Microvascular free flaps in head and neck surgery

1994 ◽  
Vol 108 (11) ◽  
pp. 962-968 ◽  
Author(s):  
Marcelle Macnamara ◽  
Sarah Pope ◽  
A. Sadler ◽  
H. Grant ◽  
M. Brough
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Neck Region ◽  
Free Flaps ◽  
Neck Surgery ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
Wide Range ◽  
Radial Forearm ◽  
Microvascular Free Flap

AbstractThis study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.

scholarly journals 240 Aetiology and Outcomes of Head and Neck Free Flaps in Patients Aged ≥ 65 Years: The Cambridge Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Hjalmarsson ◽  
T Chan ◽  
R Chawla ◽  
A Patel
Keyword(s):  
Free Flap ◽  
Free Flaps ◽  
Flap Surgery ◽  
Related Factors ◽  
Flap Failure ◽  
Standard Management ◽  
Free Flap Surgery ◽  
Radial Forearm ◽  
Surgery Department

Abstract Introduction Elderly patients often present to the Head & Neck Plastic Surgery department with complex reconstructive needs, for which free flaps are the gold-standard management. In order to provide appropriate, patient-centred care, it is imperative to understand how increasing age and related factors affect long-term free flap outcomes. Method The authors carried out a retrospective review of all patients 65+ years who underwent free flap surgery at Addenbrooke’s Hospital from 2008-2019. Patient, operative, and flap characteristics, and outcomes, were analysed using Excel and RStudio. Results 163 patients were identified (54F, 109M). The majority were ALT (n = 74), radial forearm (n = 35), and fibula flaps (n = 23). Of pre-operative comorbidities, only neurological comorbidities (n = 16), were significantly associated with long-term flap failure (p = 0.016). There was no significant association between number of comorbidities and flap outcome. There was no association between age group and length of stay. Flap site complications, and particularly venous complications, were significantly associated with later failure (p = 0.001). No other complications were statistically associated with flap failure. Conclusions The high success rate supports the use of free flaps in the 65+ population. This data supports a case-by-case approach to assessing fitness for free flap surgery rather than excluding patients on the basis of age or specific comorbidities.

scholarly journals Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

2014 ◽  
Vol 3 (2) ◽  
pp. 33-37
Author(s):  
Debashis Biswas ◽  
Md Abul Kalam ◽  
Tanveer Ahmed ◽  
Md Rabiul Karim Khan
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Tissue Defect ◽  
Radial Forearm ◽  
After Cancer ◽  
Microvascular Free Flap ◽  
Tissue Defects

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

scholarly journals Improvised perioperative techniques to meet the challenges of microvascular free flap surgery

2016 ◽  
Vol 3 (2) ◽  
pp. 99-100
Author(s):  
Soumi Pathak ◽  
Itee Chowdhury ◽  
Ajay Kumar Bhargava
Keyword(s):  
Free Flap ◽  
Neck Region ◽  
Flap Surgery ◽  
Surgical Morbidity ◽  
Head And Neck Region ◽  
Form And Function ◽  
Free Flap Surgery ◽  
And Function ◽  
Microvascular Free Flap

Deformities of the head and neck region after radical oncosurgery can have devastating effects on the appearance of the patient with significant impact on patients quality of life. Reconstruction of such defects continues to be an extremely demanding challenge for plastic surgeons who aim to restore form and function with minimal surgical morbidity. The purpose of this communications is to highlight the various interventions and the protocols that are adopted to decrease the free flap failure rate.  

scholarly journals Late Free Flap Failure in Head and Neck Reconstruction: A Systematic Review

2018 ◽  
Vol 97 (7) ◽  
pp. 213-216 ◽  
Author(s):  
David Forner ◽  
Blair A. Williams ◽  
Fawaz M. Makki ◽  
Jonathan R.B. Trites ◽  
S. Mark Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Head And Neck Reconstruction ◽  
Time To Failure ◽  
Close Monitoring ◽  
Flap Failure ◽  
Vascular Compromise

Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.

Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

2016 ◽  
Vol 126 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Neerav Goyal ◽  
Bharat B. Yarlagadda ◽  
Daniel G. Deschler ◽  
Kevin S. Emerick ◽  
Derrick T. Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Free Flap ◽  
Operating Time ◽  
Surgical Site Infections ◽  
Free Flaps ◽  
Neck Surgery ◽  
Pedicled Flap ◽  
American Society ◽  
Clean Contaminated

Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay ( P = .004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification ( P = .03), longer operating time ( P = .03), and clindamycin prophylaxis ( P = .009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

scholarly journals Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review

2021 ◽  
Vol 8 (1) ◽  
pp. 58-67
Author(s):  
Parintosa Atmodiwirjo ◽  
Nadhira Anindita Ralena ◽  
Mohamad Rachadian Ramadan ◽  
Sara Ester Triatmoko
Keyword(s):  
Systematic Review ◽  
Neck Region ◽  
Free Flaps ◽  
Neck Surgery ◽  
Pedicled Flap ◽  
Pedicled Flaps ◽  
Medical Issues ◽  
Radial Forearm ◽  
Cosmetic Outcomes ◽  
Supraclavicular Artery Island Flap

Introduction: Pedicled flaps from infrahyoid, pectoralis major, and trapezius were commonly used for partial tongue reconstruction. Not until a free radial forearm flap was introduced. The flap is recommended for patients with tongue defects ≤ 50% because of its thinness, pliability, and long pedicle. This systematic review explores the functional and cosmetic outcomes of pedicled flaps from the neck region for patients who underwent partial tongue resection or hemiglossectomy. Method: A systematic literature searching was performed on PubMed, Medline, Scopus, Embase, and Cochrane. Keywords included were pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Inclusion and exclusion criteria were applied to the search results. Relevant studies were assessed for their methodological quality using appropriate instruments. Results: Four hundred and twenty-four articles were obtained from the initial literature search. The authors finally gathered 11 full-text articles comparing the pedicled neck flaps with free flaps for partial tongue resection reconstructions. Pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, are clinically relevant for hemiglossectomy reconstruction with comparable functional and aesthetic outcomes. Conclusion: Regional flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery.

scholarly journals Combined Free Flap Reconstruction Following Head And Neck Cancer Resection: Chimeric And Double Free Flap Reconstruction

2019 ◽  
Vol 5 (1) ◽  
pp. 188-194
Author(s):  
Parintosa Atmodiwirjo ◽  
Tasya Anggrahita
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Free Flaps ◽  
Cancer Resection ◽  
Free Fibular Flap ◽  
Radial Forearm ◽  
Mandibular Defect ◽  
Fibular Flap

Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.

scholarly journals Primary thrombolysis for free flap surgery in head and neck reconstruction: a case report and review

2021 ◽  
Vol 48 (5) ◽  
pp. 511-517
Author(s):  
Steven Liben Zhang ◽  
Hui Wen Ng
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Arterial Thrombosis ◽  
Free Flaps ◽  
Recombinant Tissue Plasminogen Activator ◽  
Head And Neck Reconstruction ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Free Flap Surgery ◽  
Flap Perfusion

The use of free flaps is an essential and reliable method of reconstruction in complex head and neck defects. Flap failure remains the most feared complication, the most common cause being pedicle thrombosis. Among other measures, thrombolysis is useful when manual thrombectomy has failed to restore flap perfusion, in the setting of late or established thrombosis, or in arterial thrombosis with distal clot propagation. We report a case of pedicle arterial thrombosis with distal clot propagation which occurred during reconstruction of a maxillectomy defect, and was successfully treated with thrombolysis using recombinant tissue plasminogen activator. We also review the literature regarding the use of thrombolysis in free flap surgery, and propose an algorithm for the salvage of free flaps in head and neck reconstruction.

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