A 15-year Experience of Complex Scalp Reconstruction Using Free Tissue Transfer—Analysis of Risk Factors for Complications

Background. No studies report robust data on the national incidence and risk factors associated with catastrophic medical outcomes following free tissue transfer. Methods. The American College of Surgeons (ACS) multicenter, prospective National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent free tissue transfer between 2006 and 2011. Multivariable logistic regression was used for statistical analysis. Results. Over the 6-year study period 2,349 patients in the NSQIP database underwent a free tissue transfer procedure. One hundred and twenty-two patients had at least one catastrophic medical outcome (5.2%). These 122 patients had 151 catastrophic medical outcomes, including 93 postoperative respiratory failure events (4.0%), 14 pulmonary emboli (0.6%), 13 septic shock events (0.5%), 12 myocardial infarctions (0.5%), 6 cardiac arrests (0.3%), 4 strokes (0.2%), 1 coma (0.0%), and 8 deaths (0.3%). Total length of hospital stay was on average 14.7 days longer for patients who suffered a catastrophic medical complication (P<0.001). Independent risk factors were identified. Conclusions. Free tissue transfer is a proven and safe technique. Catastrophic medical complications were infrequent but added significantly to length of hospital stay and patient morbidity.

Download Full-text

Risk Factors Associated with Prolonged Postoperative Stay following Free Tissue Transfer

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000000735 ◽

2014 ◽

Vol 134 (6) ◽

pp. 1323-1332 ◽

Cited By ~ 13

Author(s):

Anaeze C. Offodile ◽

Andrew Aherrera ◽

Lifei Guo

Keyword(s):

Risk Factors ◽

Free Tissue Transfer ◽

Postoperative Stay ◽

Factors Associated ◽

Tissue Transfer

Download Full-text

Free Tissue Reconstruction of the Scalp

Seminars in Plastic Surgery ◽

10.1055/s-0039-1678470 ◽

2019 ◽

Vol 33 (01) ◽

pp. 067-071 ◽

Cited By ~ 1

Author(s):

Mofiyinfolu Sokoya ◽

Emily Misch ◽

Aurora Vincent ◽

Weitao Wang ◽

Sameep Kadakia ◽

...

Keyword(s):

Free Tissue Transfer ◽

Free Flaps ◽

Advantages And Disadvantages ◽

Scalp Reconstruction ◽

Tissue Transfer ◽

Scalp Defects ◽

Calvarial Defects ◽

Reconstructive Option ◽

Tissue Reconstruction

AbstractReconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer. Different free flaps for scalp reconstructed are described with a comparison of their advantages and disadvantages. Overall, free tissue transfer for scalp defects provides a reliable, durable, and cosmetically adequate reconstructive option.

Download Full-text

A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1702175 ◽

2020 ◽

Vol 36 (06) ◽

pp. 450-457 ◽

Cited By ~ 1

Author(s):

