Analysis of Salvage Treatments following the Failure of Free Flap Transfer Caused by Vascular Thrombosis in Reconstruction for Head and Neck Cancer

Okazaki, Mutsumi; Asato, Hirotaka; Takushima, Akihiko; Sarukawa, Shunji; Nakatsuka, Takashi; Yamada, Atsushi; Harii, Kiyonori

doi:10.1097/01.prs.0000254400.29522.1c

Cited by 75 publications

(57 citation statements)

References 29 publications

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“…Thus, with comparable final costs and better functional outcome, the antebrachial flap is considered as the first option for reconstruction [17]. In spite of this, when the regional or general conditions of the patient do not permit the use of microvascular flaps, even in salvage reconstructions after dehiscence or previous failure, pedicled flaps should be considered [18]. Despite the…”

Section: Discussionmentioning

confidence: 99%

The Pectoralis Major Musculocutaneous Flap in Head and Neck Cancer Reconstruction

Bogado¹,

Souza²,

Dedivitis³

2017

Glob Surg

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Section: Discussionmentioning

confidence: 99%

The Pectoralis Major Musculocutaneous Flap in Head and Neck Cancer Reconstruction

Bogado¹,

Souza²,

Dedivitis³

2017

Glob Surg

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“…Overall a success rate of 96% seems to be the watermark for a program to accept [8][9][10][11][12]21,30]. Factors like OR availability, the start time of the reconstruction, and involvement of the resident versus fellow probably also contribute [23,26,32,33].…”

Section: Discussionmentioning

confidence: 99%

“…A culture of success is reflected in their failure rates which are historically low [8][9][10][11][12]17,28,31]. It's important to mention that when a variety of flaps or new flaps are used the success rate goes down with a thrombotic rate of 17.4%, even at centers of excellence [28].…”

Section: Discussionmentioning

confidence: 99%

“…We would characterize the 1990's as the age of anastomosis. In this time of Centers of Excellence, MD Anderson, Sloan Kettering, and the Bunke Clinic established benchmarks of success in the anastomosis patency [8][9][10][11][12]. However, similar to theories about Nature vs. Nurture in raising children; is success at their centers a result of their technique versus their environment?…”

Section: Introductionmentioning

confidence: 99%

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Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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“…Em um período de 20 anos, Milenovic et al 4 utilizaram 506 RMPM em 500 pacientes para reconstrução intra-oral (387 casos -77%) e faríngea (78 casos -15% 8 . No entanto, quando as condições regionais ou gerais do paciente não permitem a utilização de retalho microvascularizado, inclusive nas reconstruções de "resgate" após deiscência ou falha prévia, retalhos pediculados devem ser considerados 9 . Apesar do uso amplo dos retalhos microvascularizados, o RMPM ainda é considerada a principal opção reconstrutiva para cân-cer de cabeça e pescoço em muitos centros.…”

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O retalho músculo-cutâneo peitoral maior na reconstrução do câncer de cabeça e pescoço

Júnior

Andrade²,

Lehn

et al. 2008

Arq. Bras. Ciên. Saúde

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ResumoIntrodução: Descrito inicialmente por Ariyan na década de 1970, o retalho de peitoral maior tem grande aceitação nas reconstruções por câncer em cabeça e pescoço pela sua versatilidade. Ele é irrigado pela artéria toracoacromial com uma circulação adicional proveniente da artéria torácica lateral. Método e casuística:O retalho foi utilizado para a reconstrução de 104 pacientes com câncer de cabeça e pescoço, sendo: reconstrução de boca/língua (57); reconstrução do trânsito faringo-esofágico (12); reparo de perda de pele cervical (15); reconstrução de faringe (10); reparo de perda de pele de face (7); e reparo de fístula faringo-cutânea (3). Resultados: Necrose total do retalho foi observada em quatro pacientes, necrose parcial e deiscência em 22 pacientes e epidermólise em 31. Conclusão: O retalho foi funcionalmente adequado para a reconstrução de grandes defeitos cirúrgicos. Palavras-chave:Retalhos cirúrgicos; procedimentos cirúrgicos reconstrutivos; neoplasias de cabeça e pescoço; complicações pós-operatórias. AbstractIntroduction: The pectoralis major flap was initially described by Ariyan in the 1970s. It has high acceptance due to its versatility for head and neck

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Analysis of Salvage Treatments following the Failure of Free Flap Transfer Caused by Vascular Thrombosis in Reconstruction for Head and Neck Cancer

Cited by 75 publications

References 29 publications

The Pectoralis Major Musculocutaneous Flap in Head and Neck Cancer Reconstruction

The Pectoralis Major Musculocutaneous Flap in Head and Neck Cancer Reconstruction

Anatomy of Free Flap Failures: Dissection of a Series

O retalho músculo-cutâneo peitoral maior na reconstrução do câncer de cabeça e pescoço

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