Bedside Neck Exploration for Venous Flow Coupler Signal Loss in Postoperative Free Tissue Transfer Monitoring

2021 ◽  
pp. 019459982110529
Author(s):  
Kyle P. Davis ◽  
James Reed Gardner ◽  
Quinn A. Dunlap ◽  
Emre A. Vural ◽  
Jumin Sunde ◽  
...  
Keyword(s):  
Operating Room ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Hospital Charges ◽  
Neck Exploration ◽  
Signal Loss ◽  
Venous Anastomosis ◽  
Tissue Transfer

Objective To describe the role and efficacy of bedside neck exploration following free tissue transfer. Study Design Retrospective case series. Setting Single tertiary care institution. Methods A retrospective chart review was conducted of 353 patients who underwent free tissue transfer between January 2017 and April 2021. Bedside exploration was performed under mild sedation in patients who had loss of venous Doppler signal with equivocal clinical signs of venous insufficiency. Results A total of 11 patients underwent bedside assessment of the microvascular pedicle. In 6 cases, a return to the operating room was avoided. Five of these patients had coupler malfunction, and in 1 patient a venous kink was discovered and remedied at the bedside. Five patients required return to the operating room. Venous thrombosis requiring thrombectomy and revision of the venous anastomosis was discovered in 3 patients. One patient had a developing hematoma necessitating evacuation in the operating room, and 1 returned to the operating room due to sternocleidomastoid muscular compression of the venous pedicle. There were no flap failures within the study group. In all cases, broad-spectrum intravenous antibiotic coverage was prophylactically used, and no instances of wound infection were observed. Avoidance of returning to the operating room prevented an estimated $9222 of hospital charges per event. Conclusion Bedside neck exploration can be incorporated as a safe and cost-effective intermediary for definitive determination of need for return to the operating room.

scholarly journals Long-term results of microvascular free-tissue transfer reanimation of the paralyzed face: Three cases

2008 ◽  
Vol 87 (4) ◽  
pp. 226-233
Author(s):  
John P. Leonetti ◽  
Chad A. Zender ◽  
Daryl Vandevender ◽  
Sam J. Marzo
Keyword(s):  
Facial Nerve ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Free Tissue Transfer ◽  
Long Term Results ◽  
Wide Field ◽  
Facial Movement ◽  
Tissue Transfer ◽  
Facial Reanimation

We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve–sural nerve graft, and lower facial movement was achieved through proximal facial nerve–long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper-and lower-division reanimation.

scholarly journals Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction—An Analysis of 1694 Venous Anastomoses

2021 ◽  
Vol 54 (02) ◽  
pp. 118-123
Author(s):  
Rajan Arora ◽  
Kripa Shanker Mishra ◽  
Hemant T. Bhoye ◽  
Ajay Kumar Dewan ◽  
Ravi K. Singh ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Head And Neck ◽  
Free Tissue Transfer ◽  
Effective Alternative ◽  
Head And Neck Reconstruction ◽  
Venous Anastomosis ◽  
Neck Reconstruction ◽  
Coupling Device ◽  
Tissue Transfer ◽  
Flap Loss

Abstract Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

Microvascular free tissue transfer and cochlear implants: A case series and literature review

2019 ◽  
Vol 130 (6) ◽  
pp. 1552-1557
Author(s):  
Nathan R. Lindquist ◽  
Daniel B. Vinh ◽  
Eric N. Appelbaum ◽  
Jeffrey T. Vrabec ◽  
Andrew T. Huang
Keyword(s):  
Literature Review ◽  
Cochlear Implants ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Tissue Transfer

scholarly journals Microvascular Free Tissue Transfer in the Reconstruction of Scalp and Lateral Temporal Bone Defects

2011 ◽  
Vol 4 (4) ◽  
pp. 179-187 ◽  
Author(s):  
Daniel A. O'Connell ◽  
Marita S. Teng ◽  
Eduardo Mendez ◽  
Neal D. Futran
Keyword(s):  
Temporal Bone ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Wound Dehiscence ◽  
Free Flaps ◽  
Bone Defects ◽  
Unique Challenge ◽  
Cosmetic Results ◽  
Tissue Transfer ◽  
Anterolateral Thigh

