Free flap head and neck reconstruction in the elderly: what is the impact on quality of life?

Background Microvascular anastomotic patency is fundamental to head and neck free flap reconstructive success. The aims of this study were to identify factors associated with intraoperative arterial anastomotic issues and analyze the impact on subsequent complications and cost in head and neck reconstruction. Methods A retrospective review was performed on all head and neck free flap reconstructions from 2005 to 2013. Patients with intraoperative, arterial anastomotic difficulties were compared with patients without. Postoperative outcomes and costs were analyzed to determine factors associated with microvascular arterial complications. A regression analysis was performed to control for confounders. Results Total 438 head and neck free flaps were performed, with 24 (5.5%) having intraoperative arterial complications. Patient groups and flap survival between the two groups were similar. Free flaps with arterial issues had higher rates of unplanned reoperations (p < 0.001), emergent take-backs (p = 0.034), and major surgical (p = 0.002) and respiratory (p = 0.036) complications. The overall cost of reconstruction was nearly double in patients with arterial issues (p = 0.001). Regression analysis revealed that African American race (OR = 5.5, p < 0.009), use of vasopressors (OR = 6.0, p = 0.024), end-to-side venous anastomosis (OR = 4.0, p = 0.009), and use of internal fixation hardware (OR =3.5, p = 0.013) were significantly associated with arterial complications. Conclusion Intraoperative arterial complications may impact complications and overall cost of free flap head and neck reconstruction. Although some factors are nonmodifiable or unavoidable, microsurgeons should nonetheless be aware of the risk association. We recommend optimizing preoperative comorbidities and avoiding use of vasopressors in head and neck free flap cases to the extent possible.

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Palatomaxillary Obturation and Facial Prosthetics in Head and Neck Reconstruction

Facial Plastic Surgery ◽

10.1055/s-0040-1721114 ◽

2020 ◽

Vol 36 (06) ◽

pp. 715-721

Author(s):

Weitao Wang ◽

Tom Shokri ◽

Aurora Vincent ◽

Allison Vest ◽

Fayette Williams ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck ◽

Three Dimensional ◽

Free Tissue Transfer ◽

Poor Quality ◽

Surgical Reconstruction ◽

Head And Neck Reconstruction ◽

Neck Reconstruction ◽

Facial Prostheses

AbstractRehabilitation of head and neck defects following trauma, oncologic resection, or congenital malformation is a challenging task. Not only is the restoration of three-dimensional form necessary for acceptable cosmesis, but simultaneous restoration of functional speech and swallow is also essential for optimal reconstruction outcomes. While advances in free tissue transfer have allowed surgical reconstruction of head and neck defects once considered inoperable and associated with poor quality of life, not all patients are ideal surgical candidates. As such, nonsurgical solutions to both functional and cosmetic restoration remain a necessary alternative option. Facial prostheses and palatomaxillary obturators have evolved with increasingly biocompatible materials as well as retention systems to address significant defects that challenge the limits of surgical reconstruction.

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Donor site morbidity and quality of life after microvascular head and neck reconstruction with free fibula and deep-circumflex iliac artery flaps

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2016.11.014 ◽

2017 ◽

Vol 45 (2) ◽

pp. 304-311 ◽

Cited By ~ 12

Author(s):

Christopher Schardt ◽

Angela Schmid ◽

Jens Bodem ◽

Johannes Krisam ◽

Jürgen Hoffmann ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck ◽

Iliac Artery ◽

Donor Site ◽

Donor Site Morbidity ◽

Head And Neck Reconstruction ◽

Neck Reconstruction ◽

Deep Circumflex Iliac Artery ◽

Free Fibula

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The effect of head and neck reconstruction on quality of life

Current Opinion in Otolaryngology & Head & Neck Surgery ◽

10.1097/00020840-199908000-00003 ◽

1999 ◽

Vol 7 (4) ◽

pp. 180

Author(s):

