Factors that influence the outcome of salvage in free tissue transfer

Brown, James S.; Devine, J.C.; Magennis, Patrick; Sillifant, P.; Rogers, Simon N.; Vaughan, E.D.

doi:10.1016/s0266-4356(02)00260-7

Cited by 183 publications

(167 citation statements)

References 14 publications

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“…These complications often occur in the first twenty-four hours [1,5,[12][13][14]. This acute period does not allow the creation of a microvascular network, unlike what happens in chronic occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…This type of reconstruction requires a patient in good general condition. The free flap failure rate varies between 2% and 5% [1,2]. There are multiple causes: infection, dehiscence of sutures, compression or vascular thrombosis.…”

Section: Introductionmentioning

confidence: 99%

“…It is therefore essential to detect as soon as possible arterial or venous thrombosis [1,2]. Currently clinical monitoring is the gold standard.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

View full text Add to dashboard Cite

“…Drawback of intravenous heparin use is the potential for bleeding and hematoma formation. Brown et al (7) reviewed 427 free tissue transfers with 16% requiring return to the operating theatre within seven days for compromised flap or hematoma. Venous compromise (83%) was once again much higher than arterial compromise (8%).…”

Section: Discussionmentioning

confidence: 99%

“…Successful salvage rates range from 28% to over 90%. (3,4,7,14,15) The rates vary depending upon the etiology, timing of salvage and experience of the centre. In a review of 150 cases Hidalgo (8) suggested that attempted salvage of compromised flaps significantly increases flap survival rates and recommended an aggressive approach towards early exploration.…”

Section: Discussionmentioning

confidence: 99%

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

2016

IJASHNB

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The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in Maxillofacial reconstruction. Although associated complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction. With early recognition and prompt intervention salvage of compromised flap is possible. The purpose of this article is to emphasise the importance of keeping low threshold for re-exploration in situation of any suspected failing free flap. Pt ReportA 60 year-old male patient presented with an ulcero-proliferative mass measuring around 4cmx3.5 cm which involved the right lip mucosa and had infiltrated the underlying tissue to appear over the skin with central zone of necrosis and surrounding erythematous induration. (Fig. 1) Incisional biopsy from mucosal surface of the lesion revealed well to moderately differentiated squamous cell carcinoma. The neck was clinically N0 which similarly correlated following contrast CT scan of the neck. The surgical planning for the tumour was wide excision, SOND (Supra Omohyoid neck dissection) and reconstruction of the defect with FRAFF. Wide excision of the primary lesion was carried out along with the SOND on the affected side.The neck dissection was done with extreme care to preserve the facial vessels when dissecting level IB. Dissection of the submandibular gland was done by safely ligating the submandibular branches of the facial artery to the gland and preserving the whole artery along its course on the posterior aspect of the gland. The right lip commissure involving lateral one third of the lower lip, part of skin in the cheek along with underlying part of cheek musculature, inner buccal and labial mucosa, gingivo-buccal sulcus and gingiva along with the alveolar bone sparing the lower border of the mandible were resected. The size of the primary defect following tumour resection was 5.2x4.8x3.7 cm. The reconstruction of the surgical defect was done with FRAFF. On completion of the reconstruction the flap looked well perfused and healthy. The flap was monitored clinically at an hourly basis. By 4 th -5 th hours mild ooze from the drain port had become noticeable along with marked oedema in the flap. (Fig. 2) On the 8 th hour post operatively there was dusky appearance of the flap, along with oedema. On needle prick there was dark blood ooze from the flap and therefore the decision for re exploration was taken suspecting venous compromise. On re exploration a huge hematoma was noticed under the flap, around the anastomosis and along the IJV. The clots were delicately removed. The adjoining areas were irrigated with warm saline, and venous and arterial anastomoses were evaluated. There were no clots in the vein and normal flow through the artery was seen. Acland's "milking" test was performed. In the test the artery was occluded with a forceps immediately caudal to anastomosis and then with a second forceps artery was occl...

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No reduction in complication rate by stay in the intensive care unit for patients undergoing surgery for head and neck cancer and microvascular reconstruction

et al. 2009

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Factors that influence the outcome of salvage in free tissue transfer

Cited by 183 publications

References 14 publications

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

No reduction in complication rate by stay in the intensive care unit for patients undergoing surgery for head and neck cancer and microvascular reconstruction

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