Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?

2019 ◽  
Vol 35 (07) ◽  
pp. 516-521 ◽  
Author(s):  
James J. Drinane ◽  
John Drinane ◽  
Lakshmi Nair ◽  
Ashit Patel
Keyword(s):  
Head And Neck ◽  
Plastic Surgery ◽  
Resource Utilization ◽  
Average Length ◽  
Bleeding Complications ◽  
Unplanned Readmission ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Potential Cost ◽  
Neck Reconstruction

Background Reconstruction of head and neck defects resulting from resection of head and neck masses is performed by both plastic surgeons and otolaryngologists. The American College of Surgeons National Surgical Quality Improvement (NSQIP) database allows one to directly compare the outcomes for a given procedure based upon specialty. The purpose of this study is to compare outcomes and resource utilization of microvascular head and neck reconstruction between plastic surgery and otolaryngology. Methods Institutional review board approval was obtained and NSQIP was queried from 2005 to 2015 with inclusion of Current Procedural Terminology codes for free tissue transfer performed for head and neck reconstruction. Outcomes were compared between cases having otolaryngology and plastic surgery as performing the free flap reconstruction. Results During 2005 to 2015, a total of 2,322 flaps were performed, 893 by plastic surgery and 1,429 by otolaryngology. Average length of stay (LOS) was 13.7 and 11.4 days for plastic surgery and otolaryngology, respectively. It was found that plastic surgery performed more osteocutaneous flaps than otolaryngology. Higher rates of superficial surgical site infection, deep surgical site infections, wound dehiscence, myocardial infarction, bleeding complications, sepsis, unplanned return to the operating room, and unplanned readmission were observed for patients treated by otolaryngology (p < 0.05). Conclusion This study shows plastic surgery patients have superior outcomes with regards to free tissue transfers of the head and neck when compared with otolaryngology patients. Although plastic surgery patients experienced a longer LOS, the significantly lower complication rate supports an overall more optimal resource utilization. Future studies may elucidate potential cost savings in patients treated by plastic surgery.

scholarly journals Disappearance of Internal Jugular Vein Thrombosis After Use of Edoxaban Following Head and Neck Reconstruction: A Case Report

2020 ◽  
pp. 1-4
Author(s):  
Masahiro Sasaki ◽  
Yoichiro Shibuya ◽  
Akio Nishijima ◽  
Junya Oshima ◽  
Kaoru Sasaki ◽  
...  
Keyword(s):  
Head And Neck ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Bleeding Complications ◽  
Head And Neck Reconstruction ◽  
Free Flap Reconstruction ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
Neck Reconstruction ◽  
Internal Jugular Vein Thrombosis

Internal jugular vein thrombosis (IJVT) is a complication of neck dissection. After head and neck reconstruction, flap congestion due to IJVT may lead to flap necrosis, and early diagnosis and treatment should be considered. We experienced a case of disappearance of IJVT in which edoxaban was administered after free-flap reconstruction, and the entire flap survived. Edoxaban has few bleeding complications and was useful as a single drug approach for IJVT after head and neck reconstruction.

scholarly journals The Decline of Head and Neck Reconstruction in Plastic Surgery

2020 ◽  
Vol 145 (2) ◽  
pp. 467e-468e
Author(s):  
Z.-Hye Lee ◽  
David A. Daar ◽  
Adam S. Jacobson ◽  
Jamie P. Levine
Keyword(s):  
Head And Neck ◽  
Plastic Surgery ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction

Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?

2019 ◽  
Vol 35 (07) ◽  
pp. e1-e2
Author(s):  
Andrés M. Bur ◽  
Steven B. Cannady ◽  
Urjeet A. Patel ◽  
Eben L. Rosenthal ◽  
Mark K. Wax
Keyword(s):  
Head And Neck ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Surgical Specialty ◽  
Neck Reconstruction

Breaking Down Silos: Collaboration in Head and Neck Reconstruction Research

2020 ◽  
Author(s):  
Amanda K. Silva ◽  
Eduardo D. Rodriguez ◽  
Adam S. Jacobson ◽  
Jamie P. Levine
Keyword(s):  
Head And Neck ◽  
Plastic Surgery ◽  
Interdisciplinary Collaboration ◽  
Maxillofacial Surgery ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Reconstructive Microsurgery ◽  
Working Together ◽  
American Society ◽  
Oral Presentations

