Resident training in head and neck flap reconstruction in U.S. academic otolaryngology programmes

2001 ◽  
Vol 115 (2) ◽  
pp. 119-121 ◽  
Author(s):  
Mahesh H. Bhaya ◽  
Gady Har-El
Keyword(s):  
Head And Neck ◽  
Latissimus Dorsi ◽  
Pearson Correlation ◽  
Inverse Correlation ◽  
Free Flaps ◽  
Resident Training ◽  
Flap Reconstruction ◽  
Pedicled Flaps ◽  
Significant Difference ◽  
Radial Forearm

The main objective of this study was to assess resident training in head and neck flap reconstruction, and to determine the confidence of graduating residents in performing these flaps independently. Questionnaires were distributed to otolaryngology residents graduating in 1997. Respondents recorded the number of pedicled and free flap procedures they performed, or assisted with, and indicated flaps they felt confident about performing independently.Pectoralis major myocutaneous (PMMC) (n = 560, mean 6.59) and radial forearm (RF) (66, 0.78) were the most common pedicled and free flaps performed. There was a significant difference (p = 0.0002, Mann-Whitney U test) between median confidence for pedicled (44.5 per cent) and free flaps (two per cent). Ten of the 17 flaps showed a significant Pearson correlation (p<0.05) between number of procedures performed and confidence in performing them independently. Of the pedicled flaps, latissimus dorsi (LD) showed good correlation (r = 0.67), PMMC showed low correlation (r = 0.19) and other pedicled flaps fair correlation. Of the free flaps, LD (r = 0.64) and fibula (r = 0.50) showed good correlation and rectus abdominis and RF fair correlation. There was a fair inverse correlation (r =−0.29) between numbers of pedicled and free flaps performed.Higher correlation in flaps uncommonly performed reflects greater operative training necessary to achieve the confidence for performing these flaps independently. As respondents perfomed greater numbers of free flaps, the number of pedicled flaps decreased. It might thus be important to train residents in all aspects of pedicled flaps. Most respondents were of the opinion that additional training in free flaps was necessary for those planning a career in head and neck reconstructive surgery.

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

2019 ◽  
Author(s):  
Wen-Kuan Chiu ◽  
Chang-Yi Chou ◽  
Shyi-Gen Chen ◽  
Chiehfeng Chen ◽  
Hsian-Jenn Wang ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Head And Neck ◽  
Free Flap ◽  
Odds Ratio ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
Second Primary ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Significant Difference

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.

scholarly journals Assessment of perfusion of free flaps used in head and neck reconstruction using pulsatility index

2017 ◽  
Vol 50 (02) ◽  
pp. 173-179
Author(s):  
Akshay Kapoor ◽  
Malay Karmakar ◽  
Collin Roy ◽  
Kaushal Priya Anand
Keyword(s):  
Head And Neck ◽  
Pulsatility Index ◽  
Free Flaps ◽  
Peroneal Artery ◽  
Head And Neck Reconstruction ◽  
Anastomotic Site ◽  
Flap Reconstruction ◽  
Neck Reconstruction ◽  
Vascular Insufficiency ◽  
Radial Forearm

ABSTRACTObjective: To detect venous or arterial obstruction in the pedicle of a free flap we can monitor resistance in the flap bed which is reflected in Pulsatility Index (PI) Therefore if we detect change in the values of the PI in these flaps then we can detect complications in flap due to vascular insufficiency early. Materials and Methods: Seven patients of Free Fibular Flap Reconstruction and ten patients of Free Radial Forearm Flap reconstruction were evaluated over a period of 18 months. In the pre op we recorded PI of Radial and Peroneal artery using colour doppler study. In the Post Operative Period 2 readings of PI at the anastomotic site were taken on Day 1 and Day 7. Results: Both Free Radial Forearm and Free Fibula flaps which were healthy (n = 15) showed a significant decrease in PI values on first Post Op day as compared to Pre Op. Also there was a significant fall in PI on Post Op Day 7 as compared to post op Day 1 (P < 0.05) in these flaps. The flaps developing complications (n = 2) had significantly higher Day 1 Post op PI readings as compared to healthy flaps (P < 0.05). Conclusion: PI is an objective index which can indicate changes in perfusion of free flaps used in Head and Neck reconstruction based on which we can predict if a flap is susceptible to circulatory compromise.

scholarly journals 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

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.

Effect of Anemia on Survival of Myocutaneous Flaps in the Pig

1994 ◽  
Vol 111 (4) ◽  
pp. 509-512 ◽  
Author(s):  
Ilsa Schwartz ◽  
Kun Z. Kim ◽  
David H. Thompson ◽  
Thomas F. George ◽  
Patrick M. McQuillan ◽  
...  
Keyword(s):  
Head And Neck ◽  
Latissimus Dorsi ◽  
Survival Rates ◽  
Surgical Flaps ◽  
Control Group ◽  
Oncologic Surgery ◽  
Flap Survival ◽  
Myocutaneous Flaps ◽  
Significant Difference ◽  
Normovolemic Anemia

The decision to transfuse patients after major head and neck reconstructive surgery has been influenced by the dictum that a hematocrit level of 30% or more is necessary for the survival of surgical flaps. Pedicled myocutaneous flaps are among the most frequently used methods of reconstruction after major head and neck oncologic surgery. No studies have addressed the survival of myocutaneous pedicied flaps in anemic animals. In this study survival of latissimus dorsi myocutaneous flaps in pigs was evaluated in anemic and control groups. A total of 26 pigs were randomly divided into two groups. The pigs in the anemic group were exsanguinated to normovolemic anemia (average hematocrit, 19%), followed by elevation of a latissimus dorsi myocutaneous flap. In the control group the same operation was performed without exsanguination. All other variables were kept constant. The flap survival was judged on postoperative3 days 7, and 14 by two evaluators. Ten pigs from each group were found to have 100% flap survival on postoperative day 14. There was no significant difference in mean flap survival rates between two groups for postoperative3 days 7, and 14. It is concluded that normovolemic anemia does not adversely affect the survival of the myocutaneous flaps. This finding may save unnecessary transfusions in postoperative patients.

