scholarly journals The Use of Harmonic Scalpel for Free Flap Dissection in Head and Neck Reconstructive Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Sebastien Albert ◽  
Charles Guedon ◽  
Caroline Halimi ◽  
Jean Pierre Cristofari ◽  
Beatrix Barry
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Harmonic Scalpel ◽  
Tissue Injury ◽  
Free Flaps ◽  
Surgical Instruments ◽  
Surgical Clips ◽  
Free Flap Surgery ◽  
Surgical Clip

Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic Scalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of this study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical instruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery between March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used in 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group), and in the other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group). The following parameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower in the HS group), blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of the Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps.

scholarly journals Primary thrombolysis for free flap surgery in head and neck reconstruction: a case report and review

2021 ◽  
Vol 48 (5) ◽  
pp. 511-517
Author(s):  
Steven Liben Zhang ◽  
Hui Wen Ng
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Arterial Thrombosis ◽  
Free Flaps ◽  
Recombinant Tissue Plasminogen Activator ◽  
Head And Neck Reconstruction ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Free Flap Surgery ◽  
Flap Perfusion

The use of free flaps is an essential and reliable method of reconstruction in complex head and neck defects. Flap failure remains the most feared complication, the most common cause being pedicle thrombosis. Among other measures, thrombolysis is useful when manual thrombectomy has failed to restore flap perfusion, in the setting of late or established thrombosis, or in arterial thrombosis with distal clot propagation. We report a case of pedicle arterial thrombosis with distal clot propagation which occurred during reconstruction of a maxillectomy defect, and was successfully treated with thrombolysis using recombinant tissue plasminogen activator. We also review the literature regarding the use of thrombolysis in free flap surgery, and propose an algorithm for the salvage of free flaps in head and neck reconstruction.

scholarly journals NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

OTO Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 2473974X1668569 ◽  
Author(s):  
Charles A. Riley ◽  
Blair M. Barton ◽  
Claire M. Lawlor ◽  
David Z. Cai ◽  
Phoebe E. Riley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Flap Surgery ◽  
Improvement Program ◽  
Free Flap Surgery ◽  
The Mean

Objective The National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses. Methods A case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator. Results Thirty-five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP-predicted LOS was 10.3 (2.2) days ( P = .027). Discussion The NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population. Implications for Practice: Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population.

Microvascular free flaps in head and neck surgery

1994 ◽  
Vol 108 (11) ◽  
pp. 962-968 ◽  
Author(s):  
Marcelle Macnamara ◽  
Sarah Pope ◽  
A. Sadler ◽  
H. Grant ◽  
M. Brough
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Neck Region ◽  
Free Flaps ◽  
Neck Surgery ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
Wide Range ◽  
Radial Forearm ◽  
Microvascular Free Flap

AbstractThis study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.

scholarly journals Adverse Outcomes Following Free Tissue Transfer: A 3-year Experience From a Major Referral Centre

2021 ◽  
Author(s):  
Silas Nann ◽  
Jia Miin Yip ◽  
Tyler Glanville ◽  
Nicholas Marshall
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Case Series ◽  
Free Flaps ◽  
Adverse Outcomes ◽  
The Body ◽  
Complication Rates ◽  
Retrospective Case ◽  
Tissue Transfer ◽  
Free Flap Surgery

Abstract BackgroundFree tissue transfer encompasses a variety of techniques by which tissue is moved to another region of the body, with anastomosis of the divided artery and vein. Currently, success rates are reported at 91-99% [1], however, little is known regarding predictors for adverse outcomes.We aim at identifying predictors for negative outcomes following free flap surgery; and predict that elderly patients and patients with head and neck free flaps will have inferior outcomes due to comorbidity.MethodsThis is a retrospective case series. All free flap surgeries between 02/2018 to 02/2021 were identified using the electronic operation record system at Flinders Medical Centre. Chi squared hypothesis testing assessed patient factors and implications on outcome. Results67 patients of varying demographics were included in this study. The odds of wound infection was much higher in patients aged older than 65 (OR: 4.1 (95%CI 1.24-13.6, z-score: 2.31, p=0.017)). The odds of unplanned reoperation was also higher in this population (OR: 13.7 (95%CI 1.42-132.9, p=0.0053)). Free flap location was significant in determining whether patients would require a subsequent blood transfusion (p=0.0071). Head and neck patients did not experience a higher rate of adverse events.ConclusionPatients aged 65 and older are more likely to require treatment for infection and more often require reoperation because of flap related issues. Patients with limb free flaps are more likely to require transfusions. Head and neck patients did not have higher complication rates.

