scholarly journals From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2890
Author(s):  
Rosie Twomey ◽  
T. Wayne Matthews ◽  
Steven C. Nakoneshny ◽  
Christiaan Schrag ◽  
Shamir P. Chandarana ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Clinical Decision Making ◽  
Enhanced Recovery ◽  
Hospital Length Of Stay ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Recommended Care

One of the foundational elements of enhanced recovery after surgery (ERAS) guidelines is early postoperative mobilization. For patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction, the ERAS guideline recommends patients be mobilized within 24 h postoperatively. The objective of this study was to evaluate compliance with the ERAS recommendation for early postoperative mobilization in 445 consecutive patients who underwent HNC surgery in the Calgary Head and Neck Enhanced Recovery Program. This retrospective analysis found that recommendation compliance increased by 10% despite a more aggressive target for mobilization (from 48 to 24 h). This resulted in a decrease in postoperative mobilization time and a stark increase in the proportion of patients mobilized within 24 h (from 10% to 64%). There was a significant relationship between compliance with recommended care and time to postoperative mobilization (Spearman’s rho = −0.80; p < 0.001). Hospital length of stay was reduced by a median of 2 days, from 12 (1QR = 9–16) to 10 (1QR = 8–14) days (z = 3.82; p < 0.001) in patients who received guideline-concordant care. Engaging the clinical team and changing the order set to support clinical decision-making resulted in increased adherence to guideline-recommended care for patients undergoing major HNC surgery with free flap reconstruction.

scholarly journals Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

2017 ◽  
Vol 143 (3) ◽  
pp. 292 ◽  
Author(s):  
Joseph C. Dort ◽  
D. Gregory Farwell ◽  
Merran Findlay ◽  
Gerhard F. Huber ◽  
Paul Kerr ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Perioperative Care ◽  
Cancer Surgery ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

Microsurgical Free Flap Reconstruction Outcomes in Head and Neck Cancer Patients after Surgical Extirpation and Intraoperative Brachytherapy

2004 ◽  
Vol 114 (7) ◽  
pp. 1170-1176 ◽  
Author(s):  
Douglas A. Ross ◽  
Jagdeep S. Hundal ◽  
Yung H. Son ◽  
Stephan Ariyan ◽  
Joseph Shin ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Surgical Extirpation

Interpretability of PET/CT imaging in head and neck cancer patients following composite mandibular resection and osteocutaneous free flap reconstruction

Head & Neck ◽  
2008 ◽  
Vol 30 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Christopher Oliver ◽  
Ashok Muthukrishnan ◽  
James Mountz ◽  
Erin Deeb ◽  
Jonas Johnson ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Free Flap ◽  
Ct Imaging ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Pet Ct

Results of free flap reconstruction for patients aged 80 years or older with head and neck cancer

2020 ◽  
Vol 47 (1) ◽  
pp. 123-127 ◽  
Author(s):  
Naoki Otsuki ◽  
Tatsuya Furukawa ◽  
Mehmet Ozgur Avinçsal ◽  
Masanori Teshima ◽  
Hirotaka Shinomiya ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

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.

scholarly journals Reconstructive considerations in head and neck surgical oncology: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S191-S197 ◽  
Author(s):  
M Ragbir ◽  
J S Brown ◽  
H Mehanna
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Pharyngocutaneous Fistula ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Tissue Transfer ◽  
First Choice ◽  
Ablative Surgery

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The reconstructive needs following ablative surgery for head and neck cancer are unique and require close attention to both form and function. The vast experience accrued with microvascular reconstructive surgery has meant a significant expansion in the options available. This paper discusses the options for reconstruction available following ablative surgery for head and neck cancer and offers recommendations for reconstruction in the various settings.Recommendations• Microsurgical free flap reconstruction should be the primary reconstructive option for most defects of the head and neck that need tissue transfer. (R)• Free flaps should be offered as first choice of reconstruction for all patients needing circumferential pharyngoesophageal reconstruction. (R)• Free flap reconstruction should be offered for patients with class III or higher defects of the maxilla. (R)• Composite free tissue transfer should be offered as first choice to all patients needing mandibular reconstruction. (R)• Patients undergoing salvage total laryngectomy should be offered vascularised flap reconstruction to reduce pharyngocutaneous fistula rates. (R)

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