Are antithrombotic agents necessary for head and neck microvascular surgery?

Abstract

198underwent conventional surgery based on the surgeon's experience. Condyle position and reconstructed mandible contour were evaluated based on postoperative computed tomography. Complications were also evaluated during the follow-up. Findings: Flap success rate of the patients was 95.6% (43/45). Those in the computer-assisted group presented with better outcomes of the mandibular contour (P = 0.001) and condyle position (P = 0.026). Further, they also experienced beneficial dental restoration (P = 0.011) and postoperative appearance (P = 0.028). The difference between postoperative effect and virtual plan was within the acceptable error margin. There is no significant difference in the incidence of postoperative complications. Conclusion: Computer-assisted techniques can improve the clinical outcomes of mandibular reconstruction with vascularised iliac crest flap.http://dx. Background:The use of free fibular flaps and anterolateral thigh (ALT) flaps for repairing the oromandibular defects is well established, whereas few attentions were focused on postoperative analgesia for the donor area. Objective: To evaluate the effect and safety of lower limb blocks in postoperative analgesia for the free flap donor site. Methods: 40 patients with oromandibular defects who were scheduled for elective reconstructive surgery using free fibular or ALT flaps, were divided into two groups in a randomised, singleblind fashion. In Group PCA, only intravenous patient controlled analgesia (PCA) was used postoperatively. In Group PCA + B, both intravenous PCA and lower limb blocks were used. For patients with fibular flaps harvested, femoral nerve block and common peroneal nerve with ropivacaine were administered. For patients with ALT flaps harvested, femoral nerve block with ropivacaine was administered. Pain scores at donor site, monitoring of vital signs, onset and duration of sensory and motor block, the dose of postoperative rescue analgesics and patient satisfaction with pain relief were performed. Results: Pain scores were lower in Group PCA + B. In Group PCA + B, sensory blocks lasted 13.5 ± 4.1 h. Expectations of patients were improved in Group PCA + B. None experienced motor blockade. Lower limb blocks reduced postoperative analgesic requirements. Conclusions: Lower limb blocks may be safe and effective in postoperative analgesia for the donor site of free fibular and ALT flaps. Lower limb blocks also improve patient satisfaction. http://dx.Background: Mandibular reconstruction is one of the cornerstones of oral and maxillofacial surgery. Bone grafting is a favourable option for such reconstruction. Deep circumflex iliac artery terminal musculocutaneous perforator flap with iliac crest is a good choice for oromandibular defect because of its adequate bone and satisfactory soft tissue. Objectives: This study examined oromandibular defects reconstructed using deep circumflex iliac artery perforator flap with iliac crest (DCIAPF). Methods: From November 2015 to August 2016, 23 patients with mandibular defects after oncologi...

Outcome of Free-Flap Transfer for Head and Neck Reconstruction in Hypercoagulable Patients

“…In a previous study we have found a similar pattern in patients with normal coagulation status. 23 We believe that the signi cance of this change needs further study. We did not analyze the changes in PT because abnormal PT was seen in only three patients in this study.…”

Interdisciplinary management of skull base surgery

“…Different anticoagulation regimes for modification of the secondary hemostasis have been developed and are currently under investigation; further optimization of the protocols already established has been done. 54,55 Latest findings could even demonstrate the primary hemostasis being responsible for flap loss, especially in severely injured patients.…”

Principios básicos de la cirugía microvascular aplicados a la cirugía maxilofacial. Revisión bibliográfica

“…50 Other blood vessels commonly used as receptors for the anastomosis are the superior thyroid artery and branches of the internal jugular vein whose diameters range from 1.5 to 5 mm. 51 When the blood vessels to be reconstructed have a diameter of less than 5 mm, the use of optical magnification gives us certain advantages such as:…”