Comparison of patient‐reported upper extremity disability following free flaps in head and neck reconstruction: A systematic review and meta‐analysis

Ranganath, Kushi; Miller, Lauren E.; Goss, Deborah; Lin, Derrick T.; Faden, Daniel L.; Deschler, Daniel G.; Emerick, Kevin S.; Richmon, Jeremy D.; Varvares, Mark A.; Feng, Allen L.

doi:10.1002/hed.27375

Cited by 3 publications

(1 citation statement)

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“…For soft tissue reconstruction, a myriad of different donor sites are available, but concerns with donor site morbidity are becoming increasingly scrutinized. The radial forearm flap, which was historically the primary option for a thin pliable donor site, has been criticized more frequently in the modern era with the popularity of alternate donor sites that can avoid a skin graft and potential cold intolerance, and impaired function of the upper extremity [ 77 , 78 , 79 ]. The search for the ideal donor site remains elusive, but likely there is no single donor site that is ideal, and the reconstructive microsurgeon must decide which donor site to use based on the extent and type of defect as well as the patient’s body habitus and available donor sites [ 80 ].…”

Section: Future Directionsmentioning

confidence: 99%

Innovative Strategies in Microvascular Head and Neck Reconstruction

et al. 2023

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The field of reconstructive microsurgery has witnessed considerable advancements over the years, driven by improvements in technology, imaging, surgical instruments, increased understanding of perforator anatomy, and experience with microsurgery. However, within the subset of microvascular head and neck reconstruction, novel strategies are needed to improve and optimize both patient aesthetics and post-operative function. Given the disfiguring defects that are encountered following trauma or oncologic resections, the reconstructive microsurgeon must always aim to innovate new approaches, reject historic premises, and challenge established paradigms to further achieve improvement in both aesthetic and functional outcomes. The authors aim to provide an up-to-date review of innovations in head and neck reconstruction for oncologic defects.

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Section: Future Directionsmentioning

confidence: 99%

Innovative Strategies in Microvascular Head and Neck Reconstruction

et al. 2023

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Outcomes for 160 Consecutive Lateral Arm Free Flaps for Head and Neck Reconstruction

Contrera,

Hassan,

Shuck

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveExamine outcomes for lateral arm autologous tissue transfer in head and neck reconstruction.Study DesignRetrospective cohort study.SettingTertiary cancer center.MethodsAll patients who underwent traditional lateral arm, extended lateral arm, and lateral forearm flaps for head and neck reconstruction from 2012 to 2022 were assessed. Disabilities of the arm, shoulder, and hand (DASH) was measured. Factors associated with complications and enteral or mixed diet were evaluated by multivariable regression.ResultsAmong 160 patients followed for a median of 2.3 ± 2.1 years, defects were 54% oral tongue, 18% external, 9% maxilla, 8% buccal mucosa, 9% floor of mouth, and 3% pharynx. Flap types (and median pedicle lengths) were 41% traditional lateral arm (8 cm), 25% extended lateral arm (11.5 cm), and 34% lateral forearm (14 cm). All donor sites were closed primarily; 19.6% and 0% of patients had increased DASH scores 2 and 12 weeks after reconstruction. Major complications occurred in 18.1% of patients, including 6.3% reoperation, 6.9% readmission, 3.7% fistula, and 1.8% flap loss. Complications were independently associated with peripheral vascular disease (odds ratio [OR]: 5.71, 95% confidence interval [CI]: 1.5‐21.6, P = .01), pharyngeal defects (OR: 11.3, 95% CI: 1.4‐94.5, P = .025), and interposition vein grafts (OR: 3.78, 95% CI: 1.1‐13.3, P = .037).ConclusionThe lateral arm free flap was safe, versatile, and reliable for head and neck reconstruction with low donor‐site morbidity. Complications occurred in a fifth of patients and were associated with peripheral vascular disease, pharyngeal defects, and vein grafts.

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