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.

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.

Avoiding Complications in Free Flap Surgery

1995 ◽  
Vol 112 (5) ◽  
pp. P38-P38
Author(s):  
Neal D. Futran ◽  
Jeffrey R. Haller
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Postoperative Care ◽  
Preoperative Planning ◽  
Head And Neck Reconstruction ◽  
Flap Surgery ◽  
Educational Objectives ◽  
Neck Reconstruction ◽  
Free Flap Surgery

Educational objectives: To avoid complications in microvascular head and neck reconstruction by having a better understanding of patient and flap selection, preoperative planning, postoperative care, and monitoring and to delineate the techniques and procedures to manage free flap complications when they occur.

scholarly journals Role of heparin in microvascular free flap surgery in head and neck reconstruction

2015 ◽  
pp. 534-538
Author(s):  
Gunjan Agrawal ◽  
Ashutosh Gupta ◽  
Vivek Choudhary ◽  
Santanu Tiwari ◽  
Kshitij Verma ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Free Flap Surgery ◽  
Microvascular Free Flap

scholarly journals Cost analysis of free flap surgery in head and neck reconstruction

2017 ◽  
Vol 46 ◽  
pp. 193
Author(s):  
K. Tewfik ◽  
P. Chiarelli ◽  
C. Copelli ◽  
L. Cassano ◽  
L. Mangiacotti ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Free Flap Surgery

Complications and Cost Analysis of Intraoperative Arterial Complications in Head and Neck Free Flap Reconstruction

2017 ◽  
Vol 33 (05) ◽  
pp. 318-327 ◽  
Author(s):  
Michael Chu ◽  
Jonas Nelson ◽  
Marten Basta ◽  
Patrick Gerety ◽  
Suhail Kanchwala ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Head And Neck ◽  
Free Flap ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Venous Anastomosis ◽  
Factors Associated ◽  
Neck Reconstruction ◽  
Arterial Complications ◽  
The Impact

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.

Securing a tracheostomy when circumferential ties may compromise flap perfusion: the ‘epaulette’ technique

2010 ◽  
Vol 124 (6) ◽  
pp. 666-667 ◽  
Author(s):  
P Loizou ◽  
P A Tierney ◽  
J Savage
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Tracheostomy Tube ◽  
Pressure Effect ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Local Pressure ◽  
Unplanned Extubations ◽  
Vascular Compromise ◽  
Flap Perfusion

AbstractThe use of free flaps in head and neck reconstruction raises the question of how to adequately fix a tracheostomy tube without causing local pressure to the vascular anastomosis. We describe a previously unreported technique of securing a tracheostomy tube in the immediate and early post-operative period without vascular compromise of the free flap, using the ‘epaulette’ technique. We undertook a PubMed literature search for articles describing similar methods of securing a tracheostomy tube in patients with head and neck free flaps, but found none. In our experience of using this method, we encountered no compromised flaps or unplanned extubations. We believe the epaulette technique to be an easy and safe method of securing a tracheostomy tube whilst simultaneously avoiding any local pressure effect on the free flap vessels and anastomosis.

Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery

2019 ◽  
Vol 133 (09) ◽  
pp. 742-746
Author(s):  
L F Jones ◽  
E M Farrar ◽  
D J H Roberts ◽  
J W Moor
Keyword(s):  
Head And Neck ◽  
Imaging Techniques ◽  
Pedicled Flap ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Success Rates ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Free Flap Surgery ◽  
Variable Nature

AbstractBackgroundThe sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.ObjectiveTo provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.MethodsA literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.ResultsReported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.ConclusionThe sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.

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

Postoperative Complications Associated with the Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis of 4,712 Patients from the ACS-NSQIP Database

2021 ◽  
Author(s):  
Jacob Y. Katsnelson ◽  
Richard Tyrell ◽  
Murad J. Karadsheh ◽  
Ely Manstein ◽  
Brian Egleston ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Hospital Readmission ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Head And Neck Reconstruction ◽  
Pedicled Flaps ◽  
Neck Reconstruction

Abstract Background Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years. Methods Patients undergoing head and neck reconstruction were identified in the 2011–2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay. Results A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02–6.85, p = 0.045), sepsis (OR = 2.95, CI 1.52–5.71, p = 0.001), and infection (OR = 2.03, CI 1.39–2.96, p <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, p <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50–0.85, p = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12–0.92, p = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps. Conclusion Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay.

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