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

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.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001049 ◽

2017 ◽

Vol 131 (7) ◽

pp. 585-592 ◽

Cited By ~ 5

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.

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HEAD AND NECK RECONSTRUCTION

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.02.2092 ◽

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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Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001592 ◽

2019 ◽

Vol 133 (09) ◽

pp. 742-746

Author(s):

L F Jones ◽

E M Farrar ◽

D J H Roberts ◽

J W Moor

Keyword(s):

Head And Neck ◽

Imaging Techniques ◽

Pedicled Flap ◽

Head And Neck Reconstruction ◽

Complication Rates ◽

Success Rates ◽

Flap Surgery ◽

Neck Reconstruction ◽

Free Flap Surgery ◽

Variable Nature

AbstractBackgroundThe sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.ObjectiveTo provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.MethodsA literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.ResultsReported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.ConclusionThe sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.

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

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-1688711 ◽

2019 ◽

Vol 35 (07) ◽

pp. 516-521 ◽

Cited By ~ 2

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.

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