Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients

Han, Seung Hoon; Kim, Young Chul; Kwon, Taekyoung; Lee, Doh Young

doi:10.21053/ceo.2021.01053

Cited by 6 publications

(10 citation statements)

References 28 publications

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“…For this reason, intraoral resection and vessel preparation as well as flap raising and reconstruction were performed by senior consultants of our clinic. Nevertheless, the influence of surgical experience by varying surgeons cannot be ruled out in this university hospital setting as well as in this retrospective study (37,38) (38,39). However, the bony reconstruction was always well manageable by the operating senior consultant with the use of angled tools and pre-bent mini-osteosynthesis plates.…”

Section: Discussionmentioning

confidence: 77%

“…According to recent CUSUM analyses by Han et al. and Zhu et al., the learning curve in microsurgical reconstruction or mandibular reconstruction stabilizes after 20 or 8–17 cases ( 38 , 39 ). However, the bony reconstruction was always well manageable by the operating senior consultant with the use of angled tools and pre-bent mini-osteosynthesis plates.…”

Section: Discussionmentioning

confidence: 99%

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Superficial Temporal Artery and Vein as Alternative Recipient Vessels for Intraoral Reconstruction With Free Flaps to Avoid the Cervical Approach With the Resulting Need for Double Flap Transfer in Previously Treated Necks

et al. 2022

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BackgroundMicrovascular reconstruction remains challenging in previously operated and irradiated patients, especially when double flaps seem to be the only solution due to osteoradionecrosis. An alternative reconstructive option could be microvascular anastomosis to the temporal vessels to avoid the obligatory cervical incision.Methods and MaterialsAll consecutive cases between January 2013 and 2020 that underwent either mandibular resection and reconstruction with a free fibula flap (FFF) and another soft tissue flap (group I) or pure intraoral resection and reconstruction with an FFF or radial forearm flap (RFF) with temporal microvascular anastomosis (group II) were included. Patients’ general information, indication and extent of surgery, time of ischemia, time of total surgery, and duration of hospital stay as well as incidence of complications were retrospectively recorded and analyzed.ResultsSeventeen (group I) and 11 (group II) cases were included. In group I, FFF was combined with RFF (n = 9), anterolateral thigh flap (ALT, n = 7), or latissimus dorsi flap (n = 1). Group II consisted of six FFFs and five RFFs. Operation time and hospitalization duration were significantly shorter in group II (p < 0.001 and p = 0.025), whereas ischemic time of FFF was significantly shorter in group I (p = 0.002). All patients in group I required a tracheostomy, while only four cases in group II did (p = 0.004). The complication rate regarding hematoma removal, revision of anastomosis, flap loss, delirium, sepsis, pleural effusion, pneumonia, and pulmonary artery embolism showed no significant differences between the two groups.ConclusionsThe superficial temporal vessels served as versatile recipient vessels for intraoral mandibular and soft tissue reconstruction and led to reduced operation time, hospitalization duration, and indication for a primary tracheostomy. Thus, this approach may help to avoid cervical incision for reconstruction in irradiated patients.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Superficial Temporal Artery and Vein as Alternative Recipient Vessels for Intraoral Reconstruction With Free Flaps to Avoid the Cervical Approach With the Resulting Need for Double Flap Transfer in Previously Treated Necks

et al. 2022

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“…Normal tissue at a surgical site must be restored within 72 h after the free flap surgery, as shown in Figure 1(a). 2 The surgical site can develop venous thrombosis (54%–57%), alternative thrombosis (20%–43%), and blood vessel flow disorders (5%–25%), as shown in Figure 1(b). Necrosis can occur if the color of the tissue at the surgical site changes.…”

Section: Analysis Of Monitoring Methods For Surgical Patientsmentioning

confidence: 99%

“…1 Skin necrosis affects the surrounding tissues (muscles, nerves, blood vessels, and heart), which can lead to scarring, general paralysis, and death. 2 Free flap (skin graft) surgery is essential for such patients. Free flap surgery restores normal tissue within 72 h after surgery.…”

