scholarly journals Factors Predicting Total Free Flap Loss after Microsurgical Reconstruction Following the Radical Ablation of Head and Neck Cancers

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Masaki Fujioka
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Radiation Treatment ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Tumor Type ◽  
Flap Necrosis ◽  
Microsurgical Reconstruction ◽  
Flap Failure ◽  
Flap Loss

Background. With greater experience in microsurgical reconstruction, free tissue transfer has become common and reliable. However, total flap necrosis after microsurgical reconstruction is sometimes seen in patients who have undergone radical ablation of head and neck malignancies. We investigated factors predicting free flap loss in head and neck reconstruction. Methods. We reviewed the records of 111 free flap reconstructions carried out among 107 patients with head and neck cancer who required radical resection and microsurgical reconstruction in our unit from 2004 through 2010. Among these patients, 6 showed total flap necrosis postoperatively. We investigated the associations between primary or recurrent tumor, type of flaps, chemotherapy, and radiotherapy and flap loss. Results. Five of 20 (25.0%) patients who underwent radiotherapy developed flap necrosis: among the 91 patient who did not undergo radiotherapy, only one (1.1%) developed. Preoperative radiotherapy was statistically identified as the most important risk factor for postoperative flap failure. Conclusions. Patients receiving radiation treatment are more likely to develop total flap failure when they undergo reconstructive surgery with free flaps after tumor ablation, because the combination of endarteritis and chronic ischemia caused by radiation damaged endothelial membrane in the recipient vessels, consequently, thrombosis tends to develop.

Factors Associated with Free Flap Failures in Head and Neck Reconstruction

2019 ◽  
Vol 161 (4) ◽  
pp. 598-604 ◽  
Author(s):  
Meghan B. Crawley ◽  
Larissa Sweeny ◽  
Prasanti Ravipati ◽  
Ryan Heffelfinger ◽  
Howard Krein ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Alcohol Withdrawal ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Ischemic Time ◽  
Ischemia Time ◽  
Flap Failure

Objective To investigate causes of failure of free flap reconstructions in patients undergoing reconstruction of head and neck defects. Study Design Case series with chart review. Setting Single tertiary care center. Subjects and Methods Patients underwent reconstruction between January 2007 and June 2017 (n = 892). Variables included were clinical characteristics, social history, defect site, donor tissue, ischemia time, and postoperative complications. Statistical methods used include univariable and multivariable analysis of failure. Results The overall failure rate was 4.8% (n = 43). Intraoperative ischemia time was associated with free flap failures (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.019-1.107; P = .004) for each addition of 5 minutes. Free flaps that required pedicle revision at time of initial surgery were 9 times more likely to fail (OR, 9.953; 95% CI, 3.242-27.732; P < .001). Patients who experienced alcohol withdrawal after free flap placement were 3.7 times more likely to experience flap failure (OR, 3.690; 95% CI, 1.141-10.330; P = .031). Ischemia time remained an independent significant risk factor for failure in nonosteocutaneous free flaps (OR, 1.105; 95% CI, 1.031-1.185). Alcohol withdrawal was associated with free flap failure in osteocutaneous reconstructions (OR, 5.046; 95% CI 1.103-19.805) while hypertension was found to be protective (OR, 0.056; 95% CI, 0.000-0.445). Conclusion Prolonged ischemia time, pedicle revision, and alcohol withdrawal were associated with higher rates of flap failure. Employing strategies to minimize ischemic time may have potential to decrease failure rates. Flaps that require pedicle revision and patients with a history of significant alcohol use require closer monitoring.

scholarly journals Microvascular free flap for head and neck reconstruction: our experiences with 218 free flaps for head and neck reconstructions

2021 ◽  
Vol 7 (12) ◽  
pp. 1868
Author(s):  
N. Brian Shunyu ◽  
Suvamoy Chakraborty ◽  
Lomtu Ronrang ◽  
Zareen Lynrah ◽  
Hanifa Aktar ◽  
...  
Keyword(s):  
Survival Rate ◽  
Head And Neck ◽  
Free Flap ◽  
Free Flaps ◽  
Radical Resection ◽  
Complete Loss ◽  
Head And Neck Reconstruction ◽  
Flap Survival ◽  
Flap Loss ◽  
Microvascular Free Flap