Defects of the scalp and lateral temporal bone (LTB) represent a unique challenge to the reconstructive surgeon. Simple reconstructive methods such as skin grafts, locoregional flaps, or tissue expanders are often not feasible due to a myriad of reasons. Vascularized free tissue transfer coverage offers distinct advantages in managing these defects. A retrospective case series was performed on all patients at the University of Washington Medical Center who had scalp or LTB defects reconstructed with free tissue transfer from May 1996 to July 2009. Cases were analyzed for defect characteristics, flap type, vessel selection, radiation status, dural exposure, complications, and outcomes. Sixty-eight free flaps were performed in 65 patients with scalp or LTB defects. Twenty-two resections included craniotomy, and 48 patients had pre- or postoperative radiation. Defects ranged from 6 to 836 cm2. All flaps (46 latissimus, 11 rectus, 4 radial forearm, 6 anterolateral thigh, and 1 omental) were transferred successfully. Vein grafts were required in five cases. Complications included delayed flap failure requiring secondary reconstruction, neck hematoma, venous thrombosis, skull base infection, large wound dehiscence, small wound dehiscence, donor site hematoma and seroma, and cerebrospinal fluid leak. Cosmetic results were consistent and durable. Microvascular free tissue transfer is a safe, reliable method of reconstructing scalp and LTB defects and offers favorable cosmetic results. We favor the use of latissimus muscle-only flap with skin graft coverage for large scalp defects and rectus or anterolateral thigh free flaps for lateral temporal bone defects.

scholarly journals Reconstruction of the anterior skull base with radial forearm free tissue transfer: case series and literature review

2016 ◽  
Vol 3 (2) ◽  
pp. 47
Author(s):  
Windy A. Olaya ◽  
Lauren T. Daly ◽  
Emily G. Clark ◽  
Thomas Scholz ◽  
Vincent Laurence ◽  
...  
Keyword(s):  
Literature Review ◽  
Skull Base ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Anterior Skull Base ◽  
Tissue Transfer ◽  
Transfer Case ◽  
Radial Forearm

scholarly journals Use of the Retrograde Recipient Vein for Additional Outflow in Free Tissue Transfer

2020 ◽  
Vol 05 (01) ◽  
pp. e1-e6
Author(s):  
Tetsuji Uemura ◽  
Mamoru Kikuchi ◽  
Hidetaka Watanabe ◽  
Tetsu Yanai
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Blood Perfusion ◽  
Free Flaps ◽  
Successful Outcome ◽  
Venous Anastomosis ◽  
Venous Flow ◽  
Flap Transfer ◽  
Tissue Transfer ◽  
Free Flap Transfer

Abstract Background The selection of appropriate recipient vessels is essential to the successful outcome of free flap transfer. To improve blood perfusion after reconstruction and reduce the risk of postoperative obstruction of flap vessels, multiple vessels should be chosen as candidate recipients. Methods For certainty of venous drainage, we have been performing venous anastomosis to the distal end of the recipient vein to utilize the reverse venous flow. Results A total of 48 cases of reconstruction of the head and neck or breast region with free flaps using retrograde venous anastomosis were performed. The method possibly improves flap circulation and the success rate of the free tissue transfer and reduces the need to extend surgery to search for multiple recipient veins. Conclusion We emphasized that retrograde limb of vein is useful as a second and/or rescued recipient in free tissue transfer. Retrograde venous anastomosis is a fine and reasonable option when appropriate recipient vessels cannot be found near the defect in the head and neck such as frozen neck or breast region.

Management Patterns in Pediatric Complicated Sinusitis

2020 ◽  
Vol 163 (4) ◽  
pp. 814-821
Author(s):  
Sean M. McDermott ◽  
Amanda Onwuka ◽  
Charles Elmaraghy ◽  
Patrick C. Walz
Keyword(s):  
Medical Therapy ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Early Stage ◽  
Tertiary Care ◽  
Case Series ◽  
Hospital Charges ◽  
Intracranial Extension ◽  
Disease Characteristics ◽  
Outcome Differences

Objectives Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods An evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in-hospital management, and outcomes were recorded and analyzed. Results The most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin-sulbactam required MTS vs 57% of those started on other antibiotic regimens ( P = .01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin-sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients ( P < .01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS ( P = .92). Conclusion Nonoperative early stage patients started on ampicillin-sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen.

