scholarly journals Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review

2021 ◽  
Vol 8 (1) ◽  
pp. 58-67
Author(s):  
Parintosa Atmodiwirjo ◽  
Nadhira Anindita Ralena ◽  
Mohamad Rachadian Ramadan ◽  
Sara Ester Triatmoko
Keyword(s):  
Systematic Review ◽  
Neck Region ◽  
Free Flaps ◽  
Neck Surgery ◽  
Pedicled Flap ◽  
Pedicled Flaps ◽  
Medical Issues ◽  
Radial Forearm ◽  
Cosmetic Outcomes ◽  
Supraclavicular Artery Island Flap

Introduction: Pedicled flaps from infrahyoid, pectoralis major, and trapezius were commonly used for partial tongue reconstruction. Not until a free radial forearm flap was introduced. The flap is recommended for patients with tongue defects ≤ 50% because of its thinness, pliability, and long pedicle. This systematic review explores the functional and cosmetic outcomes of pedicled flaps from the neck region for patients who underwent partial tongue resection or hemiglossectomy. Method: A systematic literature searching was performed on PubMed, Medline, Scopus, Embase, and Cochrane. Keywords included were pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Inclusion and exclusion criteria were applied to the search results. Relevant studies were assessed for their methodological quality using appropriate instruments. Results: Four hundred and twenty-four articles were obtained from the initial literature search. The authors finally gathered 11 full-text articles comparing the pedicled neck flaps with free flaps for partial tongue resection reconstructions. Pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, are clinically relevant for hemiglossectomy reconstruction with comparable functional and aesthetic outcomes. Conclusion: Regional flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery.

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.

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.

Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

2016 ◽  
Vol 126 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Neerav Goyal ◽  
Bharat B. Yarlagadda ◽  
Daniel G. Deschler ◽  
Kevin S. Emerick ◽  
Derrick T. Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Free Flap ◽  
Operating Time ◽  
Surgical Site Infections ◽  
Free Flaps ◽  
Neck Surgery ◽  
Pedicled Flap ◽  
American Society ◽  
Clean Contaminated

Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay ( P = .004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification ( P = .03), longer operating time ( P = .03), and clindamycin prophylaxis ( P = .009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

Defining the Role of Free Flaps in Partial Breast Reconstruction

2017 ◽  
Vol 34 (03) ◽  
pp. 185-192 ◽  
Author(s):  
Bianca Molina ◽  
Erez Dayan ◽  
Eric Jablonka ◽  
Michelle Okwali ◽  
Julie Kim ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Breast Conservation ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Flap Reconstruction ◽  
Breast Cancer Patients ◽  
Pedicled Flaps ◽  
Donor Tissue ◽  
Tissue Transfer

Background Free flaps have a well-established role in breast reconstruction after mastectomy; however, their role in partial breast reconstruction remains poorly defined. We reviewed our experience with partial breast reconstruction to better understand indications for free tissue transfer. Methods A retrospective review was performed of all patients undergoing partial breast reconstruction at our center between February 2009 and October 2015. We evaluated the characteristics of patients who underwent volume displacement procedures versus volume replacement procedures and free versus pedicled flap reconstruction. Results There were 78 partial breast reconstructions, with 52 reductions/tissue rearrangements (displacement group) and 26 flaps (replacement group). Bra cup size and body mass index (BMI) were significantly smaller in the replacement group. Fifteen pedicled and 11 free flaps were performed. Most pedicled flaps (80.0%) were used for lateral or upper pole defects. Most free flaps (72.7%) were used for medial and inferior defects or when there was inadequate donor tissue for a pedicled flap. Complications included hematoma, cellulitis, and one aborted pedicled flap. Conclusion Free and pedicled flaps are useful for partial breast reconstruction, particularly in breast cancer patients with small breasts undergoing breast-conserving treatment (BCT). Flap selection depends on defect size, location, and donor tissue availability. Medial defects are difficult to reconstruct using pedicled flaps due to arc of rotation and intervening breast tissue. Free tissue transfer can overcome these obstacles. Confirming negative margins before flap reconstruction ensures harvest of adequate volume and avoids later re-operation. Judicious use of free flaps for oncoplastic reconstruction expands the possibility for breast conservation.

