Scalp and Skull Reconstruction in Patients Irradiated for Tinea Capitis in Childhood: The Scalp Exchange Procedure

Abstract Background Approximately 70,000 Israelis underwent scalp irradiation for tinea capitis infection during their childhood, as did many other children worldwide. Long-term follow-up data showed that these children had an increased risk of aggressive and multiple nonmelanoma skin cancers, meningiomas, and other malignancies. Resection of these lesions creates a defect of soft tissue, bone, and dura, and requires scalp and skull reconstruction with local or free flaps in the irradiated field. Methods Sixteen patients with a history of childhood scalp irradiation underwent scalp and skull reconstruction in our department (2000–2018). Data on demographics, oncological status, operative details, and postoperative outcome were retrospectively collected and analyzed. Results The study group included 11 males and 5 females (average age at surgery, 70 years). The most common lesions were meningiomas (n = 9) and basal cell carcinomas (n = 8), and the most common indication for reconstruction was chronic exposure of deep structures (skull, dura, brain tissue, and titanium mesh; n = 9). Thirteen patients underwent primary free flap reconstruction and three underwent primary local flap reconstruction. Flap failure requiring reoperation occurred in one patient of the free flap reconstruction group (7%) and in all three patients of the local flap reconstruction group. Conclusion Long-term consequences of childhood depilatory treatments of the scalp by irradiation are now surfacing. Our experience showed that in such cases, surgeons should aim for a more aggressive approach with wide resection and primary free flap reconstruction, and that favorable long-term functional and aesthetic results can safely be achieved using this reconstruction approach.

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Assessing the Influence of Failed Implant Reconstruction on Patient Satisfaction and Decision Regret after Salvage Free-Flap Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1735224 ◽

2021 ◽

Author(s):

Ronnie L. Shammas ◽

Amanda R. Sergesketter ◽

Mahsa Taskindoust ◽

Sonali Biswas ◽

Scott T. Hollenbeck ◽

...

Keyword(s):

Patient Satisfaction ◽

Breast Reconstruction ◽

Free Flap ◽

Well Being ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Decision Regret ◽

History Of ◽

Implant Reconstruction

Abstract Background Free-flap breast reconstruction after failed implant reconstruction is associated with improved patient outcomes. How the level of satisfaction achieved compares between patients with and without previously failed implant reconstruction remains unknown. The aim of this study was to assess the influence of prior failed implant-based reconstruction on long-term patient-reported outcomes after free-flap breast reconstruction. Methods All patients undergoing free-flap breast reconstruction between 2015 and 2019 were identified. Patient satisfaction using the BREAST-Q and decisional regret using the Decision Regret Scale were compared between patients with and without a history of implant breast reconstruction. Results Overall, 207 patients were contacted and 131 completed the BREAST-Q and Decision Regret Scale. A total of 23 patients had a history of failed implant-based reconstruction requiring free-flap-flap salvage, most commonly due to infection (39.1%), chronic pain (34.8%), capsular contracture (26%), and implant malposition (26.1%). Following definitive free-flap reconstruction, patients with prior failed implant reconstruction had significantly lower BREAST-Q scores for satisfaction with breast (61.2 ± 16.7 vs. 70.4 ± 18.7; p = 0.04) and sexual well-being (38.5 ± 18.2 vs. 52.8 ± 24.7; p = 0.01) and reported higher decision regret (19.1 ± 18.6 vs. 9.6 ± 15.6, respectively). There were no significant differences for psychosocial well-being (p = 0.67), physical well-being (chest; p = 0.27), and physical well-being (abdomen; p = 0.91). Conclusion A history of failed implant-based reconstruction is associated with reduced satisfaction and increased decision regret with the final reconstructive outcome. This data underscores the importance of appropriate patient selection at the initial consultation, and informed preoperative counseling regarding long-term outcomes in patients presenting for free-flap reconstruction after a failed implant-based reconstruction.

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Long-term Outcomes After Pediatric Free Flap Reconstruction

Annals of Plastic Surgery ◽

10.1097/sap.0000000000001549 ◽

2018 ◽

Vol 81 (4) ◽

pp. 449-455 ◽

Cited By ~ 3

Author(s):

Lee W. T. Alkureishi ◽

Chad A. Purnell ◽

Patricia Park ◽

Bruce S. Bauer ◽

Neil A. Fine ◽

...

Keyword(s):

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Long Term Outcomes

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Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

Otolaryngology ◽

10.1177/0194599818777240 ◽

2018 ◽

Vol 159 (5) ◽

pp. 817-823 ◽

Cited By ~ 7

Author(s):

Meghan M. Crippen ◽

Jacob S. Brady ◽

Alexander M. Mozeika ◽

Jean Anderson Eloy ◽

Soly Baredes ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Postoperative Complications ◽

Head And Neck ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Flap Surgery ◽

Free Flap Surgery ◽

Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

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Effect of Blood Transfusion on Short- and Long-Term Outcomes in Oral Squamous Cell Carcinoma Patients Undergoing Free Flap Reconstruction

Frontiers in Surgery ◽

10.3389/fsurg.2021.666768 ◽

2021 ◽

Vol 8 ◽

Author(s):

Aimin Feng ◽

Jiaqiang Zhang ◽

Xihua Lu ◽

Qigen Fang

Keyword(s):

Squamous Cell Carcinoma ◽

Blood Transfusion ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Short And Long Term

