Complications and outcome after free flap surgery for cancer of the head and neck

Lahtinen, Sanna; Koivunen, Petri; Ala‐Kokko, Tero; Kaarela, Outi; Ohtonen, Pasi; Laurila, Päivi; Liisanantti, Janne

doi:10.1016/j.bjoms.2018.07.009

Cited by 43 publications

(52 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other authors have reported total flap loss rates for head and neck reconstruction anywhere from 1.7 to 13.6%, with flap loss being more common in irradiated sites and late reconstructions. [24][25][26][27] Half of our cohort included irradiated patients; thus, these results are in line with those reported in the literature. Data regarding incidence intraoperative vasospasms, specifically in free flaps utilizing SVTS, appears to be limited in current literature.…”

Section: Discussionsupporting

confidence: 89%

Utilization of Intraparotid Segments of Superficial Temporal Vessels for Head and Scalp Free Flap Microanastomosis: A Clinical, Histological, and Cadaveric Study

Venkatesh

Fracol

Turin

et al. 2019

J Reconstr Microsurg

View full text Add to dashboard Cite

Background The superficial temporal vessels (STV) are an underutilized target for head and neck microvascular reconstruction. Most surgeons regard the dissection as difficult, unreliable, and the anastomosis prone to vasospasm. The intraparotid course of the STV may provide more reliable flow without accompanying morbidity. Methods A retrospective review of patients who underwent head and scalp free flap reconstruction utilizing STV intraparotid segment was performed. Demographic factors such as intraoperative and postoperative complications are reported. Five bilateral cadaver heads were dissected to describe the relationship to the facial nerve. STV histology was performed on four of the cadavers, noting intraluminal diameter and vessel wall thickness. Results Thirty-nine patients underwent free flap reconstruction with anastomosis to intraparotid STVs. Defect etiology included tumor resection (71.8%), traumatic brain injury (10.3%), intracranial bleed (12.8%), and acute trauma (5.1%). Flaps transferred included anterolateral thigh (51.3%), latissimus (33.3%), thoracodorsal artery perforator (7.7%), radial forearm (2.8%), and vastus lateralis (5.1%). Two flaps (5.1%) required takeback for arterial thrombosis, with one incidence of total flap loss (2.8%). There were no instances of transient or permanent facial nerve damage nor sialocele. On cadaver dissection, three distinct vessel segments were identified. Segments 1 and 2 represented the STVs superior to the upper tragal border. Segment 3 (intraparotid segment) began at the upper tragal border and STVs enlarged with a targeted anastomosis point at an average of 16.3 mm medial and 4.5 mm inferior to the upper border of the tragus. The frontal branch coursed 11.7 mm inferior and 11.5 mm anterior to this point. On histology, the intraluminal diameter of segment 3 was significantly larger than segment 2 (1.2 vs. 0.9 mm, p = 0.007). Conclusion Head and neck free flap reconstruction with microanastomosis to the intraparotid segment of STVs can be safely and reliably performed.

show abstract

Section: Discussionsupporting

confidence: 89%

Utilization of Intraparotid Segments of Superficial Temporal Vessels for Head and Scalp Free Flap Microanastomosis: A Clinical, Histological, and Cadaveric Study

Venkatesh

Fracol

Turin

et al. 2019

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…Increased operative duration may be a reflection of the increased technical challenges during the operation accounting for the subsequent higher rates of free flap compromise and failure as operative duration increases. 16,33 Management of a compromised free flap is associated with significant resource utilization and increased overall cost. 15 Previously it was found flap compromise with successful salvage resulted in a 1.3 times increase in the mean hospitalization cost.…”

Section: Discussionmentioning

confidence: 99%

Factors impacting successful salvage of the failing free flap

et al. 2020

View full text Add to dashboard Cite

Background: Understanding factors impacting successful salvage of a compromised free flap. Methods: Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764). Results: Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P < .001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P = .035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P < .0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P < .0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P < .0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P = .04). Conclusions: There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision. K E Y W O R D S free flap, free flap salvage, head and neck reconstruction, outcomes, surgical complications 1 | INTRODUCTION Microvascular free flap reconstruction of head and neck defects was first introduced in the 1970s and has resulted in superior aesthetic and functional results and improved patient quality of life. 1-3 Free flap survival rates in recent years are consistently cited as greater than 95%, 4-10 with still a small percentage of free flaps experiencing vascular compromise. Salvage of a compromised free flap is often attempted as complete failure of a free flap results in significant morbidity for the patient, increased length of hospitalization, and increased health care cost. 7,11-15 The ability to salvage a compromised free flap has been cited as high as 60% to 80%. 9,16-19 Therefore, great efforts are undertaken to salvage a compromised free flap. Most academic centers, which perform high volume free tissue transfer, are prepared to rapidly intervene once a compromised free flap is identified. A timely recognition of a

show abstract

“…As surgical techniques have improved, especially the availability of myocutaneous flaps as well as free flaps with microvascular anastomosis, surgeons have the opportunity to bring unirradiated tissue into the surgical filed for reconstruction, facilitating wound healing. However flap reconstruction caries it own risks [41] and patients that received flap reconstruction were more likely to have postoperative complications (p = 0.01).…”

Section: Mortality and Complications Associated With Rescue Surgerymentioning

confidence: 99%

Surgical rescue for persistent head and neck cancer after first-line treatment

Steinbichler

Golm

Dejaco

et al. 2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC). Methods Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery ± ND were analysed separately (primary site surgery ± ND). Results During the observation period, 35 patients received ND only and 17 primary site surgery ± ND. No perioperative mortality was observed. In nine patients with ND only and 12 patients with primary site surgery ± ND at least one complication was encountered. 41/52 (79%) patients had a complete response. Median overall survival of patients receiving rescue surgery was 56 months (95% CI 44-69 months). Median overall survival was best for patients with initial laryngeal and oropharyngeal cancer and worst for patients with hypopharyngeal cancer (p = 0.02). Functional deficits following rescue surgery were mainly observed in the domains speech, nutrition, and shoulder/arm mobility. The risk of functional impairment was higher for patients with rescue surgery at the primary tumor site (OR 2.5 ± 2; p = 0.07). Conclusion Rescue surgery offers patients with resectable, persistent disease a realistic chance to achieve long-term survival. Especially patients with laryngeal and oropharyngeal cancer profited from rescue surgery. Rescue neck dissection is an effective and safe procedure. Patients with rescue surgery at the primary tumor site ± ND should expect complications and permanent functional impairment.

show abstract

Complications and outcome after free flap surgery for cancer of the head and neck

Cited by 43 publications

References 19 publications

Utilization of Intraparotid Segments of Superficial Temporal Vessels for Head and Scalp Free Flap Microanastomosis: A Clinical, Histological, and Cadaveric Study

Utilization of Intraparotid Segments of Superficial Temporal Vessels for Head and Scalp Free Flap Microanastomosis: A Clinical, Histological, and Cadaveric Study

Factors impacting successful salvage of the failing free flap

Surgical rescue for persistent head and neck cancer after first-line treatment

Contact Info

Product

Resources

About