scholarly journals The learning curve in head and neck reconstruction with microvascular free flaps: a retrospective review

2010 ◽  
Vol 4 (6) ◽  
pp. 949-954
Author(s):  
Patnarin Mahattanasakul ◽  
Veerachai Kerekhanjanarong ◽  
Porn-ake Apipan
Keyword(s):  
Learning Curve ◽  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Retrospective Review ◽  
Free Flaps ◽  
Plastic And Reconstructive Surgery ◽  
Post Surgery ◽  
Facial Plastic ◽  
Microvascular Free Flaps

Abstract Background: Tissue defect around the head and neck region is a great challenge for reconstructive surgeons. Successful outcomes of surgery is influenced by many factors such as surgical technique in recipient and donor site, meticulous microvascular anastomosis, position of vascular pedicle, and post-surgery monitoring. The learning curve is important for any new microvascular surgeons. Objectives: Evaluate the quality of training for a new otolaryngologist, head and neck surgeon, on their performance of free flaps in facial plastic and reconstructive surgery using a retrospective review. Methods: Nineteen microvascular free flaps in patients from the ENT Center of Rajavithi Hospital were reviewed between November 2008 and October 2009. Incidences of free flap survival, and partial and complete necrosis were examined. Results: Eighteen patients with microvascular free flaps had head and neck cancer. 88.9% of the patients had squamous cell carcinoma. There were nine radial forearm free flaps, five anterolateral thigh free flaps, two rectus abdominis free flap, two iliac-free flap, and one fibular-free flap. The overall success rate of the free flap reconstructions was 84%. One partial and three total necrosis were done on the 19 flaps. Conclusion: Causes of free flap failure were similar and not dependent on the experienced of the surgeons. The postgraduate training program in facial plastic and reconstructive surgery is effective in providing new microvascular surgeons the skills to perform successful microvascular and reconstructive surgeries.

Designing a Masterclass in free flap surgery for head and neck surgeons: Our experience

Microsurgery ◽  
2020 ◽  
Vol 40 (8) ◽  
pp. 929-929
Author(s):  
Karim Tewfik ◽  
Alfonso Manfuso ◽  
Lazzaro Cassano ◽  
Nicola Pederneschi ◽  
Chiara Copelli
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Flap Surgery ◽  
Free Flap Surgery

Optimizing value in head and neck cancer free flap surgery

2019 ◽  
Vol 27 (5) ◽  
pp. 413-419 ◽  
Author(s):  
Harrison Cash ◽  
Marianne Abouyared ◽  
Jeffrey J. Houlton
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Flap Surgery ◽  
Free Flap Surgery

Plastic and burns surgery

2021 ◽  
pp. 647-668
Author(s):  
Brian Chen ◽  
Simon Davis ◽  
Fynn Maguire
Keyword(s):  
Surgical Procedures ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Breast Augmentation ◽  
Skin Grafting ◽  
Anaesthetic Management ◽  
Surgical Patients ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Surgical Operations

This chapter discusses the anaesthetic management of plastic and burns surgery. It begins with general principles of the anaesthetic management of plastic surgical patients. Surgical procedures covered include breast augmentation, reconstruction and reduction surgery; free flap surgery; liposuction; skin grafting and burns reconstructive surgery. The chapter includes pertinent anaesthetic features for a series of additional miscellaneous plastic surgical operations.

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