Abstract Background Collaboration has been shown to be beneficial when we have complex problems and highly specialized groups, such as in head and neck reconstruction. Otolaryngology, plastic surgery, and oral maxillofacial surgeons perform head and neck reconstruction research. While the specialties represent unique backgrounds, the degree of interdisciplinary collaboration and subtopic focus is unknown. We sought to describe the frequency of interinstitutional interdisciplinary collaboration and examine the association of specialty with research subtopics. Methods Oral presentations from 2014 to 2018 focused on head and neck reconstruction or associated principles at the main reconstructive academic meetings in otolaryngology (American Head and Neck Society), plastic surgery (American Society for Reconstructive Microsurgery), and oral maxillofacial surgery (American Association of Oral and Maxillofacial Surgeons) were reviewed. Author specialty and institution data were recorded. All abstracts were assigned a research subtopic, chosen based on identified themes. Subtopic frequencies among the specialties were compared. Results Thirteen of 88 (15%) US institutions participate in interdisciplinary collaboration in head and neck reconstruction research. Of the remaining institutions, 23 (31%) have researchers performing parallel work and not collaborating. Certain research subtopics were more often presented by each specialty, representing differing interests. Conclusion Collaboration among head and neck reconstruction research at the US institutions is low compared with the potential. Specialties focus on different research subtopics, and therefore can benefit from working together.

scholarly journals Scapular Tip Free Flap in Composite Head and Neck Reconstruction

2018 ◽  
Vol 160 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Jeremiah C. Tracy ◽  
Bryan Brandon ◽  
Samip N. Patel
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Average Length ◽  
Academic Medical Center ◽  
Donor Site ◽  
Case Series ◽  
Head And Neck Reconstruction ◽  
Bony Defect ◽  
Neck Reconstruction ◽  
Postoperative Hematoma

Objectives To describe the use of the scapular tip free flap (STFF) in the reconstruction of head and neck defects. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods A review of the electronic medical record was performed of all patients who underwent head and neck reconstructive surgery with STFFs from January 1, 2014, through January 1, 2016. Details regarding the disease, defect reconstructed, and surgical outcomes were quantified. Results Thirty-one consecutive cases were performed at our institution within the period reviewed. The procedures included reconstruction of 5 maxillectomy and 26 mandibulectomy defects. The mean length of mandible reconstructed was 6.8 cm (95% CI, 6.01-7.59; range, 4.0-10.2). Osteotomies were made to contour the scapular bone in 11 cases, including double osteotomies performed in 2 cases. The most common surgical complications were orocutaneous fistula and postoperative hematoma, which occurred in 3 (10%) and 2 (6.5%) of 31 patients, respectively. Conclusion This series describes a large number of STFFs performed in head and neck reconstruction. The average length of bony defect repair can be significantly larger than what was previously described. Performing osteotomies to the STFF allows for application to anterior mandibular defects. The STFF offers a large soft tissue component, a relatively long pedicle, and acceptable donor site morbidity. The STFF is a versatile reconstructive option that should be considered to address composite defects of the head and neck.

scholarly journals The effect of admission to intensive care unit on outcomes and complication rates after head and neck reconstruction

2018 ◽  
Vol 8 (3) ◽  
pp. 61-71
Author(s):  
F. Carta ◽  
A. Figus ◽  
N. Chuchueva ◽  
D. Quartu ◽  
G. B. Sambiagio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Head And Neck ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Study Objective ◽  
Reconstructive Procedures ◽  
Neck Reconstruction

The study objectiveis to evaluate the utilisation and effectiveness of intensive care unit (ICU) in the postoperative period as to its potential benefits to the head and neck reconstruction services.Materials and methods. This is a retrospective study on 143 consecutive patients who underwent 144 major head and neck microvascular reconstructive procedures performed by a single surgeon, that focused on perioperative management and on the relation between admission to ICU and complications/outcomes.Results.Thirty-four (23.6 %) patients were admitted to ICU during the early postoperative period. Admission to ICU was not associated with lower incidence of complications compared to direct admission to the Head and Neck ward: 29.4 % vs 27.3 % (p = 0.807709).Conclusion.Routinely early postoperative admission to ICU seems not to improve outcomes and/or reduce complications, and, as a consequence, ICU admission should be restricted to selected patients only.