Section: Introductionmentioning

confidence: 99%

Remote Monitoring System for Condition Management of Patients in Free Flap Surgery

et al. 2023

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Introduction Free flap surgery is inconvenient because an attending physician must observe a patient’s condition every day to ensure that normal tissue is restored within 72 h after the surgery. To address this problem, this paper proposes a remote monitoring technology to observe a patient’s condition in real time. Methods To design a monitoring system, the camera consists of MCU board, DC-DC converter, alarm performance, Wi-fil module, and server, and the camera and MCU part is connected to the server through the wi-fi network. A camera obtains the images of the surgical site once every 2 s, and the images are transmitted to the attending physician or nurse via Wi-Fi communication. The working distance between camera and surgical site is 56 cm, and the viewing angle of a camera is 60° (radius). Results A video shooting test is also performed, in which the images are obtained once per hour between 17:00 and 08:00 the next day; the results show that high-quality images are obtained in the video shooting test. The imaging error is zero (0 GB) in the video shooting test results. Discussion and Conclusion The imaging of the surgical site can be obtained by camera system, and the proposed method is that there no storage error occurs during the shooting process. In addition, the shooting performance has high velocity. It is possible to control the WD according to a patient’s body via a holding manipulator used for the camera. The new method is expected to be used for remote patient management, for a wide range of procedures, in the medical field.

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“…Moreover, the 8-year study period might lead to the assumption that a possibly changing team of surgeons can in uence surgical outcomes. This argument can be weakened by the consistent teaching mentality of our experienced surgeons toward residents, which leads to reliable and quick results (Zhu et al 2021;Han et al 2022). Furthermore, tumor surgeries are always led by a senior consultant.…”

Section: Limitationsmentioning

confidence: 99%

Effect of segmental versus marginal mandibular resection on local and lymph node recurrences in oral squamous cell carcinoma: Is tumorous bone infiltration or location and resulting soft-tissue recurrences the long-term problem?

Ritschl,

Niu,

Sackerer

et al. 2023

Preprint

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Purpose Oral squamous cell carcinomas (OSCC) adjacent to the mandible or with clinically suspected bone infiltration are surgically treated either with marginal or segmental resections. This retrospective study compared both resections regarding local recurrence and lymph node recurrence or secondary lymph node metastases. Methods All consecutive primary OSCC cases between January 2007 and December 2015 that underwent mandibular marginal or segmental resection were included. Rates of local and lymph node recurrences or secondary metastases and possible risk factors such as tumor localization according to Urken’s classification were recorded. Results In total, 180 patients with 85 marginal (group I) and 95 segmental (group II) mandibular resections were analyzed. The local recurrence rates were comparable between the groups (28.2% vs. 27.4%; p = 0.897). Lymph node recurrences or secondary metastases were higher in group I (9.4% (n = 8) vs. 6.2% (n = 6); p = 0.001). Tumor localization appears to affect the outcomes. Significantly fewer local and lymph node recurrences/metastases were found for Urken’s classification SB and S calculated by two-proportion z-test (p = 0.014 and 0.056, respectively). Local recurrences mostly emerged from soft tissues, which should be resected more radically than the bones. Conclusion While bone infiltration appears technically well controllable from an oncologic view, local recurrences, and lymph node recurrences/metastases remain an issue. Regular clinical aftercare with imaging is crucial to detect recurrences.

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Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients

Cited by 6 publications

References 28 publications

Superficial Temporal Artery and Vein as Alternative Recipient Vessels for Intraoral Reconstruction With Free Flaps to Avoid the Cervical Approach With the Resulting Need for Double Flap Transfer in Previously Treated Necks

Superficial Temporal Artery and Vein as Alternative Recipient Vessels for Intraoral Reconstruction With Free Flaps to Avoid the Cervical Approach With the Resulting Need for Double Flap Transfer in Previously Treated Necks

Remote Monitoring System for Condition Management of Patients in Free Flap Surgery

Effect of segmental versus marginal mandibular resection on local and lymph node recurrences in oral squamous cell carcinoma: Is tumorous bone infiltration or location and resulting soft-tissue recurrences the long-term problem?

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