Is sequential free flap safe in oral cancer reconstruction in the same patient? An outcome and complication analysis

Abstract Background Sequential free flap reconstruction in patient with head and neck cancer can provide reliable and effective wound coverage. Only a few studies have reported on the outcome and complications analysis but without consensus on the recipient vessels and flap chosen. Herein, we presented the outcome and analysed the risk factors for complications in sequential free flap reconstruction. Patients and methods Patients who had sequential free tissue transfers due to cancer recurrence, second primary cancer, or secondary correction of the soft tissue contractures and volume deficits were all included. Variables extracted included demographics, comorbidities, free flap characteristics, infection, dehiscence and flap necrosis rates. Results In total, 40 patients with 92 free flaps were analyzed; 42 initial and 50 sequential free flaps. The most common recipient vessels for sequential flap were contralateral superficial thyroid vessels (68%). The most common flap for both initial and sequential free flap was anterolateral thigh flap (64.3 and 62%). The success rate of sequential free flap was 92.0 compared to 92.9% for initial free flap, which showed no significant difference. Female was independently associated with delayed wound healing with an odds ratio of 90.91 (95% confidence interval 0.001–0.17, P = 0.001), as well as diabetes with an odds ratio of 31.14 (95% confidence interval 2.60–373.19, P = 0.007). Sequential free flap was not a risk factor for any complication. Conclusions Sequential free flap is a reliable method for head and neck surgery without more complication rate comparing to initial free flap reconstruction. More attentions should be paid on patients with preferential risk for certain complications.

Download Full-text

Reconstruction with free flaps in robotic head-and-neck onco-surgeries

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_35_18 ◽

2018 ◽

Vol 51 (03) ◽

pp. 283-289 ◽

Cited By ~ 1

Author(s):

Rajan Arora ◽

Vinay Kumar Verma ◽

Kripa Shanker Mishra ◽

Hemant Bhoye ◽

Rahul Kapoor

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Dissection ◽

Neck Cancer ◽

Free Flap ◽

Free Flaps ◽

Cancer Surgery ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Good Outcome

ABSTRACT Aims and Objective: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. Materials and Methods: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. Results: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. Conclusion: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

Download Full-text

Is the microsurgical end-to-side continuous suture technique a safe and favourable procedure for free flap reconstruction of the head and neck? The experience of over 750 microsurgical free flaps

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2017.02.611 ◽

2017 ◽

Vol 46 ◽

pp. 178-179

Author(s):

C. Dinu ◽

H. Nachawati ◽

M. Kos ◽

E. Gudewer ◽

L. Li

Keyword(s):

Head And Neck ◽

Free Flap ◽

Free Flaps ◽

Suture Technique ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Continuous Suture ◽

Microsurgical Free Flaps

Download Full-text

Intraoperative fluorescent angiography analysis for head and neck micro-vascula free flap reconstruction- a preliminary experience

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2014.07.019 ◽

2014 ◽

Vol 52 (8) ◽

pp. e48

Author(s):

Melvyn Yeoh ◽

D. David Kim

Keyword(s):

Head And Neck ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction

Download Full-text

Free Flap Reconstruction in the Head and Neck. Indications, Technical Aspects and Outcomes

Acta Otorrinolaringologica (English Edition) ◽

10.1016/j.otoeng.2014.02.011 ◽

2014 ◽

Vol 65 (1) ◽

pp. 33-42

Author(s):

José Luis Llorente ◽

Fernando López ◽

Vanessa Suárez ◽

Ángel Fueyo ◽

Susana Carnero ◽

...

Keyword(s):

Head And Neck ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Technical Aspects

Download Full-text

Simultaneous Interstitial Radiotherapy With Regional or Free-Flap Reconstruction, Following Salvage Surgery of Recurrent Head and Neck Carcinoma: Analysis of Complications

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1994.01880330047009 ◽

1994 ◽

Vol 120 (9) ◽

pp. 965-972 ◽

Cited By ~ 25

Author(s):

J. F. Moscoso ◽

M. L. Urken ◽

J. Dalton ◽

M. F. Wesson ◽

H. F. Biller

Keyword(s):

Head And Neck ◽

Free Flap ◽

Salvage Surgery ◽

Head And Neck Carcinoma ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Interstitial Radiotherapy ◽

Neck Carcinoma ◽

Recurrent Head

Download Full-text

Prospective Randomized Trial on Postoperative Administration of Diet Containing Eicosapentaenoic Acid, Docosahexaenoic Acid, Gamma-linolenic Acid, and Antioxidants in Head and Neck Cancer Surgery Patients with Free-flap Reconstruction

Japanese Clinical Medicine ◽

10.4137/jcm.s18125 ◽

2014 ◽

Vol 5 ◽

pp. JCM.S18125

Author(s):

Kiyoaki Tsukahara ◽

Ray Motohashi ◽

Hiroki Sato ◽

Minoru Endo ◽

Yuri Ueda ◽

...

Keyword(s):

Head And Neck Cancer ◽

Docosahexaenoic Acid ◽

Head And Neck ◽

Control Diet ◽

Diet Group ◽

Flap Reconstruction ◽

Gamma Linolenic Acid ◽

Free Flap Reconstruction ◽

Significant Difference ◽

Primary Assessment

Objectives The purpose of this prospective, randomized study was to evaluate the effects of a diet containing eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), gamma-linolenic acid (GLA), and antioxidants in head and neck cancer surgery patients with free-flap reconstruction. METHODS In this randomized, prospective study, 62 patients with head and neck cancers were assigned to receive a general control diet (Ensure® H; Abbott Japan, Tokyo, Japan) or the study diet (Oxepa®; Abbott Japan) containing EPA, DHA, GLA, and antioxidants (eg vitamins A, E, and C). The primary assessment item was the degree of postoperative inflammation, as assessed by measuring maximum body temperature and levels of C-reactive protein (CRP) and procalcitonin from the day of surgery to postoperative day 8. Secondary assessment items were lengths of stays in the intensive care unit (ICU) and hospital. Results The control diet group ( n = 32) and study diet group ( n = 30) showed no significant difference in energy administered through diet. No significant differences in the parameters of the primary assessment item were noted. Length of stay in the ICU was significantly shorter for the control diet group than for the study diet group ( P = 0.011). No significant difference in duration of hospitalization was seen between groups. CONCLUSION No usefulness of a diet containing EPA, DHA, GLA, and antioxidants was demonstrated.

Download Full-text