scholarly journals Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases

2014 ◽  
Vol 5 (1) ◽  
pp. 48-55
Author(s):  
Suha Nafea Aloosi
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Free Flap ◽  
Free Flaps ◽  
Primary Defect ◽  
Pedicled Flaps ◽  
Submental Flap ◽  
Regional Flap

ABSTRACT This case series highlights the advantages in the use of three regional flaps, submental flap, sternocleidomastoid flap and transverse cervical flap in maxillofacial primary defect reconstruction after ablative cancer surgery through presentation of three head and neck cancer patients in whom it was decided to do pedicled flaps rather than free flaps. Aim and objective This article is done in an attempt for encouraging for more introduction of these three flaps in head and neck reconstruction practice, and to encourage more studies be done to describe skin territory of cervical flap. Materials and methods Three patients presented to oral and maxillofacial department, diagnosed as having different kinds of cancer. All were managed according to the evidence-based guideline of head and neck cancer management, including the work up, diagnosis, TNM classification, surgical treatment, adjuvant treatment and follow-up. In all the three cases, regional flaps were used to close the primary defect. For the first patient, transverse cervical flap was used, the sternocleidomastoid flap in the second and submental flap in the third one. Results All flaps were easy to be harvested, in term of time and technique, and successful in term of viability, extension and in achieving the functional and cosmetic aim of reconstruction, with minimum donor site morbidity, all the patient are enjoying good quality of life. Conclusion and recommendations The regional flaps have their place to overcome limitation of free flaps due to the shortage in the armamentarium available in the hospital, especially in low resources regions, or limitations related to patients general condition, in addition, regional flaps are the best option available in case of failed free flap, or when free flap failure is anticipated and avoided. Highlighting the different maneuvers in harvesting and using regional pedicled flaps for further extensions widens the scope of indications and giving the reconstructive surgeon variability of options in reconstruction, obviates the need for special microvascular expertise in free flaps with comparable results and relatively less complication. How to cite this article Aloosi SN. Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases. Int J Head Neck Surg 2014;5(1):48-55.

Assessment of volume changes of radial forearm free flaps in head and neck cancer: Long-term results

Oral Oncology ◽  
2011 ◽  
Vol 47 (1) ◽  
pp. 72-75 ◽  
Author(s):  
Young-Hoon Joo ◽  
Se-Hwan Hwang ◽  
Dong-Il Sun ◽  
Jun-Ook Park ◽  
Kwang-Jae Cho ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flaps ◽  
Long Term Results ◽  
Volume Changes ◽  
Radial Forearm

scholarly journals Comparison of Anterolateral Thigh and Radial Forearm Free Flaps in Head and Neck Reconstruction

In Vivo ◽  
2018 ◽  
Vol 32 (4) ◽  
pp. 893-897 ◽  
Author(s):  
CARLO M. ORANGES ◽  
BARBARA LING ◽  
MATHIAS TREMP ◽  
RETO WETTSTEIN ◽  
DANIEL F. KALBERMATTEN ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Anterolateral Thigh ◽  
Radial Forearm

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

2018 ◽  
Vol 51 (03) ◽  
pp. 283-289 ◽  
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.

113 CONCURRENT SURGICAL TREATMENT STRATEGY FOR SYNCHRONOUS ESOPHAGEAL CANCER AND HEAD AND NECK CANCER IN OUR INSTITUTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Ayako Shimada ◽  
Motomu Tanaka ◽  
Satoru Ishii ◽  
Yusuke Yamamoto ◽  
Masaumi Oosaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Regional Lymph Node ◽  
Clinical Stage ◽  
Stage Iv ◽  
Regional Lymph Node Dissection ◽  
Significant Difference ◽  
Radial Forearm ◽  
Surgery Department

Abstract   Esophageal cancer patients have a high frequency to coincide with head and neck (H&N) cancer. We have corporated together with Otorhinolaryngology, H&N Surgery, and Plastic surgery department doctors for the treatment of synchronous esophageal and H&N cancer patients. The aim of this study is to analyze the treatment results and prognosis of synchronous esophageal and H&N cancer patients. Methods From January 2014 to December 2019, 5 patients underwent concurrent surgical resection of synchronous esophageal and H&N cancer in our institution. We retrospectively reviewed the surgical outcomes and prognosis of these patients of synchronous esophageal and H&N cancer (HNEC group) and compared the results with 27 patients who had esophagectomy with 3 regional lymph node dissection during the same period (EC group). Results The location of H&N cancers were pharynx/tongue; 4/1, and clinical stage was all Stage IV. The clinical stage of esophageal cancers was Stage 0/I/II/III; 1/1/2/1. All patients underwent video-assisted thoracic esophagectomy. The surgical procedures concurrently performed for the H&N cancer were pharyngolaryngectomy with free jejunum transfer for 3 patients, wide tongue and mandibular segment resection with mandibular reconstruction in 1 patient, and mandibular transection with radial forearm flap reconstruction in 1 patient. There was no significant difference in the frequency of postoperative complication between 2 groups. HNEC group tend to have shorter recurrence free survival compared to EC group (p = 0.051). Conclusion H&N surgery with thoracotomy is a highly invasive surgery, however, it can be safely performed with local management. The risk of recurrence is high in H&N cancer patients, therefore it is important to move onto adjuvant therapy without delay. Paraenteral nutrition may be useful in management of these patients.

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