635 Free Versus Pedicled Flaps for Primary Reconstruction of Electrical Injuries: A Systematic Review and Observational Meta-Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S173-S174
Author(s):  
Kimberly Khoo ◽  
Laura Bashour ◽  
Joshua M Peterson ◽  
Pablo L Padilla ◽  
Sagar R Mulay ◽  
...  
Keyword(s):  
Low Voltage ◽  
Meta Analysis ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Burn Injuries ◽  
Tissue Loss ◽  
Complication Rates ◽  
Post Injury ◽  
Pedicled Flaps ◽  
Significant Difference

Abstract Introduction Both high-voltage (&gt;1000 V) and low-voltage (&lt; 1000 V) electrical burns can cause serious injuries due to dissipation of heat as electric current passes through deep tissues. Because of tissue loss and vital structure exposure, flap-based reconstruction is frequently performed in patients with these injuries. Depending on clinical presentation, both free and pedicled flaps may be indicated. We wondered if reported reconstructive outcomes after electrical injury differ between free and pedicled flaps when implemented in the immediate post-injury period. Methods A systematic literature review following PRISMA guidelines was conducted using PubMed and Ovid MEDLINE databases. Articles that were included described patients with electrical burn injuries who underwent reconstruction with either free or pedicled flaps within 90 days of injury. Technique articles or articles lacking outcomes analysis were excluded. Data was extracted from articles that met inclusion and exclusion criteria, including flap type, timing of reconstruction, complications, and patient demographics. Statistical analysis was performed with chi-square tests. Results Of 536 articles obtained from the literature search, 37 met criteria. To date, no randomized control trials comparing these modalities have been performed. In total, these studies reported on 364 total patients who experienced high- and low-voltage electrical burn injuries. Pooled reported outcomes of 374 flap reconstructions were analyzed, including 145 free flaps and 229 pedicled flaps. Reported complication rates did not differ significantly between free flaps (30/145, 20.7%) and pedicled flaps (46/229, 20.1%; p = .89). However, free flaps experienced significantly higher failure rates than pedicled flaps (13/145, 9.0% vs. 0/229, 0%; p = &lt; .05). Conclusions Electrical burn injuries present a unique indication for flap-based reconstruction in the immediate post-burn phase of care. However, substantial variation exists amongst physicians regarding whether to proceed with a free flap or pedicled flap surgery when indicated. Our data identified an overall significant difference between free versus pedicled flap failure rate but did not identify a significant difference between overall complication rates.

Osteocutaneous free flaps for mandibular reconstruction: systematic review of their frequency of use and a preliminary quality of life comparison

2014 ◽  
Vol 128 (12) ◽  
pp. 1034-1043 ◽  
Author(s):  
S P Moubayed ◽  
B L'Heureux-Lebeau ◽  
A Christopoulos ◽  
J S Sampalis ◽  
L Letourneau-Guillon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Free Flap ◽  
Free Flaps ◽  
Mandibular Reconstruction ◽  
Depression And Anxiety ◽  
Frequency Of Use ◽  
Fibula Free Flap ◽  
Radial Forearm

AbstractObjectives:To determine whether the fibula free flap is the most frequently used osteocutaneous flap for mandible reconstruction, and whether it provides quality of life, depression and anxiety advantages.Methods:A systematic review of the public Medline database was conducted. Thirteen patients who underwent mandibular reconstruction at our hospital centre completed questionnaires to evaluate quality of life, depression and anxiety outcomes.Results:The most frequently used free flaps are those of the fibula (n = 982), radial forearm (n = 201), iliac crest (n = 113), subscapular system (n = 50) and rib–serratus (n = 7). In our patient population, there was a trend towards a better quality of life in those with a fibula free flap. However, patients in this group were significantly younger than patients with other flap types (p = 0.025). Patients with a subscapular system free flap were more depressed (p = 0.031); however, they had large through-and-through defects.Conclusion:The flap used most frequently in the literature is the fibula free flap. Comparative quality of life data are lacking, and homogeneous populations should be used to reach significant conclusions.

