scholarly journals Importance of Postoperative Use of External Warming Devices in Flap Reconstructive Surgery

2021 ◽  
Author(s):  
Mohamed Maklad ◽  
Ahmed Emam
Keyword(s):  
Temperature Control ◽  
Reconstructive Surgery ◽  
Negative Impact ◽  
Thermal Regulation ◽  
Flap Survival ◽  
Flap Failure ◽  
Vascular Compromise ◽  
Standard Of Practice ◽  
Warming Devices

AbstractFlap failure, partial or complete, can have great negative impact on the patient and the reconstructive outcome. The effect of thermal regulation on flap survival is well recognized. This article focuses on the importance of external warming devices as a standard on postoperative flap care to avoid any temperature-related vascular compromise. PubMed, Medline, and EMBASE search had been performed. More than 60 papers have been reviewed. Out of them, that 29 references have been included in this review. The authors emphasize on the importance of strict postoperative flap temperature control with active warming devices as a standard of practice to minimize any related microcirculatory changes.

Does Laterality of Lower Extremity Donor Site Affect Outcomes in Microvascular Soft Tissue Lower Extremity Reconstruction?

2020 ◽  
Vol 36 (04) ◽  
pp. 289-293
Author(s):  
Jason W. Yu ◽  
William J. Rifkin ◽  
Z-Hye Lee ◽  
Zachary Borab ◽  
Allyson R. Alfonso ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Donor Site ◽  
Contralateral Side ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Flap Survival ◽  
Flap Failure ◽  
Vascular Compromise ◽  
Lower Extremity Reconstruction

Abstract Background There are many different variables to consider in lower extremity microvascular soft tissue reconstruction including flap choice. Our aim is to objectively evaluate recipient complications related to lower extremity donor flap laterality. Methods A total of 77 lower extremity soft tissue reconstructions utilizing microvascular free tissue transfers for Gustilo type III between 1979 and 2016 were collected. We compared complication rates between ipsilateral and contralateral donor sites relative to the injured leg. The following parameters were analyzed: overall complications, total flap failure, partial flap failure, major complications, operative takebacks, and salvage rates. Results In this study, 25 ipsilateral reconstructions were performed, while 52 cases utilized the contralateral leg. Overall complication rates were higher in the ipsilateral group (40.0%) compared with the contralateral side (23.1%) but were not statistically significant (p = 0.12). The ipsilateral group was four times as likely to experience vascular compromise (24.0 vs. 5.8%; p = 0.05). However, there were no significant differences in complications, flap failures or flap survival. Mean operative time was significantly greater in the same side group as compared with the contralateral group (11.3 vs. 7.5 hours; p = 0.006). Conclusion Although there is a higher risk of anastomotic thrombosis, particularly venous thrombosis, associated with ipsilateral donor-site group, there were no significant differences in complications or flap survival. Flaps can be harvested from a traumatized leg with acceptable complication rates while avoiding the morbidity of operating on an uninjured limb.

scholarly journals Postoperative care in ICU versus non-ICU after head and neck free-flap surgery: a systematic review and meta-analysis

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e053667
Author(s):  
Mubarak Ahmed Mashrah ◽  
Taghrid Aldhohrah ◽  
Ahmed Abdelrehem ◽  
Bahia Sabri ◽  
Hyat Ahmed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Meta Analysis ◽  
Postoperative Pneumonia ◽  
Flap Survival ◽  
Flap Failure

ObjectiveAdmission to the intensive care unit (ICU) has long been considered as routine by most head and neck surgeons after microvascular free-flap transfer. This study aimed to answer the question ‘Is there a difference in the flap survival and postoperative complications rates between admission to intensive care unit (ICU) versus Non-ICU following microvascular head and neck reconstructive surgery?’.DesignSystematic review, and meta-analysis.MethodsThe PubMed, Embase, Scopus and Cochrane Library electronic databases were systematically searched (till April 2021) to identify the relevant studies. Studies that compared postoperative nursing of patients who underwent microvascular head and neck reconstructive surgery in ICU and non-ICU were included. The outcome variables were flap failure and length of hospital stay (LOS) and other complications. Weighted OR or mean differences with 95% CIs were calculated.ResultsEight studies involving a total of 2349 patients were included. No statistically significant differences were observed between ICU and non-ICU admitted patients regarding flap survival reported (fixed, risk ratio, 1.46; 95% CI 0.80 to 2.69, p=0.231, I2=0%), reoperation, readmission, respiratory failure, delirium and mortality (p>0.05). A significant increase in the postoperative pneumonia (p=0.018) and sepsis (p=0.033) was observed in patients admitted to ICU compared with non-ICU setting.ConclusionThis meta-analysis showed that an immediate postoperative nursing in the ICU after head and neck microvascular reconstructive surgery did not reduce the incidence of flap failure or complications rate. Limiting the routine ICU admission to the carefully selected patients may result in a reduction in the incidence of postoperative pneumonia, sepsis, LOS and total hospital charge.