637 Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose and Throat Defects: A Case Series

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S174-S175
Author(s):  
Jake Laun ◽  
Julian Pribaz
Keyword(s):  
Head And Neck ◽  
External Auditory Canal ◽  
Case Series ◽  
Free Tissue Transfer ◽  
External Auditory Meatus ◽  
Cancer Resection ◽  
Stoma Creation ◽  
Tissue Transfer ◽  
Reconstructive Ladder ◽  
Radial Forearm

Abstract Introduction Head and neck defects, whether from burns or cancer resections, are complex and often require free flap reconstruction. Radial forearm and anterolateral thigh (ALT) flaps are commonly used due to their thin and versatile nature. However, abdominal based free tissue transfer is one valuable alternative that can cover large defects and may become a more appropriate option on the reconstructive ladder when the defect includes reconstruction of a tubular structure, such as the external auditory canal, a neck tracheostomy/stoma site or an external nasal opening. We present a novel utilization of abdominal free tissue transfer for coverage of large ear and scalp burn defects as well as neck and midface defects with usage of the umbilical stalk for tubed reconstruction. Methods Four patients presented for reconstruction: two patients had sustained large ear and scalp burns resulting in complete ear loss; one had a large neck defect resulting from recurrent cancer resection which necessitated a laryngectomy and stoma creation; and one patient had a large central face defect post-cancer resection. All four patients underwent an abdominal based free tissue transfer with reconstruction of the external auditory canal in the ear and scalp burns, stoma creation in the neck defect, and the external nasal opening in the central face defect, all utilizing the vascularized umbilical stalk for the tubed reconstruction. Results All patients recovered post-operatively without any reported complications such as tubular stenosis or contracture while maintaining umbilical stalk tubular patency. Conclusions Reconstruction of a tubed structure in head and neck defects, whether the external auditory meatus, an external nasal opening or a neck stoma post burn or cancer resection, can be a difficult and challenging operation fraught with potential complications. We present a novel method of reconstruction of large defects employing the use of the uniquely thin and vascularized umbilical stalk for tubular reconstruction.

scholarly journals Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review

2015 ◽  
Vol 8 (3) ◽  
pp. 179-189 ◽  
Author(s):  
Michael Sosin ◽  
Arif Chaudhry ◽  
Carla De La Cruz ◽  
Branko Bojovic ◽  
Paul N. Manson ◽  
...  
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
The Elderly ◽  
Lessons Learned ◽  
Soft Tissue Coverage ◽  
Scalp Reconstruction ◽  
Tissue Transfer ◽  
The Mean

This article aims to demonstrate an individualized approach to an elderly patient requiring scalp reconstruction, to describe the methodology in flap selection, lessons learned, and report outcomes. A retrospective review of a single surgeon's experience of scalp reconstruction (E. D. R.) using free tissue transfer from 2005 to 2011, in patients older than 70 years, was completed. A total of eight patients met the inclusion criteria, five males and three females, with a mean age of 80.4 years (range, 73–92). Free tissue transfer achieved 100% soft tissue coverage. Six of the eight patients required cranioplasty. The mean size calvarial defect was 92 cm2 (range, 35–285 cm2). The mean flap size was 117.6 cm2 (range, 42–285 cm2). Free flaps included three ulnar, three anterolateral thigh, one latissimus dorsi, and one thoracodorsal perforator flap. The mean follow-up time was 18.4 months (range, 3–46 months). Donor site morbidity was minimal. Mortality was 0%. Immediate flap failure was 0%. Other complications occurred in six of the eight patients. Mean revisionary procedures were 1.25 procedures per patient. It was concluded that chronological age does not increase mortality or catastrophic flap complications; however, morbidity is increased in the elderly and revisionary surgery is likely.

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