Resource Utilization and Patient Morbidity in Head and Neck Reconstruction

1997 ◽  
Vol 107 (8) ◽  
pp. 1028-1031 ◽  
Author(s):  
Matthew R. Brown ◽  
Timothy M. McCulloch ◽  
Gerry F. Funk ◽  
Scott M. Graham ◽  
Henry T. Hoffman
Keyword(s):  
Head And Neck ◽  
Resource Utilization ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Patient Morbidity

Use of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction: systematic review

2017 ◽  
Vol 131 (7) ◽  
pp. 585-592 ◽  
Author(s):  
A Hui ◽  
P Hong ◽  
M Bezuhly
Keyword(s):  
Head And Neck ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Neck Reconstruction ◽  
Dermal Matrices ◽  
Acellular Dermal ◽  
Pharyngeal Reconstruction

AbstractBackground:Acellular dermal matrices are increasingly used in laryngotracheal and pharyngeal reconstruction, but specific indications and the type of acellular dermal matrix used vary. The authors systematically reviewed outcomes relating to acellular dermal matrix use in head and neck reconstruction.Methods:Electronic databases were searched through 1 May 2016 for literature on acellular dermal matrix use in laryngotracheal and pharyngeal reconstruction. Studies were appraised for surgical indications, outcomes and study design.Results:Eleven publications with 170 cases were included. Eight articles reported on acellular dermal matrix use in oncological reconstruction. Most studies were case series; no high-level evidence studies were identified. Graft extrusion was more common in non-oncological applications. In general, post-oncological reconstruction with an acellular dermal matrix demonstrated complication rates similar to those reported without an acellular dermal matrix.Conclusion:Evidence in support of acellular dermal matrix use in head and neck reconstruction is generally poor. Prospective comparative studies are required to define the indications, safety and effectiveness of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction.

S171 – Head and Neck Microvascular Reconstruction: Changing Trends

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P133-P133
Author(s):  
Rene M Pena ◽  
Paul Dae-Gwon Kim ◽  
Mark R Rowe
Keyword(s):  
Head And Neck ◽  
Plastic Surgery ◽  
Surgical Techniques ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Residency Programs ◽  
Neck Reconstruction ◽  
Case Number ◽  
Microvascular Free Flaps

Objectives The practice of head and neck reconstruction has been evolving over the past 15 years with the introduction of new surgical techniques, and increasing options for tissue harvest. We sought to investigate corresponding trends in the disciplines performing head and neck microvascular reconstruction. Methods 2 specialties for the proportion of head and neck microvascular reconstruction were compared: those performed by otolaryngologists and those done by plastics surgery. A 3-part study was performed to evaluate these trends: 1) Total case number of microvascular cases of otolaryngology residents and plastic surgery residents over the last 4 years was evaluated through the ACGME national data; 2) A poll of the percentage of otolaryngology residency programs that have their own microvascular reconstructive surgeon, and if that surgeon was hired within the last 5 years; and 3) The number of scientific articles published relating to microvascular head and neck reconstruction were systematically queried for 2 timeframes, (1995–2000) and (2002–2007). Results The national number of cases has steadily increased in the last 5 years. It has slowly increased compared to plastic surgery, but when all flaps are evaluated, it is not significant. We also found that the number of peer-reviewed articles relating to microvascular free flaps authored by otolaryngologists has increased. The data from the polls are still pending. Conclusions There is an increasing trend emerging in the practice of head and neck microvascular reconstruction, with an increase number of articles being authored and increased number of surgeries being performed by otolaryngolo-gists, compared to plastic surgeons.

scholarly journals HEAD AND NECK RECONSTRUCTION

2011 ◽  
Vol 18 (02) ◽  
pp. 310-316
Author(s):  
FIRDOUS KHAN ◽  
SYED ASIF SHAH ◽  
HIFSA HAMEED ◽  
Naji ullah Khan
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Pedicled Flap ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Salvage Procedure ◽  
Pedicle Flap ◽  
Reconstructive Procedures ◽  
Neck Reconstruction

Background: The pectoralis major myocutaneous pedicle flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. Objective: To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Patients and Methods: Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Results: Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity (25 patients); oropharynx/ hypopharynx, (7 patients); and neck or face (5 patients). Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients (67.59%) had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. Conclusions: The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed.

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