David Alejandro Magno-Padron ◽

Willem Collier ◽

Jaewhan Kim ◽

Jayant P. Agarwal ◽

Alvin C. Kwok

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Breast Reconstruction ◽

Cancer Patients ◽

Postoperative Period ◽

Readmission Rate ◽

Free Tissue Transfer ◽

Breast Cancer Patients ◽

Tissue Transfer ◽

History Of

Abstract Background Traditionally, surgical quality outcomes are assessed using a 30-day postoperative window. For breast cancer patients undergoing free tissue transfer for breast reconstruction, we sought to describe the distribution of and specific risk factors for early and late readmissions within a 0- to 90-day postoperative period. Patients and Methods The Nationwide Readmissions Database was used to conduct a retrospective cohort study. Breast cancer patients undergoing free tissue transfer for breast reconstruction were identified using International Classification of Diseases -9 diagnosis and procedure codes. Ninety-day readmissions related to infection or wound complications were identified. Univariable and multivariable logistic regression models were used to identify patient risk factors for readmissions that occurred early (0–30 days) and late (31–90 days) after their index procedure. Results In the weighted sample, we identified approximately 7,305 free flap breast reconstructions and a surgical wound-related readmission rate of 4.3% (n = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after surgery. The mean days to readmission was 26, and 75% of all readmissions occurred within the first 36 days after surgery. Variables independently associated with readmissions during the 0- to 90-day postoperative period included: history of chronic obstructive pulmonary disease (p = 0.036), hypertension (p = 0.03), obesity (p ≤ 0.001), and history of smoking (p = 0.004). The variables independently associated with the early readmission period were the same as those identified for the 0- to 90-day postoperative period. The variables independently associated with late readmissions were different: history of depression (p = 0.001) and history of smoking (p = 0.001). Conclusion The conventional 30-day hospital readmission rate classically used as a quality metric is overlooking a significant portion of admissions after free flap-based breast reconstruction. Different variables were found to be associated with readmission in the early versus late cohorts. Interventions targeting these variables could decrease readmissions and their associated costs.

Download Full-text

Scalp Reconstruction

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0035 ◽

2019 ◽

pp. 343-354

Author(s):

Joseph J. Disa ◽

Edward Ray

Keyword(s):

Patient Compliance ◽

Physical Condition ◽

Systematic Approach ◽

Free Tissue Transfer ◽

Defect Identification ◽

Scalp Reconstruction ◽

Tissue Transfer ◽

Life Threatening ◽

History Of ◽

Definition Of

The scalp serves both protective and aesthetic functions. Injury or loss of the scalp may lead to desiccation and osteonecrosis of the underlying calvarium as well as potentially life-threatening osteomyelitis and meningitis. Reconstruction of the scalp starts with a systematic approach, beginning with definition of the defect, identification of the reconstructive priorities, and a thorough assessment of the patient’s anatomy and history. Comorbidities, history of radiation or prior reconstruction, physical condition, and patient compliance are important factors to consider as well. Depending on each of these considerations, options available to the reconstructive surgeon include single- and multiple-stage procedures, grafts, local/regional flaps, and free tissue transfer.

Download Full-text

Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1393725 ◽

2015 ◽

Vol 8 (3) ◽

pp. 179-189 ◽

Cited By ~ 11

Author(s):

Michael Sosin ◽

Arif Chaudhry ◽

Carla De La Cruz ◽

Branko Bojovic ◽

Paul N. Manson ◽

...

Keyword(s):

Donor Site ◽

Case Series ◽

Perforator Flap ◽

Free Tissue Transfer ◽

The Elderly ◽

Lessons Learned ◽

Soft Tissue Coverage ◽

Scalp Reconstruction ◽

Tissue Transfer ◽

The Mean

This article aims to demonstrate an individualized approach to an elderly patient requiring scalp reconstruction, to describe the methodology in flap selection, lessons learned, and report outcomes. A retrospective review of a single surgeon's experience of scalp reconstruction (E. D. R.) using free tissue transfer from 2005 to 2011, in patients older than 70 years, was completed. A total of eight patients met the inclusion criteria, five males and three females, with a mean age of 80.4 years (range, 73–92). Free tissue transfer achieved 100% soft tissue coverage. Six of the eight patients required cranioplasty. The mean size calvarial defect was 92 cm2 (range, 35–285 cm2). The mean flap size was 117.6 cm2 (range, 42–285 cm2). Free flaps included three ulnar, three anterolateral thigh, one latissimus dorsi, and one thoracodorsal perforator flap. The mean follow-up time was 18.4 months (range, 3–46 months). Donor site morbidity was minimal. Mortality was 0%. Immediate flap failure was 0%. Other complications occurred in six of the eight patients. Mean revisionary procedures were 1.25 procedures per patient. It was concluded that chronological age does not increase mortality or catastrophic flap complications; however, morbidity is increased in the elderly and revisionary surgery is likely.

Download Full-text