Anatomy, Exposure, and Preparation of Recipient Vessels in Microsurgical Head and Neck Reconstruction

2020 ◽  
Author(s):  
Hope Xu ◽  
Leila Jazayeri ◽  
Evan Matros ◽  
Peter W. Henderson
Keyword(s):  
Head And Neck ◽  
Clinical Anatomy ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Submandibular Region ◽  
Comprehensive Review ◽  
Neck Reconstruction ◽  
Posterior Triangle

AbstractSuccessful microvascular reconstruction of head and neck defects requires the ability to safely identify, isolate, and utilize recipient vessels. To date, however, a comprehensive review of the anatomy and techniques relevant to the available anatomic regions has not been undertaken. This review covers the relevant clinical anatomy of the anterior triangle, posterior triangle, submandibular region, intraoral region, preauricular region, chest, and arm, taking particular care to highlight the structures that are crucial to identify while performing each dissection. Finally, a step-by-step technique for safely dissecting the recipient vessels at each site is provided.

scholarly journals Head and neck oncological reconstruction with 114 free flaps in a Portuguese tertiary cancer center

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Andreia Silva ◽  
Patrícia Caixeirinho ◽  
Miguel Vilares ◽  
Carina Semedo ◽  
Mariluz Martins ◽  
...  
Keyword(s):  
Head And Neck ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
Functional Results ◽  
Cancer Center ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Oncological Surgery ◽  
Microsurgical Reconstruction ◽  
Neck Reconstruction

Introduction: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted.Results: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived.Discussion: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world.Conclusion: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.

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.

Outcomes of Head and Neck Microvascular Reconstruction in Hypercoagulable Patients

2019 ◽  
Vol 36 (04) ◽  
pp. 271-275
Author(s):  
Trang T. Nguyen ◽  
Katie G. Egan ◽  
Danielle L. Crowe ◽  
Niaman Nazir ◽  
Wojciech H. Przylecki ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Head And Neck ◽  
Thrombotic Event ◽  
Vena Cava ◽  
Head And Neck Reconstruction ◽  
Microvascular Reconstruction ◽  
Neck Reconstruction ◽  
Flap Loss

Abstract Background Inherited coagulopathies and previous thrombotic events are often considered relative contraindications to microvascular reconstruction. We hypothesize that with planning, head and neck microvascular reconstruction can be successfully performed in hypercoagulable individuals. Methods A retrospective review was conducted of subjects with coagulopathies or previous thrombotic events who underwent microvascular head and neck reconstruction. Outcomes studied were “flap-related complications” (arterial/venous compromise or flap loss) and “patient-related complications” (hematoma, deep venous thrombosis, pulmonary embolism, infection, stroke, or death). Results One hundred thirty-four microvascular flaps were performed in 117 subjects. Twenty-four subjects (20.5%) had a preoperative hypercoagulable condition and underwent 28 microvascular reconstructions. Twenty-three of 24 subjects had a previous thrombotic event, with five subjects identified with an inherited or acquired coagulopathy. All microvascular reconstructions were successful; however, complications occurred in 12 of 28 reconstructions (42.9%). Complications were “flap related” in four reconstructions (14.3%), “patient related” in nine reconstructions (32.1%), and both in one reconstruction (3.6%). Flap-related complications included small partial flap loss (n = 2), arterial compromise (n = 1), and venous compromise (n = 1), with all undergoing successful salvage. Patient-related complications included hematoma (n = 3), pulmonary embolism (n = 2), infection (n = 2), deep venous thrombosis (n = 1), and death (n = 1). Statistical analysis demonstrated that complications were more common in subjects with inferior vena cava filters (p = 0.06) and hematomas were associated with the use of therapeutic heparin infusion (p = 0.04). Conclusion Microvascular head and neck reconstruction can be successfully performed in hypercoagulable subjects. However, patient-related complications remain a concern in these subjects.

Mechanical venous Anastomosis in Head and Neck Microvascular Reconstruction as an Equivalent to the Gold Standard

2017 ◽  
Vol 96 (2) ◽  
pp. E32-E36 ◽  
Author(s):  
Eric Thorpe ◽  
Yash Patil
Keyword(s):  
Head And Neck ◽  
Gold Standard ◽  
Case Series ◽  
Head And Neck Reconstruction ◽  
Consecutive Series ◽  
Microvascular Reconstruction ◽  
Venous Outflow ◽  
Venous Anastomosis ◽  
Flap Survival ◽  
Neck Reconstruction

To define the most successful and efficient manner to perform venous microvascular anastomoses, the effectiveness of mechanical venous anastomosis in head and neck microvascular reconstruction is reviewed. Head and neck reconstruction with free flap techniques has become the norm and gold standard for large defects. This retrospective, multicenter case series of a single microvascular surgeon's experience with mechanical venous anastomoses specifically assessed the effectiveness of head and neck reconstruction and the complications associated with it. Data were collected from two separate academic centers and are reported from a consecutive series of patients over the course of 10 years. All patients underwent microvascular reconstruction of the head and neck region using venous couplers and flap survival. Flap survival was greater than 98% using mechanical venous couplers as the primary means for venous outflow in this series of 402 consecutive patients and 431 total microvascular flaps. Venous couplers were performed in every instance. The study shows that mechanical venous anastomosis provides a highly effective and efficient means for venous outflow in head and neck microvascular reconstruction, and should be considered equivalent to the gold standard suture technique, even in the most difficult cases.

Preoperative radiation therapy and its effects on outcomes in microsurgical head and neck reconstruction

2005 ◽  
Vol 132 (6) ◽  
pp. 845-848 ◽  
Author(s):  
Samuel Lin ◽  
Jose Dutra ◽  
JAY Keni ◽  
Gregory A. Dumanian ◽  
Neil Fine ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Complication Rate ◽  
Head And Neck Reconstruction ◽  
Consecutive Series ◽  
Microvascular Reconstruction ◽  
Preoperative Radiation ◽  
Ischemic Time ◽  
Neck Reconstruction ◽  
Preoperative Radiation Therapy

OBJECTIVE: Preoperative radiation therapy is considered a significant factor in head and neck reconstruction. STUDY AND DESIGN AND SETTING: In our consecutive series of 114 patients, 44 patients had prior head and neck irradiation. The 2 groups were compared on the basis of age, ischemic time, and flap size and were found not to be statistically different. The average ischemic time for the irradiated group was 94.1 minutes, and the average was 102.8 minutes for the nonirradiated group. The average flap size for the irradiated group was 69.5 cm 2 , and was 72.0 cm 2 , for the nonirradiated group. RESULTS: Using a single-factor analysis of variance, the 2 groups did not differ statistically. The overall major flap complication rate for both irradiated and nonirradiated groups was approximately 10%. CONCLUSION: Microvascular reconstruction was accomplished in both irradiated and nonirradiated head and neck patients, with a 99% total flap survival rate and a 10% major flap complication rate.

Head and Neck Reconstruction with Perforator Flaps

2006 ◽  
Vol 22 (03) ◽  
Author(s):  
G. Pons ◽  
J. Masia ◽  
J. Sancho ◽  
J. Larrañaga ◽  
P. Serret
Keyword(s):  
Head And Neck ◽  
Head And Neck Reconstruction ◽  
Perforator Flaps ◽  
Neck Reconstruction
Sign in / Sign up

Export Citation Format

Share Document