Postoperative Complications Associated with the Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis of 4,712 Patients from the ACS-NSQIP Database

2021 ◽  
Author(s):  
Jacob Y. Katsnelson ◽  
Richard Tyrell ◽  
Murad J. Karadsheh ◽  
Ely Manstein ◽  
Brian Egleston ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Hospital Readmission ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Head And Neck Reconstruction ◽  
Pedicled Flaps ◽  
Neck Reconstruction

Abstract Background Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years. Methods Patients undergoing head and neck reconstruction were identified in the 2011–2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay. Results A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02–6.85, p = 0.045), sepsis (OR = 2.95, CI 1.52–5.71, p = 0.001), and infection (OR = 2.03, CI 1.39–2.96, p <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, p <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50–0.85, p = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12–0.92, p = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps. Conclusion Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay.

scholarly journals Combining free tissue transfer with pedicled flap in reconstruction of extensive oromandibular malignancy defects: a clinical study

2020 ◽  
Vol 7 (2) ◽  
pp. 376
Author(s):  
Naveen Narayan ◽  
Kamal Kumar Manakchand
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Team Approach ◽  
One Stage ◽  
Free Flap Surgery ◽  
Ablative Surgery ◽  
Free Fibula ◽  
Radial Forearm

Background: Extensive composite defects of the oromandibular site involve skin, mandible, soft tissue and oral mucosa. Though many opine that with the coming on of free flap surgery, the pedicled flap is an outdated surgical option, the latter still has its uses. Free flaps are criticized as being medically risky, expensive, and time-consuming. Combining both these flaps in a single surgery would bring in the baggage of all negatives along with the benefits of these flaps.Methods: Over a period of 3 years, 13 patients with expected large composite oral defects after ablative surgery for malignancy were included in the study requiring both skin cover and mucosal lining. A one-stage reconstructive procedure employing combination of free and pedicled flaps was used. Data was abstracted pertaining to cancer demography and surgical outcome.Results: The free fibula osteocutaneous flap (FFOCF)- deltopectoral fasciocutaneous flap (DPF) combination was most commonly used (n=5), secondly by free radial forearm flap (FRAFF)-DPF combination (n=4), FRAFF- pectoralis major myocutaneous flap (PMMF) amalgamation and FFOCF-PMMF (n=2). The complete flap survival rate was 88.5 percent with 3.8% percent total (1 of 26 flaps) and 7.7% partial (2 of 26 flaps) flap failures. Minimum follow-up period was 6 months with 2 (7.7%) recurrences and 2 (7.7%) mortalities.Conclusions: We believe that in combined use of free-flap and pedicled flap procedure for one-stage reconstruction of massive mandibular defects with through-and-through cheek defects is justified because it is safe and effective and improves the quality of life for these patients albeit a bit prolonged surgery which can effectively be shortened with 2 reconstructive team approach as in our study.

scholarly journals Free Tissue Transfer in Pressure Ulcer Reconstruction: A Systematic Review

2021 ◽  
Vol 06 (01) ◽  
pp. e35-e39
Author(s):  
Chelsi Robertson ◽  
Charles Patterson ◽  
Hugo St. Hilaire ◽  
Frank H. Lau
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Final Analysis ◽  
The United States ◽  
Local Flap ◽  
Recurrence Rates ◽  
Tissue Transfer ◽  
Cochrane Database

Abstract Background Pressure ulcers (PUs) affect 2.5 million people in the United States annually and incur health-care costs of 11 billion dollars annually. Stage III/IV PU often require local flap reconstruction. Unfortunately, PU recurrence is common following reconstruction; recurrence rates as high as 82% have been reported. When local flap options are inadequate, free tissue transfer may be indicated but the indications have yet to be delineated. To develop evidence-based guidelines for the use of free flaps in PU reconstruction, we performed a systematic review. Methods A systematic review of the available English-language, peer-reviewed literature was conducted using PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. Articles were manually reviewed for relevance. Results Out of 272 articles identified, 10 articles were included in the final analysis. Overall, this systematic review suggests that free-flap PU reconstruction yields fewer recurrences compared with local flaps (0–20 vs. 13–82%). Further, several types of free flaps for PU reconstruction were identified in this review, along with their indications. Conclusion Free tissue transfer should be considered for recurrent PU. We offer specific recommendations for their use in PU reconstruction.

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