scholarly journals Current evidence for outcomes of free-flap reconstruction in factor V Leiden patients

2019 ◽  
Vol 2 (2) ◽  
pp. 58-66
Author(s):  
Isobel Yeap ◽  
Chris Ahn ◽  
Stuart Hoffman ◽  
Rowan Gillies ◽  
John Vandervord
Keyword(s):  
Free Flap ◽  
Factor V Leiden ◽  
Free Flaps ◽  
Current Evidence ◽  
Factor V ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Surgery ◽  
Flap Failure ◽  
Free Flap Surgery

Background: Factor V Leiden is the most common form of inherited thrombophilic syndrome, affecting five per cent of caucasians. While increased rates of venous thromboembolic complications have been regularly reported in factor V Leiden patients, little is known about their risk of microvascular complications or flap failure rates in free-flap surgery. The aim of this review is to qualitatively review the published literature on outcomes of free-flap surgery in patients with factor V Leiden. Methods: MEDLINE®, PubMed, EMBASE and Cochrane were searched from their dates of inception to March 2017. Nine studies of level IV evidence were included in this qualitative review. In total, these studies included 22 patients who underwent 24 free-flap operations. Results: Nine flap failures were reported due to thrombotic complications. Even heterozygous factor V Leiden patients had a relatively high risk of free-flap failure (3/15 free flaps), and patients who were heterozygous for factor V Leiden and had other coexistent thrombophilias had an even higher failure rate (5/6 free flaps). However, the small sample size across the nine studies, as well as the inevitable publication bias, means that definitive conclusions cannot be drawn. Conclusion: Despite factor V Leiden being a relatively common condition in Australia, current evidence for outcomes of free-flap reconstruction in this patient population is lacking.

Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

2018 ◽  
Vol 159 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Meghan M. Crippen ◽  
Jacob S. Brady ◽  
Alexander M. Mozeika ◽  
Jean Anderson Eloy ◽  
Soly Baredes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

Considerations in Free Flap Reconstruction of the Midface

2021 ◽  
Author(s):  
Daniel Hammer ◽  
Aurora G. Vincent ◽  
Fayette Williams ◽  
Yadranko Ducic
Keyword(s):  
Free Flap ◽  
Preoperative Assessment ◽  
Free Flaps ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Pedicle Flap ◽  
Free Flap Surgery ◽  
Management Of Complications ◽  
Flap Design ◽  
Midface Reconstruction

AbstractMidface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is required to properly assess the defect or anticipated defect, determine proper reconstructive surgical plan, and discuss expected functional and aesthetic outcomes with the patient. For years we have employed local flaps, regional flaps, obturators, alloplastic implants, free flaps, or a combination of the previously mentioned techniques to address complex midface reconstruction. Free flap reconstruction in the midface requires special considerations for the pedicle, flap selection, and flap design to ensure an optimal outcome. The introduction of virtual surgical planning for reconstruction has enhanced patient outcomes to include advances in immediate dental rehabilitation at the time of free flap surgery. Postoperative considerations including quality of life, functional and aesthetic outcomes, and management of complications will also be discussed.

scholarly journals Effect of Dexmedetomidine on Postoperative Hemodynamics and Outcome of Free Flaps in Head and Neck Reconstructive Surgeries

2016 ◽  
Vol 10 (1) ◽  
pp. 12-17
Author(s):  
Sunil Rajan ◽  
Sumana Moorthy ◽  
Jerry Paul ◽  
Lakshmi Kumar
Keyword(s):  
Free Flap ◽  
Randomized Study ◽  
Free Flaps ◽  
Uncontrolled Hypertension ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Morphine Group ◽  
Chi Square ◽  
Flap Failure ◽  
Group D

Background and Aims: Dexmedetomidine is less frequently used during free flap surgeries for fear of causing vasoconstriction leading to flap failure as it is an α2 agonist. But most patients following major resections with free flap reconstruction develop uncontrolled hypertension postoperatively which could lead to complications resulting in reduced flap perfusion. We aimed to compare the effects of dexmedetomidine on postop haemodynamics, re-exploration rates and final outcome of free flaps in patients who underwent reconstructive surgeries. Material and Methods: This prospective, randomized study was conducted in 40 patients aged 20-70 years. Patients in both groups received morphine 0.1mg/kg, 30 minutes before end of surgery. In addition, in Group D dexmedetomidine 1mcg/kg bolus was also given at the same time, followed by 0.5mcg/kg/hr infusion. Post operatively the patients received either dexmedetomidine 0.5mcg/kg/h (Group D) or morphine 2mg/hr (Group M) infusion for 12 hours. Statistical analysis was done using Chi-Square test and independent sample t test. Results: Morphine group had significantly higher heart rate (105.2 ± 7.5 vs 90.0 ± 11.7), systolic blood pressure (167.5 ± 7.3 vs 125.4 ±16.6) and mean arterial pressures (103.5 ± 4.6 vs 87.8 ± 12.2) than dexmedetomidine group. Same trend persisted till 12 hours post operatively. More patients in morphine group required re-exploration of the flap (15 vs 10%) and had flap failure (7.5 vs 2.5%), but these differences were not statistically significant. Conclusion: Dexmedetomidine can be safely used in patients with free flap reconstruction as it optimizes postoperative hemodynamics and is not associated with any significant increase in re-exploration or flap failures. Key Messages: Dexmedetomidine resulted in optimal postoperative hemodynamics, reduced re-exploration rate and better flap outcome.

