Long-term Functional Speech and Swallowing Outcomes Following Pharyngolaryngectomy With Free Jejunal Flap 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 for penile cancer patients presenting with advanced N3 disease requiring a myocutaneous flap reconstruction or primary closure—a retrospective single centre study

Translational Andrology and Urology ◽

10.21037/tau.2019.01.05 ◽

2019 ◽

Vol 8 (S1) ◽

pp. S13-S21 ◽

Cited By ~ 4

Author(s):

Hussain M. Alnajjar ◽

Findlay MacAskill ◽

Michelle Christodoulidou ◽

Ash Mosahebi ◽

Clare Akers ◽

...

Keyword(s):

Cancer Patients ◽

Penile Cancer ◽

Primary Closure ◽

Myocutaneous Flap ◽

Flap Reconstruction ◽

Long Term Outcomes ◽

Single Centre ◽

Centre Study ◽

Single Centre Study

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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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Long-Term Results of Flap Reconstruction in Median Sternotomy Wound Infections

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199405000-00015 ◽

1994 ◽

Vol 93 (6) ◽

pp. 1208-1214 ◽

Cited By ~ 90

Author(s):

Paul R. Ringelman ◽

Craig A. Vander Kolk ◽

Duke Cameron ◽

William A. Baumgartner ◽

Paul N. Manson

Keyword(s):

Median Sternotomy ◽

Long Term Results ◽

Wound Infections ◽

Flap Reconstruction

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Indications and Use of Hydrogen Peroxide during Microvascular Flap Reconstruction Surgery: A Literature and Procedural Use Review

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0037-1601326 ◽

2017 ◽

Vol 02 (01) ◽

pp. e23-e25

Author(s):

E. Rodriguez-Collazo ◽

D. Riddle ◽

K. Schmidtke

Keyword(s):

Hydrogen Peroxide ◽

Arterial Disease ◽

Tissue Loss ◽

Flap Reconstruction ◽

Muscle Belly ◽

Reconstruction Surgery ◽

Microvascular Flap ◽

Peripheral Arterial

AbstractMicrovascular flap reconstruction surgery is a limb preservation procedure performed in an effort to maintain the integrity of the lower limb and avoid amputations. Individuals facing the prospect of amputation often have long-term diabetes with multiple comorbidities, including severe peripheral vascular disease; peripheral arterial disease; chronic ulcerations; and Charcot arthropathy. Long-term clinical research has shown that these patients are at much higher risk for secondary amputations after a first amputation is performed. According to Sohn et al, Charcot and ulcer groups had 4.1 and 4.7 amputations per 100 person-years, respectively. In patients younger than 65 years old at the end of follow-up, amputation risk, relative to patients with Charcot alone, was 7 times higher for patients with ulcer alone and 12 times higher for patients with Charcot and ulcer. Patients with infected hardware, suffering from acute ulcerative conditions, may also be candidates for this type of surgery due to extensive tissue loss secondary to infection. Microvascular flap reconstruction surgery is a highly technical surgery involving the use of orthoplastic techniques, which is performed under ×3.5 loupe magnification. Due to the inability to perform this procedure with the use of a tourniquet, visibility within the field is obfuscated from continuous blood flow along the dissected muscle belly. Hydrogen peroxide (H2O2) is an excellent alternative to tourniquet use. The use of H2O2 allows additional benefits, such as visual field clearance and antisepsis.

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