Purpose: To analyze the short- and long-term effect of perioperative blood transfusion (PBT) in patients undergoing surgical treatment for oral squamous cell carcinoma (SCC).Methods: Patients undergoing free flap reconstruction were retrospectively enrolled and divided into two groups based on the implementation of PBT. Flap revision, surgical site infection (SSI), flap failure, overall survival (OS), and disease-specific survival (DSS) were compared between the two groups.Results: In 170 patients with PBT, 10 (5.9%) flaps required exploration revision, SSI occurred in 18 (10.6%) patients, and flap necrosis was noted in 6 (3.5%) patients. These rates were comparable to those in patients without PBT. The two groups had similar DSS rates, but the 5-year OS rates were 49 and 59% in patients with PBT and without PBT, respectively. This difference was significant. Patients with 4 units of PBT had OS rates comparable to those of patients with >4 units of PBT. A Cox model confirmed the fact that the decrease in OS was independent of PBT.Conclusion: In patients with free flap reconstruction for oral SCC, PBT did not increase the short-term complication rate or cancer-linked mortality. However, it was related to an elevated overall risk of death.

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Free flap reconstruction after surgical release of oral submucous fibrosis: Long-term maintenance and its clinical implications

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2013.12.004 ◽

2014 ◽

Vol 67 (3) ◽

pp. 344-349 ◽

Cited By ~ 8

Author(s):

Richie Chiu-Lung Chan ◽

Fu-Chan Wei ◽

Chung-Kan Tsao ◽

Huang-Kai Kao ◽

Yang-Ming Chang ◽

...

Keyword(s):

Free Flap ◽

Oral Submucous Fibrosis ◽

Clinical Implications ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Submucous Fibrosis ◽

Term Maintenance ◽

Surgical Release

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Long‐term clinical and p atient‐reported outcomes in free flap reconstruction of the w eight‐bearing heel pad and n on‐weight‐bearing Achilles tendon regions

Microsurgery ◽

10.1002/micr.30658 ◽

2020 ◽

Vol 40 (8) ◽

pp. 835-845

Author(s):

Jennifer N. Grauberger ◽

Waleed O. Gibreel ◽

Steven L. Moran ◽

Brian T. Carlsen ◽

Karim Bakri

Keyword(s):

Achilles Tendon ◽

Free Flap ◽

Weight Bearing ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Heel Pad

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Long-term quality of life and psycho-social outcomes after oropharyngeal cancer surgery and radial forearm free-flap reconstruction: A GETTEC prospective multicentric study

Surgical Oncology ◽

10.1016/j.suronc.2017.11.005 ◽

2018 ◽

Vol 27 (1) ◽

pp. 23-30 ◽

Cited By ~ 17

Author(s):

Alexandre Bozec ◽

Pierre Demez ◽

Jocelyn Gal ◽

Emmanuel Chamorey ◽

Marie-Yolande Louis ◽

...

Keyword(s):

Quality Of Life ◽

Free Flap ◽

Oropharyngeal Cancer ◽

Radial Forearm Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Multicentric Study ◽

Radial Forearm

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Long-term survival after head and neck cancer surgery with immediate free flap reconstruction

Annales de Chirurgie Plastique Esthétique ◽

10.1016/j.anplas.2021.02.002 ◽

2021 ◽

Author(s):

L. Dekerle ◽

S. Cortese ◽

J. Salleron ◽

P. Rauch ◽

R. Mastronicola ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Cancer Surgery ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Term Survival ◽

Long Term Survival

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Outcomes in Head and Neck Free Flap Reconstruction Among Patients With a History of Venous Thromboembolism

Otolaryngology ◽

10.1177/01945998211011999 ◽

2021 ◽

pp. 019459982110119

Author(s):

Meghan M. Crippen ◽

Rohan S. Ganti ◽

Vivian Xu ◽

Brian Swendseid ◽

Diana L. Tzeng ◽

...

Keyword(s):

Logistic Regression ◽

Venous Thromboembolism ◽

Head And Neck ◽

Free Flap ◽

Tertiary Care ◽

Binary Logistic Regression ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Increased Risk ◽

History Of

Objective To investigate if a history of venous thromboembolism (VTE) is a risk factor for complications in head and neck free flap surgery by assessing outcomes among patients with a history of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Study Design Retrospective cohort study. Setting Single tertiary care center. Methods All patients undergoing head and neck free flap reconstruction at our institution between September 1, 2006, and April 2, 2020, were assessed for inclusion. Patients with and without a history of DVT or PE preoperatively were identified and grouped for comparison. Groups were compared for demographics, comorbidities, and 30-day complications. Significance was assessed with chi-square and binary logistic regression analyses. Results Of the 1061 patients meeting inclusion criteria, 40 (3.8%) had a history of VTE. These patients were significantly older (mean [SD], years: 67.8 [11.7] vs 63.0 [14.1], P = .038) and significantly more likely to have history of chemotherapy (35.0% vs 18.7%, P = .010) and stroke (27.5% vs 4.5%, P < .001). After accounting for patient characteristics via binary logistic regression, VTE was independently associated with an increased risk for postoperative thrombosis of the free flap pedicle (odds ratio [95% CI] = 3.65 [1.12-11.90], P = .032) and reoperation (2.45 [1.25-4.80], P = .009). Patients with history of PE had a significantly increased risk for flap failure (7.70 [1.77-33.52], P = .007). Prior VTE was not independently associated with an increased risk for medical complications or readmission. Conclusion Patients with a history of VTE may be at an increased risk for free flap compromise secondary to postoperative pedicle thrombosis. This risk should be considered in preoperative workup and postoperative monitoring.

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