scholarly journals 240 Aetiology and Outcomes of Head and Neck Free Flaps in Patients Aged ≥ 65 Years: The Cambridge Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Hjalmarsson ◽  
T Chan ◽  
R Chawla ◽  
A Patel
Keyword(s):  
Free Flap ◽  
Free Flaps ◽  
Flap Surgery ◽  
Related Factors ◽  
Flap Failure ◽  
Standard Management ◽  
Free Flap Surgery ◽  
Radial Forearm ◽  
Surgery Department

Abstract Introduction Elderly patients often present to the Head & Neck Plastic Surgery department with complex reconstructive needs, for which free flaps are the gold-standard management. In order to provide appropriate, patient-centred care, it is imperative to understand how increasing age and related factors affect long-term free flap outcomes. Method The authors carried out a retrospective review of all patients 65+ years who underwent free flap surgery at Addenbrooke’s Hospital from 2008-2019. Patient, operative, and flap characteristics, and outcomes, were analysed using Excel and RStudio. Results 163 patients were identified (54F, 109M). The majority were ALT (n = 74), radial forearm (n = 35), and fibula flaps (n = 23). Of pre-operative comorbidities, only neurological comorbidities (n = 16), were significantly associated with long-term flap failure (p = 0.016). There was no significant association between number of comorbidities and flap outcome. There was no association between age group and length of stay. Flap site complications, and particularly venous complications, were significantly associated with later failure (p = 0.001). No other complications were statistically associated with flap failure. Conclusions The high success rate supports the use of free flaps in the 65+ population. This data supports a case-by-case approach to assessing fitness for free flap surgery rather than excluding patients on the basis of age or specific comorbidities.

scholarly journals Use of the Anterolateral Thigh in Cranio-Orbitofacial Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
William J. Parkes ◽  
Howard Krein ◽  
Ryan Heffelfinger ◽  
Joseph Curry
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tissue Loss ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Anterolateral Thigh ◽  
The Many ◽  
Soft Tissue Loss

Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.

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 One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 26 (2) ◽  
pp. 91-98
Author(s):  
Jennifer L. K. Matthews ◽  
Noor Alolabi ◽  
Forough Farrokhyar ◽  
Sophocles H. Voineskos
Keyword(s):  
Systematic Review ◽  
Free Flap ◽  
Meta Analysis ◽  
Venous Congestion ◽  
Flap Surgery ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
Significant Difference ◽  
Reoperation Rates ◽  
Venous Flap

Background: The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems. Methods: A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs). Results: Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27). Conclusions: There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.

O147 The use of free flaps based on the thoracodorsal artery for free flap reconstruction

2007 ◽  
Vol 2 (1) ◽  
pp. 109
Author(s):  
R. Anand ◽  
M. Ethunandan ◽  
P. Ramchandani ◽  
V. Ilankovan
Keyword(s):  
Free Flap ◽  
Free Flaps ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Thoracodorsal Artery

S147 – Pectoralis Major Flaps: A Workhorse in Today's Free Flap Era

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P125-P126
Author(s):  
Barrie Yau-Boon Tan ◽  
Mark Khoo
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Wound Dehiscence ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Recipient Site ◽  
Neck Reconstruction ◽  
Flap Failure

Objectives To study the use, complication rate, and efficacy of pedicled local regional flaps for head and neck reconstruction, and to compare these results with those of microvascular free flap reconstruction. Methods Retrospective analysis of all head and neck oncologic resections requiring flap reconstruction in a tertiary head and neck surgery centre over a 6-year period from 2001–2007. Results In total, 77 operations with flap reconstruction were performed. 44 resections employed pedicled locoregional flaps, comprising 33 pectoralis major, 3 trapezius, 3 cervical rotation, 1 deltopectoral, 1 temporalis muscle, 2 nasolabial, 1 cheek rotation, and 2 bilobed rotation flaps. 2 patients had a combination of 2 regional flaps. There was 1 flap failure. Minor complications occurred in 25% of patients comprising wound seromas (3), wound dehiscence (6), fibrotic band formation (1) and pharyngocutaneous fistula (1). 33 resections employed free flap microvascular reconstructions, comprising 22 free radial forearm, 7 free rectus abdominis, 1 free jejunal, 1 free fibular, and 2 anterolateral thigh flaps. There was 1 flap failure. Minor complications occurred in 33% of patients, comprising donor site wound dehiscence (4), recipient site wound dehiscence or seroma (4), plate extrusion (1), abscess and wound breakdown (2). Conclusions Despite the ready access to free flap reconstruction today, pedicled flaps, especially the pectoralis major flap, remain a major workhorse in head and neck reconstruction. They are hardy, reliable, cost-effective, and can be done in a short operative time. Moreover, for several regions, the functional outcome is no worse than free flap reconstruction.

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