Background: Microvascular free ap transfers have become a preferred reconstructive technique;
however, rare complica-tions may still prove devastating.
Aim: The objective of this study was to evaluate the clinical outcomes in Head and neck cancer patients undergoing different
microvascular free ap reconstructions .
Materials and Methods: his study analyzed the surgical out-come and complications of 200 microvascular free aps head and
neck reconstruction. In most cases, after resection of the malignant tumor, reconstruction was undertaken . Four types of free
ap were performed as follows: Anterolateral thigh (80%), radial forearm (15%), bula (4%), and jejunum (1%). The most
commonly used as recipient vessels for anastomosis were superior thyroid artery and the external jugular vein. The incidence
of perioperative complications and Patient-related characteristics (age, sex, diagnosis, comorbidity, level, tumor stage, defect
site, primary versus secondary reconstruction, and history of surgery, radiation therapy, or chemotherapy) were recorded
prospectively.
Observations and results: Emergency surgical re-exploration was required in nine patients and the overall ap success rate
was 95.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection
(12.5%), wound dehiscence (15%), partial ap necrosis (2.5%), stula formation (9.5%), and bleeding (1.5%). Recipient and
donor site morbidity was limited and considered acceptable.
Conclusions: Micro surgical free ap is shown to be a valuable and reliable method in head and neck surgery which can be
used effectively and safely with minimal morbidity in selected patients. When performed by skilled surgeon, reconstruction can
be performed with acceptable outcomes and early re-exploration should be the rst choice for the management of vascular
compromised aps.
BACKGROUND Head and neck malignancies require multidisciplinary teamwork approach to achieve a considerable outcome. Adjuvant or definitive radiotherapy plays a central role in management of locally advanced head and neck cancer. Concomitant boost radiotherapy has shown a significant benefit over conventional radiotherapy in various studies done earlier. A second daily fraction given during the radiation schedule in CBT allows for an aggressive fractionation regimen with an advantage of limiting the volume of normal mucosa exposed. We wanted to compare the outcome of concomitant boost radiotherapy versus conventional radiotherapy in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).
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