scholarly journals Late Free Flap Failure in Head and Neck Reconstruction: A Systematic Review

2018 ◽  
Vol 97 (7) ◽  
pp. 213-216 ◽  
Author(s):  
David Forner ◽  
Blair A. Williams ◽  
Fawaz M. Makki ◽  
Jonathan R.B. Trites ◽  
S. Mark Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Head And Neck Reconstruction ◽  
Time To Failure ◽  
Close Monitoring ◽  
Flap Failure ◽  
Vascular Compromise

Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.

Supporting patients considering reconstructive surgery

2017 ◽  
Author(s):  
Diana Harcourt ◽  
Alex Clarke
Keyword(s):  
Body Image ◽  
Breast Reconstruction ◽  
Reconstructive Surgery ◽  
Negative Impact ◽  
Sense Of Self ◽  
Decision Aids ◽  
Well Being ◽  
Shared Decision ◽  
Significant Negative Impact

Cancer diagnosis and treatment can have a significant negative impact on patients’ well-being, body image, sexuality, and sense of self. Reconstructive surgery is commonly assumed to offer improved body image and quality of life to patients whose appearance has altered as a result of cancer treatment, but deciding whether or not to undergo reconstructive surgery can be difficult. This chapter uses the example of breast reconstruction to consider the ways in which patients faced with complex decisions about appearance-altering reconstructive surgery might be helped to make the choice that is best for them. It outlines typical options around the type and timing of breast reconstruction, considers patients’ motivation for surgery, and satisfaction with the outcome. It then explores ways of helping them make their decision, highlighting the use of decision aids and interventions focused around patients’ expectations of surgery as a way of facilitating shared decision-making in this context.

Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity

2017 ◽  
Vol 83 (10) ◽  
pp. 1161-1165 ◽  
Author(s):  
Ido Badash ◽  
Karen E. Burtt ◽  
Hyuma A. Leland ◽  
Daniel J. Gould ◽  
Alexis D. Rounds ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Arterial Injury ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Arterial Injuries ◽  
Flap Failure ◽  
Vascular Compromise ◽  
Tissue Reconstruction

Traumatic lower extremity fractures with compromised arterial flow are limb-threatening injuries. A retrospective review of 158 lower extremities with traumatic fractures, including 26 extremities with arterial injuries, was performed to determine the effects of vascular compromise on flap survival, successful limb salvage and complication rates. Patients with arterial injuries had a larger average flap surface area (255.1 vs 144.6 cm2, P = 0.02) and a greater number of operations (4.7 vs 3.8, P = 0.01) than patients without vascular compromise. Patients presenting with vascular injury were also more likely to require fasciotomy [odds ratio (OR): 6.5, confidence interval (CI): 2.3–18.2] and to have a nerve deficit (OR: 16.6, CI: 3.9–70.0), fracture of the distal third of the leg (OR: 2.9, CI: 1.15–7.1) and intracranial hemorrhage (OR: 3.84, CI: 1.1–12.9). After soft tissue reconstruction, patients with arterial injuries had a higher rate of amputation (OR: 8.5, CI: 1.3–53.6) and flap failure requiring a return to the operating room (OR: 4.5, CI: 1.5–13.2). Arterial injury did not correlate with infection or overall complication rate. In conclusion, arterial injuries resulted in significant complications for patients with lower extremity fractures requiring flap coverage, although limb salvage was still effective in most cases.

scholarly journals Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 865
Author(s):  
Michael Knitschke ◽  
Sophia Sonnabend ◽  
Christina Bäcker ◽  
Daniel Schmermund ◽  
Sebastian Böttger ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Operating Time ◽  
Adjuvant Radiation ◽  
Success Rates ◽  
Recipient Site ◽  
Skin Paddle ◽  
Flap Failure ◽  
Fibula Free Flap

