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.

Discharge Delay in Head and Neck Free Flap Surgery: Risk Factors and Strategies to Minimize Hospital Days

2019 ◽  
Vol 160 (5) ◽  
pp. 829-838 ◽  
Author(s):  
Dustin M. Lang ◽  
Deepa Danan ◽  
Raja Sawhney ◽  
Natalie L. Silver ◽  
Varun V. Varadarajan ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Quality Metric ◽  
Factors Associated ◽  
Free Flap Surgery ◽  
Hospital Resources ◽  
Hospital Days

Objective Length of stay (LOS) includes time medically necessary in the hospital and time waiting for discharge (DC) afterward. This DC delay is determined in head and neck free flap patients. Reasons for and factors leading to DC delay, as well as associated adverse outcomes, are elucidated. Methods Retrospective chart review was performed for all head and neck free flap surgeries from 2012 to 2017. Data including demographics, comorbidities, and perioperative factors were collected. Regression analyses were performed to identify factors associated with DC delay. Results In total, 264 patients were included. Mean total LOS was 13.1 days. DC delay occurred in 65% of patients with a mean of 4.8 days. Factors associated with DC delay on univariate analysis included Medicaid/self-pay insurance, DC to a facility, and not having children ( P < .05). Multivariate analysis showed prolonged medically necessary LOS and surgery on a Monday/Friday ( P < .05) were associated with DC delay. Top reasons for DC delay included case management shortages, rejection by facility, and awaiting supplies. Eleven percent experienced complications during the DC delay. Discussion DC delay can add days and complications to the LOS. Prevention begins preoperatively with DC planning involving the patient’s closest family. Understanding limitations of the patient’s insurance may help plan DC destination. Optimizing hospital resources when available should be a focus. Implications for Practice Head and neck free flap patients require a team of teams unified in optimizing quality of care. DC delay is a novel quality metric reflecting the team’s overall performance. Through strategic DC planning and capitalizing on available resources, DC delay can be minimized.

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.

Postoperative Tachycardia in Head and Neck Microvascular Free Flap Patients

2019 ◽  
Vol 160 (6) ◽  
pp. 1019-1022 ◽  
Author(s):  
Andrea Ziegler ◽  
Alexander Schneider ◽  
Amy Pittman ◽  
Eric Thorpe
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Vascular Complication ◽  
Adverse Outcomes ◽  
Free Flap Surgery ◽  
Increased Risk ◽  
Microvascular Free Flap

Objective The goal of this study was to determine the incidence of postoperative tachycardia and its predictive value of complications in patients following microvascular free flap surgery in the head and neck. Study Design Retrospective chart review. Setting Single tertiary care academic medical center. Subjects and Methods All patients who underwent a microvascular free flap of the head and neck by surgeons in the department of otolaryngology from 2013 to 2017 were included in this study. Results Of the 344 who patients met inclusion criteria, 40.4% had a maximum heart rate (HR) of the hospitalization over 110 beats per minute (bpm). Patients with a maximum HR greater than 110 bpm were 19 times more likely to experience a composite vascular complication (myocardial infarction, myocardial necrosis, or pulmonary embolism) than patients with a maximum HR <110 bpm ( P = .0063). Patients with a history of chronic kidney disease were also noted to have an increased risk of experiencing a postoperative composite vascular event. Conclusion Postoperative tachycardia is significantly associated with adverse outcomes and should not be dismissed as a normal variant. Identifying patients at an increased risk of having an underlying complication can help guide interpretation, workup, and management of postoperative patients in the head and neck population.

Utilization of microvascular couplers in salvage arterial anastomosis in head and neck free flap surgery: Case series and literature review

Head & Neck ◽  
2020 ◽  
Vol 42 (8) ◽  
Author(s):  
Michael M. Li ◽  
Akina Tamaki ◽  
Nolan B. Seim ◽  
Stephen Y. Kang ◽  
Enver Ozer ◽  
...  
Keyword(s):  
Literature Review ◽  
Head And Neck ◽  
Free Flap ◽  
Case Series ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Arterial Anastomosis

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.

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.

Reconstruction of Lower Extremity Defects Using the Serratus Anterior Free Flap: A Systematic Review and Retrospective Case Series

2019 ◽  
Vol 36 (02) ◽  
pp. 116-126 ◽  
Author(s):  
Aneesh Karir ◽  
Michael J. Stein ◽  
Sarah Shiga ◽  
Jing Zhang
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Free Flap ◽  
Case Series ◽  
Free Flaps ◽  
Complication Rates ◽  
Minor Complication ◽  
Serratus Anterior ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

Abstract Background Free tissue transfer is the most common modality for distal third lower extremity reconstruction, yet complication rates remain high. The serratus anterior muscle free flap, which can be harvested alone or as a chimeric flap, is a robust and reliable option that remains the primary modality for distal third lower extremity defects at our institution. The objective of this study was to perform a systematic review of lower extremity reconstruction with the serratus anterior free flap and provide a retrospective review of cases at our institution. Methods A systematic review of the literature was conducted using PubMed, Embase, and Cochrane Library (PROSPERO CRD42018110692). Articles reporting reconstruction of lower extremity and foot defects using serratus anterior free flaps in adults were included. A retrospective cohort study of serratus anterior free flaps was then performed from 2012 to 2018 at our institution. Results Thirty-seven articles meeting inclusion criteria provided data on 198 flaps: 125 (63%) serratus-only flaps and 73 (37%) chimeric flaps based on the subscapular axis. Among the serratus-only flaps, defects were primarily due to chronic wounds (51%) or acute infections (33%). Flap survival rate was 97%, and the major and minor complication rates were 5 and 9%, respectively. Of the 10 cases included in the case series, flap survival rate was 100%, there were no major complications, and the minor complication rate was 44%. The average time to flap healing was 95 days and average lower extremity functional scale score was 58/80 among five patients. Conclusion Serratus anterior muscle free flaps are a versatile and reliable option for distal third lower extremity reconstruction.

scholarly journals Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

2021 ◽  
pp. 219256822199478
Author(s):  
Karim Shafi ◽  
Francis Lovecchio ◽  
Maria Sava ◽  
Michael Steinhaus ◽  
Andre Samuel ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Skeletal Dysplasia ◽  
Spinal Surgery ◽  
Cardiovascular Health ◽  
Surgical Complication ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Retrospective Case ◽  
Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures

2017 ◽  
Vol 11 (3) ◽  
pp. 223-229 ◽  
Author(s):  
Zachariah W. Pinter ◽  
Kenneth S. Smith ◽  
Parke W. Hudson ◽  
Caleb W. Jones ◽  
Ryan Hadden ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Fracture Fixation ◽  
Complication Rate ◽  
Ankle Fracture ◽  
Case Series ◽  
Complication Rates ◽  
Union Rate ◽  
Retrospective Case ◽  
Retrospective Case Series

Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. Levels of Evidence: Level IV: Retrospective Case series

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