An Early Experience of Microvascular Surgery in a Tertiary Cancer Centre in North East

Abstract

BACKGROUND Microvascular surgery is a highly technique sensitive and evolving speciality in reconstructive oncosurgery. There is a definite learning curve associated with it. In this case series, we describe our initial experience in microvascular surgery at a tertiary cancer centre in North East India. METHODS It is a retrospective observational case series done at a tertiary cancer centre in North East India from May 2018 to Jul 2018. The first ten cases of our free flap journey till now were included in the study. Data were collected from patient records and the hospital online reporting system. All data were analysed using SPSS. RESULTS In our series, 8 patients were male and 2 patients were female. The mean age in the series was 37 years. Squamous cell carcinoma accounts for 4 the patients, osteosarcoma for 2 of patients and adenoid cystic carcinoma, Ewing sarcoma, rhabdomyosarcoma and low-grade soft tissue sarcoma 1 case each. Out of the ten free tissue transfers, one free ALT flap for total maxillary defect failed during the 4th postoperative day and the patient was managed with a prosthesis. The average hospital stay during the case series was 10.6 days. CONCLUSION Microvascular surgeries are very complex surgeries. The presence of a good, well-trained plastic surgery team working in conjunction with other specialities is paramount for a good outcome. A dedicated team, cooperative administration, fine and good infrastructure with high-quality equipment are the basic necessities for creating a good microsurgery unit.

Free flap reconstruction at a rural‐based tertiary medical college hospital: Barriers and outcomes

“…The authors concluded that microvascular reconstruction is feasible in rural areas, with emphasis on team approach and protocol development 13 . A recent study from the Northeastern part of the country re‐emphasised the need for a trained team with adequate infrastructure to be able to deliver the best results 14 . A couple of studies have shown that free flaps can be performed safely in community hospitals with acceptable morbidity and mortality rates when compared to academic/teaching institutes (high‐volume centres) 15,16 …”

“…which need to be streamlined and scheduled appropriately so that there is no undue delay in caring for such patients given that free flaps take almost an entire day to complete. 10,13,14,22 Last but certainly not the least, a definite learning curve exists for microvascular surgeries and flap success and subsequent salvage rates improve with time. 23 This hastens the confidence of the entire team and one must not get bogged down by early failures during the learning curve, which has been evaluated to be at least 20 cases to | 1163 overcome the learning curve.…”

“…13 A recent study from the Northeastern part of the country re-emphasised the need for a trained team with adequate infrastructure to be able to deliver the best results. 14 A couple of studies have shown that free flaps can be performed safely in community hospitals with acceptable morbidity and mortality rates when compared to academic/teaching institutes (high-volume centres). 15,16 Potential barriers to free flap reconstruction can be classified into preoperative, intraoperative and postoperative (Table 4).…”

“…They should be rechecked and confirmed just before commencement of reconstruction to avoid unnecessary delay, (d) triaging of patients who require ICU care must be protocolised to reduce overall costs and resources and (e) nononcological plastic surgery cases (like trauma, burns etc.) which need to be streamlined and scheduled appropriately so that there is no undue delay in caring for such patients given that free flaps take almost an entire day to complete 10,13,14,22 …”