Mark K. Wax ◽

Larry L. Myers ◽

Peter E. Andersen ◽

James I. Cohen

Keyword(s):

Quality Of Life ◽

Head And Neck ◽

Head And Neck Reconstruction ◽

Neck Reconstruction

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Promoting the Quality of Life of Elderly during the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136813 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6813

Author(s):

Chia-Jung Lee ◽

Yen Hsu

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Learning Experience ◽

The Elderly ◽

Learning Approach ◽

Learning Center ◽

Learning Centers ◽

Technology Learning ◽

The Impact

This study explored the technology learning model of the elderly in a senior learning center under the impact of the COVID-19 pandemic. Many senior learning centers were closed during the pandemic, and many of them adopted the mode of online education. However, problems such as decreased motivation and a lack of peer interaction still exist. To solve these problems, this study used the easy-to-implement calligraphy AR approach and E-book approach to conduct a quasi-experiment on the elderly of a calligraphy course offered by a senior learning center. The results show a higher learning motivation among the elderly who use calligraphy AR. The learning effectiveness and technology acceptance of the elderly in the E-book learning group were higher than those in the calligraphy AR group. The elderly mentioned that the E-book learning approach is more user-friendly. In general, in the face of the COVID-19 pandemic affecting the suspension of classes in senior centers, education through the development of technology has stimulated the growth of education in advanced learning centers. Through this kind of scientific and technological learning method, it will bring a whole new experience to the elderly. It can improve the stress relief methods, mental health, and quality of life of the elderly during the COVID-19 emergency shutdown, and provide a novel calligraphy technique learning experience for the elderly. Therefore, we believe that the calligraphy AR learning approach and the calligraphy E-book learning approach are practical and may promote quality of life and mental health of the elderly during the emergency closures due to COVID-19, providing elderly attendees with a novel calligraphy technology learning experience.

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Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap

Facial Plastic Surgery ◽

10.1055/s-0041-1726445 ◽

2021 ◽

Author(s):

Armando De Virgilio ◽

Andrea Costantino ◽

Raul Pellini ◽

Gerardo Petruzzi ◽

Giuseppe Mercante ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck ◽

Free Flap ◽

Functional Outcomes ◽

Vastus Lateralis ◽

Life Questionnaire ◽

Donor Area ◽

Tongue Reconstruction ◽

Eortc Qlq

AbstractThe aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75–69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5–33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0–72.5). The median PSS-HN score was 80.0 (IQR: 45.0–95.0), 75.0 (IQR: 62.5–100.0), 75.0 (IQR: 62.5–100.0) for “Normalcy of Diet,” “Public Eating,” and “Understandability of Speech,” respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5–74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.

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Health-Related Quality of Life of Elderly Women with Fall Experiences

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157804 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7804

Author(s):

Jiyoung Song ◽

Eunwon Lee

Keyword(s):

Quality Of Life ◽

Elderly Women ◽

The Elderly ◽

Basic Data ◽

Health Related Quality ◽

High Quality ◽

Related Quality ◽

Health Related ◽

The Impact

This study aimed to describe the health-related quality of life of elderly women with experience in fall treatment as well as to prepare basic data for the development of interventions to improve the quality of life for this group. The study was based on raw data from the 2019 Korea Community Health Survey. Using the SPSS program, the characteristics of the subjects were tested by frequency, percentage, and chi-square test. To establish the impact of fall experience on the health-related quality of life of elderly women, the OR and 95% CI were calculated using multiple logistic regression analysis. Of the 4260 people surveyed, 44.7% of the elderly women said they had a high quality of life, whereas 55.3% of the elderly women said they had a low quality of life. A younger age was associated with a better-rated health-related quality of life. Those who lived in a city and had a high level of education tended to describe a high quality of life. The quality of life was considered high by those who exercised, but low by those who were obese or diabetic. The results of this study can lead to a better understanding of the experiences of elderly women who have experienced falls, and they can be used as basic data for the development of related health programs.

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