scholarly journals Perioperative Care of Free Flap Patients

2019 ◽  
Vol 33 (01) ◽  
pp. 005-012 ◽  
Author(s):  
Aurora Vincent ◽  
Raja Sawhney ◽  
Yadranko Ducic
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Fluid Management ◽  
Treatment Algorithm ◽  
Free Tissue Transfer ◽  
Antibiotic Use ◽  
Head And Neck Reconstruction ◽  
Tissue Transfer ◽  
Reconstructive Option ◽  
Vasopressor Use

AbstractMicrovascular free tissue transfer is an indispensable reconstructive option in head and neck reconstruction. Flap failure is relatively rare, but it is nonetheless very morbid and psychologically devastating to patients when it does occur. Further, complications after free tissue transfer to the head and neck remain common. There are numerous ongoing debates about various facets of preoperative, intraoperative, and postoperative care of patients undergoing free flap reconstruction of the head and neck, all ultimately searching for the optimal treatment algorithm to further improve flap success, minimize complications, and maximize patient outcomes. Herein, the authors review current literature surrounding optimal preoperative nutritional support, intraoperative vasopressor use, perioperative fluid management, use of antithrombotic agents, antibiotic use, and other facets of the care of head and neck free flap patients to provide a guide to surgeons.

scholarly journals Flap Failure and Salvage in Head and Neck Reconstruction

2020 ◽  
Vol 34 (04) ◽  
pp. 314-320
Author(s):  
Weitao Wang ◽  
Adrian Ong ◽  
Aurora G. Vincent ◽  
Tom Shokri ◽  
Britney Scott ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Surgical Techniques ◽  
Free Tissue Transfer ◽  
Head And Neck Reconstruction ◽  
Success Rates ◽  
Neck Reconstruction ◽  
Flap Failure ◽  
Ablative Surgery ◽  
Reconstructive Option

AbstractWith advanced head and neck ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional and aesthetic outcomes. Contemporary microvascular reconstructive surgery with free tissue transfer has become the standard for complex head and neck reconstruction. With continued refinements in surgical techniques, larger surgical volumes, and technological advancements, free flap success rates have exceeded 95%. Despite these high success rates, postoperative flap loss is a feared complication requiring the surgeon to be aware of potential options for successful salvage. The purpose of this article is to review free flap failure and ways to optimize surgical salvage in the scenario of flap compromise.

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.

scholarly journals Regional Salvage Flap Options in Head and Neck Reconstruction

2020 ◽  
Vol 34 (04) ◽  
pp. 293-298
Author(s):  
Camil Correia ◽  
Weitao Wang ◽  
Aurora G. Vincent ◽  
David Chan ◽  
Yadranko Ducic
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Head And Neck Reconstruction ◽  
Success Rates ◽  
Neck Reconstruction ◽  
Tissue Transfer ◽  
Regional Flap

AbstractMicrovascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.

Free Flap Head and Neck Reconstruction with an Emphasis on Postoperative Care

2018 ◽  
Vol 34 (06) ◽  
pp. 597-604 ◽  
Author(s):  
Jacob D'Souza ◽  
Wendy King ◽  
Michael Bater ◽  
Daniel van Gijn
Keyword(s):  
Free Flap ◽  
Microvascular Complications ◽  
Free Tissue Transfer ◽  
Congenital Defects ◽  
Head And Neck Reconstruction ◽  
Functional Rehabilitation ◽  
Immediate Reconstruction ◽  
Flap Failure ◽  
Tissue Transfer ◽  
Free Flap Monitoring

AbstractMicrosurgical free tissue transfer represents the mainstay of care in both ablative locoregional management and the simultaneous reconstruction of a defect. Advances in microsurgical techniques have helped balance the restoration of both form and function—decreasing the significant morbidity once associated with large ablative, traumatic, or congenital defects—while providing immediate reconstruction enabling early aesthetic and functional rehabilitation. There are a multitude of perioperative measures and considerations that aim to maximize the success of free tissue transfer. These include nutritional support, tight glycemic control, acknowledgment of psychological and psychiatric factors, intraoperative surgical technique, and close postoperative monitoring of the patients' hemodynamic physiology. While the success rates of free tissue transfer in experienced hands are comparable to alternative options, the consequences of flap failure are catastrophic—with the potential for significant patient morbidity, prolonged hospital stay (and associated increased financial implications), and increasingly limited options for further reconstruction. Success is entirely dependent on a continuous arterial inflow and venous outflow until neovascularization occurs. Flap failure is multifactorial and represents a dynamic process from the potentially reversible failing flap to the necrotic irreversibly failed flap—necessitating debridement, prolonged wound care, and ultimately decisions concerned with future reconstruction. The overriding goal of free flap monitoring is therefore the detection of microvascular complications prior to permanent injury occurring—identifying and intervening within that critical period between the failing flap and the failed flap—maximizing the potential for salvage. With continued technique refinement, microvascular free flap reconstruction offers patients the chance for both reliable functional and aesthetic restoration in the face of significant ablative defects. The caveat to this optimism is the requirement for considered perioperative care and the optimization of those factors that may offer the difference between success and failure.

Simultaneous reconstruction of large skin and mucosal defect following head and neck surgery with a single skin paddle pectoralis major myocutaneous flap

2005 ◽  
Vol 119 (4) ◽  
pp. 303-305 ◽  
Author(s):  
P Chaturvedi ◽  
P S Pai ◽  
K A Pathak ◽  
D A Chaukar ◽  
M S Deshpande ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Pedicled Flap ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Skin Defect ◽  
Skin Paddle ◽  
Tissue Transfer ◽  
Mucosal Lining ◽  
Large Skin

The pectoralis major myocutaneous (PMMC) flap is commonly used for head and neck reconstruction especially in impoverished nations. PMMC is a sturdy pedicled flap with relatively fewer complications, the learning curve is short and no specialized training in microvascular surgery is needed in order to use this flap. In a defect that requires a large skin and mucosal lining the authors routinely use either a bi-paddle PMMC or a combination of PMMC (for the mucosal lining) and a delto-pectoral flap (for the skin defect). It is indisputable that free tissue transfer is a better way of reconstruction for the majority of most such defects. Unfortunately, not all patients can be offered this form of reconstruction due to the cost, time, expertise and infrastructural constraints in high volume centres such as ours. Bi-paddling of PMMC is hazardous in obese males and most female patients. In such patients the skin defect is reconstructed usually by the delto-pectoral (DP) flap but this, for obvious reasons, is less welcomed by the patients. The authors suggest a technique wherein mucosal lining is created by the myofascial lining (inner surface) of the flap and the skin defect is reconstructed by the skin paddle of the single paddle PMMC. It should be considered wherever a DP flap is unacceptable, or bi-paddling or free tissue transfer is not possible.

scholarly journals Arterial Coupling for Microvascular Free Tissue Transfer in Head and Neck Reconstruction

2005 ◽  
Vol 131 (10) ◽  
pp. 891 ◽  
Author(s):  
Douglas A. Ross ◽  
Jen Y. Chow ◽  
Joseph Shin ◽  
Richard Restifo ◽  
John K. Joe ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Tissue Transfer

Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children

2016 ◽  
Vol 27 (4) ◽  
pp. 846-856 ◽  
Author(s):  
Michael R. Markiewicz ◽  
Ramon L. Ruiz ◽  
Phillip Pirgousis ◽  
R. Bryan Bell ◽  
Eric J. Dierks ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Tissue Transfer
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