Fibula free flap (FFF) is widely used in head and neck reconstructive surgery and is considered as a standard and therapy of choice after ablative cancer surgery. The aim of this retrospective monocenter study was to determine the success rates of fibula free flaps for jaw reconstruction after ablative tumor surgery. The disease course of patients who underwent jaw reconstructive surgery with FFF from January 2002 to June 2020 was evaluated regarding the flap success rate. Flap failure was analyzed in detail and categorized into two groups: partial flap failure (PFF) and total flap failure (TFF). A total of 180 free fibular flaps were performed over the last 19 years and a total of 36 flap failures were recorded. TFF occurred in n = 20 (56.6%) and PFF in n = 16 cases (44.4%) cases. No statistically significant differences were found concerning patients’ age at flap transfer, sex, BMI, ASA-Score, preoperative non-virtual or virtual surgical planning (non-VSP vs. VSP), and time of reconstruction (immediately vs. delayed). Duration of hospitalization shows statistically significant differences between both groups (p = 0.038), but no differences concerning operating time and duration on Intensive Care Unit (ICU). Partial flap failure appears to be underreported in literature. Sub- and complete failure of the skin paddle leads to clinical complaints like uncovered bone segments and plate exposure. Partial or complete FFF failure lead to infections on the recipient site and prolonged wound healing and therefore may cause a delay of the beginning of adjuvant radiation therapy (RT). PFF of hard tissue can be induced by RT.

scholarly journals Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review

Life ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 65
Author(s):  
Anouk A. M. A. Lindelauf ◽  
Alexander G. Saelmans ◽  
Sander M. J. van Kuijk ◽  
René R. W. J. van der Hulst ◽  
Rutger M. Schols
Keyword(s):  
Systematic Review ◽  
Infrared Spectroscopy ◽  
Hyperspectral Imaging ◽  
Near Infrared Spectroscopy ◽  
Free Flap ◽  
Near Infrared ◽  
Flap Survival ◽  
Non Invasive ◽  
Vascular Compromise ◽  
Flap Monitoring

Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority

scholarly journals The Delay Phenomenon: A Compilation of Knowledge across Specialties

2014 ◽  
Vol 7 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Kristy Hamilton ◽  
Erik M. Wolfswinkel ◽  
William M. Weathers ◽  
Amy S. Xue ◽  
Daniel A. Hatef ◽  
...  
Keyword(s):  
Ischemic Preconditioning ◽  
Reconstructive Surgery ◽  
Inclusion Criteria ◽  
Plastic And Reconstructive Surgery ◽  
Flap Failure ◽  
Incomplete Model ◽  
Flap Design ◽  
Vascular Delay ◽  
Angiogenic Genes ◽  
Delay Phenomenon

Objective The purpose of this article is to review and integrate the available literature in different fields to gain a better understanding of the basic physiology and optimize vascular delay as a reconstructive surgery technique. Methods A broad search of the literature was performed using the Medline database. Two queries were performed using “vascular delay,” a search expected to yield perspectives from the field of plastic and reconstructive surgery, and “ischemic preconditioning,” (IPC) which was expected to yield research on the same topic in other fields. Results The combined searches yielded a total of 1824 abstracts. The “vascular delay” query yielded 76 articles from 1984 to 2011. The “ischemic preconditioning” query yielded 6534 articles, ranging from 1980 to 2012. The abstracts were screened for those from other specialties in addition to reconstructive surgery, analyzed potential or current uses of vascular delay in practice, or provided developments in understanding the pathophysiology of vascular delay. 70 articles were identified that met inclusion criteria and were applicable to vascular delay or ischemic preconditioning. Conclusion An understanding of IPC's implementation and mechanisms in other fields has beneficial implications for the field of reconstructive surgery in the context of the delay phenomenon. Despite an incomplete model of IPC's pathways, the anti-oxidative, anti-apoptotic and anti-inflammatory benefits of IPC are well recognized. The activation of angiogenic genes through IPC could allow for complex flap design, even in poorly vascularized regions. IPC's promotion of angiogenesis and reduction of endothelial dysfunction remain most applicable to reconstructive surgery in reducing graft-related complications and flap failure.

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