<p class="abstract"><strong>Background:</strong> Defect following radical resection for advance head and neck cancers are complex and without doubt microvascular free flap offer the best reconstructive option. The purpose of this study is to investigate the flap survival rate and review each vascular compromised flaps.</p><p class="abstract"><strong>Methods:</strong> This is a reviewed of 218 microvascular free flaps done for reconstruction of 204 head and neck patients. There were 112 (51.3%) radial forearm flaps (RFF), 82 (37.6%) fibula flaps (FF) and 24 (11%) anterior lateral thigh (ALT) flaps.  </p><p class="abstract"><strong>Results:</strong> There were 16 complete flap loss and 3 partial flap loss, giving an overall flap survival rate 91.8% (19/218) and flap survival in turn of complete loss 92.7% (16/218). In RFF, there were 7 complete and 1 partial flap loss, giving an overall flap survival rate 92.9% (8/112) and flap survival in turn of complete loss 93.8% (7/112). In FF, there were 6 complete flap loss, giving a flap survival rate 92.7% (6/82). In ALT flap, there were 3 complete and 2 partial flaps loss, giving an overall flap survival rate 79.2% (5/24) and flap survival in turn of flap complete loss 87.5% (3/24). In our series vascular flaps complications rate was 12.3% (27/218), with a salvageable rate of 29.6% (8/27). The most salvageable flap was RFF 46.6% (7/15).</p><p><strong>Conclusions:</strong> The study re-enforce the learning curve in microvascular free flap and RFF is a good flap for a beginner. </p>

Buried free flaps in head and neck reconstruction: higher risk of free flap failure?

2016 ◽  
Vol 274 (1) ◽  
pp. 427-430 ◽  
Author(s):  
M. Reiter ◽  
U. Harréus ◽  
U. Kisser ◽  
C. S. Betz ◽  
Ph. Baumeister
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Flap Failure

scholarly journals Late Free Flap Failure in Head and Neck Reconstruction: A Systematic Review

2018 ◽  
Vol 97 (7) ◽  
pp. 213-216 ◽  
Author(s):  
David Forner ◽  
Blair A. Williams ◽  
Fawaz M. Makki ◽  
Jonathan R.B. Trites ◽  
S. Mark Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Head And Neck Reconstruction ◽  
Time To Failure ◽  
Close Monitoring ◽  
Flap Failure ◽  
Vascular Compromise

Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.

scholarly journals Impact of Recipient Vein Selection on Venous Patency and Free Flap Survival in 652 Head and Neck Reconstructions

2019 ◽  
Vol 36 (02) ◽  
pp. 073-081 ◽  
Author(s):  
Jong Woo Choi ◽  
Young Chul Kim ◽  
Dong Neok Jeon ◽  
Woo Shik Jeong ◽  
Kyung S. Koh ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Radiation Treatment ◽  
Free Flaps ◽  
Venous System ◽  
Venous Congestion ◽  
Patient Factors ◽  
Flap Survival ◽  
History Of ◽  
The Impact

Background This study was conducted to evaluate the impact of choosing a particular recipient venous system on venous patency and flap survival in 652 head and neck free flap reconstructions. Methods A retrospective review was performed. Patient factors investigated included: age, sex, type of flap, tumor location, history of radiation, presence of previous neck dissection, tumor stage, and any underlying disease. Data related with recipient vein including the number of anastomosis, the repair technique, the type of recipient vein, and the configuration of selected venous system were examined. The impact of patient factors and parameters related with recipient vein on the venous patency and flap survival were analyzed using bivariate and multivariate analyses. Results Of 652 free flaps, 36 flaps (5.5%) were re-explored due to venous congestion and 28 flaps (77.8%) were salvaged. The overall survival rate of total free flaps was 98.8%. The type of recipient venous system was found to be an insignificant factor with respect to venous congestion and flap survival in multivariate analysis. A history of radiation treatments was the only factor associated with a higher risk of venous compromise (odds ratio [OR] = 13.138, p < 0.001) and a lower rate of flap survival (OR = 20.182, p = 0.002). Conclusion The selection of recipient venous systems has no impact on venous patency and flap survival. History of radiation treatment was the only factor associated with venous congestion and flap failure. Since no single method can ensure a successful reconstructive result, selecting the optimal recipient vein should be based on individual patient factors and the surgeon's experience.

Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis

2017 ◽  
Vol 34 (02) ◽  
pp. 087-094 ◽  
Author(s):  
Jinglong Liu ◽  
Quan Shi ◽  
Shuo Yang ◽  
Bo Liu ◽  
Bin Guo ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Meta Analysis ◽  
Anticoagulation Therapy ◽  
Head And Neck Reconstruction ◽  
Thromboembolic Events ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Flap Loss ◽  
Free Flap Surgery

Background Due to limited evidence, it is unclear whether postoperative anticoagulation therapy may lead to higher success rates for microvascular free-flap surgery in the head and neck. This review evaluated whether postoperative anticoagulation therapy can lead to a better result in head and neck reconstruction. Methods PubMed, Embase, and the Cochrane Library were used to search for articles on the efficacy of postoperative antithrombotic therapy in free-flap transfer during head and neck reconstruction without language restrictions in February of 2017. A random-effects model was used to estimate the relative risk ratio (RR) with 95% confidence intervals (CIs). The measured outcomes were flap loss, thromboembolic events, and hematoma formation. Results A total of 2,048 free-flap surgery procedures in the head and neck were analyzed. There was no significant difference in the occurrence of flap loss and thromboembolic events in the anticoagulation group compared with the nonanticoagulation group (RR = 1.25, 95% CI = 0.85–1.81, p = 0.26; and RR = 1.05, 95% CI = 0.74–1.48, p = 0.79, respectively). The risk of hematoma was twice as high in the anticoagulation group than the nonanticoagulation group, which was statistically significant (RR = 2.02, 95% CI = 1.08–3.76, p = 0.03). Conclusion The findings from our meta-analysis indicate that postoperative anticoagulation therapy barely decreases the risks of flap loss and thromboembolic events in free-flap surgery in the head and neck. However, it may significantly increase the risk of hematoma formation. Considering the limitations of this meta-analysis, additional high-quality, multicenter, prospective, randomized controlled studies are needed to confirm these findings.

Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction

Head & Neck ◽  
2015 ◽  
Vol 38 (S1) ◽  
pp. E771-E775 ◽  
Author(s):  
Edward I. Chang ◽  
Hong Zhang ◽  
Jun Liu ◽  
Peirong Yu ◽  
Roman J. Skoracki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Flap Loss

Free flap failure in head and neck reconstruction

Head & Neck ◽  
2014 ◽  
pp. n/a-n/a ◽  
Author(s):  
Christian Corbitt ◽  
Roman J. Skoracki ◽  
Peirong Yu ◽  
Matthew M. Hanasono
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Flap Failure

scholarly journals Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting

2019 ◽  
Vol 12 (3) ◽  
pp. 183-192 ◽  
Author(s):  
Pieter-Jan Verhelst ◽  
Flore Dons ◽  
Pieter-Jan Van Bever ◽  
Joseph Schoenaers ◽  
Lloyd Nanhekhan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Flap Failure ◽  
Fibula Free Flap ◽  
Tertiary Center ◽  
Low Volume

The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. A retrospective analysis was conducted of all FFFs performed over a 20-year period at a low-volume single tertiary center to identify risk factors and postoperative complications. A total of 129 FFFs were included (122 mandible, 7 maxilla). Complete flap failure occurred in 12.4% and partial flap failure in 7.8% of patients. A significant relation was found between younger age and flap failure, and most failures were associated with venous thrombosis. In-hospital surgical complications occurred in 60.5%, in-hospital medical complications in 49.6%, and out-of-hospital complications in 77.5% of patients. The in-hospital reintervention rate was 27.1%, and including salvaged flaps, flap survival rate was 87.6%. Osteomyocutaneous FFF failure (complete 12.4%; partial 7.8%) is an important clinical reality in a low-volume head and neck reconstruction center resulting in an in-hospital reintervention rate of 27.1%. Postoperative complications are frequent, both surgical and out-hospital complications. These results provide a better understanding of the limitations of the FFF in a low-volume center and can be used to optimize care in this kind of setting.

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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