVID-19 was hospitalized in our hospital with an initial classification of intermediate risk for myocardial injury, after serial measurements of myocardial injury markers, risk was readjusted to high, as shown later by electrocardiographic abnormalities. The patient underwent emergency diagnostic coronary angiography and successful angioplasty. The patient was discharged to home. Discussion: Myocardial injury risk-stratification is essential in patients with COVID-19, since it is essential in the recognition of patients who are susceptible to cardiovascular complications.

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Factors Affecting Cancer Recurrence after Microvascular Flap Reconstruction of the Head and Neck

The Laryngoscope ◽

10.1097/01.mlg.0000166706.61652.15 ◽

2005 ◽

Vol 115 (8) ◽

pp. 1391-1394 ◽

Cited By ~ 5

Author(s):

Jason Roostaeian ◽

Jeffrey D. Suh ◽

Joel A. Sercarz ◽

Elliot Abemayor ◽

Jivianne T. Lee ◽

...

Keyword(s):

Head And Neck ◽

Cancer Recurrence ◽

Flap Reconstruction ◽

Factors Affecting ◽

Microvascular Flap

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Microvascular Flap Reconstruction for Head and Neck Cancers in Previously Operated and/or Radiated Neck

Annals of Plastic Surgery ◽

10.1097/sap.0000000000002951 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Vinay K. Shankhdhar ◽

Mayur R. Mantri ◽

Snehjeet Wagh ◽

Shivakumar Thiagarajan ◽

Devendra Chaukar ◽

...

Keyword(s):

Head And Neck ◽

Head And Neck Cancers ◽

Flap Reconstruction ◽

Microvascular Flap

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Cardio-Rheumatology: Cardiovascular Complications in Systemic Autoimmune Rheumatic Diseases / Is Inflammation the Common Link and Target?

Current Vascular Pharmacology ◽

10.2174/1570161118666200514222236 ◽

2020 ◽

Vol 18 (5) ◽

pp. 425-430 ◽

Cited By ~ 1

Author(s):

Antonis S. Manolis ◽

Athanasios G. Tzioufas

Keyword(s):

Risk Stratification ◽

Rheumatic Diseases ◽

Cardiovascular Imaging ◽

Cardiovascular Complications ◽

Preventive Strategies ◽

Pathogenetic Mechanisms ◽

Autoimmune Rheumatic Diseases ◽

The Common ◽

Fine Tune

In the current Thematic Issue of Current Vascular Pharmacology (CVP), entitled “Systemic Autoimmune Rheumatic Diseases and Cardiology”, presented in two parts, Part 1 and Part 2, review articles are included from specialists in cardiology, rheumatology, immunology and related fields. These reviews discuss the cardiovascular complications of the main systemic Autoimmune Rheumatic Diseases (ARDs). For example, the underlying pathogenetic mechanisms, the role of cardiovascular imaging and recommendations for prevention and management. These articles place inflammation as the key process, linking cardiovascular complications with ARDs. From all these reviews, the conclusion is the need for collaboration between the disciplines of Rheumatology and Cardiology to establish the emerging field of Cardio- Rheumatology. This will aid to fine-tune risk stratification and optimize preventive strategies and pharmacological therapies for patients with ARDs.

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Outcomes of microvascular flap reconstruction of the head and neck in patients receiving systemic immunosuppressive therapy for organ transplantation

Journal of Surgical Oncology ◽

10.1002/jso.25035 ◽

2018 ◽

Vol 117 (7) ◽

pp. 1575-1583 ◽

Cited By ~ 1

Author(s):

Mark V. Schaverien ◽

Riley A. Dean ◽

Jeffrey N. Myers ◽

Lin Fang ◽

Rene D. Largo ◽

...

Keyword(s):

Head And Neck ◽

Immunosuppressive Therapy ◽

Organ Transplantation ◽

Flap Reconstruction ◽

Microvascular Flap

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Indications and Use of Hydrogen Peroxide during Microvascular Flap Reconstruction Surgery: A Literature and Procedural Use Review

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0037-1601326 ◽

2017 ◽

Vol 02 (01) ◽

pp. e23-e25

Author(s):

E. Rodriguez-Collazo ◽

D. Riddle ◽

K. Schmidtke

Keyword(s):

Hydrogen Peroxide ◽

Arterial Disease ◽

Tissue Loss ◽

Flap Reconstruction ◽

Muscle Belly ◽

Reconstruction Surgery ◽

Microvascular Flap ◽

Peripheral Arterial

AbstractMicrovascular flap reconstruction surgery is a limb preservation procedure performed in an effort to maintain the integrity of the lower limb and avoid amputations. Individuals facing the prospect of amputation often have long-term diabetes with multiple comorbidities, including severe peripheral vascular disease; peripheral arterial disease; chronic ulcerations; and Charcot arthropathy. Long-term clinical research has shown that these patients are at much higher risk for secondary amputations after a first amputation is performed. According to Sohn et al, Charcot and ulcer groups had 4.1 and 4.7 amputations per 100 person-years, respectively. In patients younger than 65 years old at the end of follow-up, amputation risk, relative to patients with Charcot alone, was 7 times higher for patients with ulcer alone and 12 times higher for patients with Charcot and ulcer. Patients with infected hardware, suffering from acute ulcerative conditions, may also be candidates for this type of surgery due to extensive tissue loss secondary to infection. Microvascular flap reconstruction surgery is a highly technical surgery involving the use of orthoplastic techniques, which is performed under ×3.5 loupe magnification. Due to the inability to perform this procedure with the use of a tourniquet, visibility within the field is obfuscated from continuous blood flow along the dissected muscle belly. Hydrogen peroxide (H2O2) is an excellent alternative to tourniquet use. The use of H2O2 allows additional benefits, such as visual field clearance and antisepsis.

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835 poster FLAP RECONSTRUCTION AND POSTOPERATIVE IRRADIATION IN LOCALLY ADVANCED HEAD-NECK CANCER: OUR MULTIDISCI-PLINARY EXPERIENCE

Radiotherapy and Oncology ◽

10.1016/s0167-8140(11)70957-4 ◽

2011 ◽

Vol 99 ◽

pp. S325

Author(s):

C.L. Deantoni ◽

A. Baio ◽

D. Cavallini Francolini ◽

S. Colombo ◽

P. de Vecchi ◽

...

Keyword(s):

Neck Cancer ◽

Locally Advanced ◽

Head Neck Cancer ◽

Advanced Head ◽

Flap Reconstruction ◽

Postoperative Irradiation ◽

Head Neck

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Cardiac risk stratification in stable coronary artery disease

The Clinician ◽

10.17650/1818-8338-2020-14-1-2-24-33 ◽

2020 ◽

Vol 14 (1-2) ◽

pp. 24-33

Author(s):

S. N. Tolpygina ◽

S. Yu. Martsevich

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Stratification ◽

Myocardial Revascularization ◽

Cardiovascular Complications ◽

Prognostic Models ◽

High Tech ◽

Risk Of Death ◽

Artery Disease ◽

Stable Cad

Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.

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