Free Flap Reconstruction Experience and Outcomes at a Low‐Volume Institution over 20 Years

Klosterman, Tristan; Siu, Eric; Tatum, Sherard A.

doi:10.1177/0194599815573726

Cited by 28 publications

(21 citation statements)

References 24 publications

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“…In the previous studies the annual operation rate has varied between 14-38. 3,7,8 However, the annual complication rate cannot be explained by this due to heterogeneity of the classification of the complications. Also Klosterman et al did not find differences in complication rates between low-volume and high-volume centers.…”

Section: Discussionmentioning

confidence: 99%

“…Also Klosterman et al did not find differences in complication rates between low-volume and high-volume centers. 3 Previous studies have found that smoking, comorbidity and advanced age are potential risk factors for postoperative complications after free flap surgery for cancer of the head and neck . 2,6,7 In our study, we did not find a significant correlation between these factors and complications.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative complications frequently occur after major head and neck surgery with free flap repair, with the reported complication rate ranging between 34% and 85%. [1][2][3][4][5] Several variables are associated with an increased risk for postoperative complications in this patient group, including smoking, advanced age, ASA class (American Society of Anesthesiologists risk classification) and excessive fluid management. 2,[6][7] However, previous studies have not reported complications in detail, and there are different ways to classify complications, making it difficult to compare different studies.…”

Section: Introductionmentioning

confidence: 99%

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

Lahtinen

Koivunen

Ala‐Kokko

et al. 2018

British Journal of Oral and Maxillofacial Surgery

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We retrospectively studied 136 patients who had free flap reconstruction for cancer of the head and neck at a single centre (2008-2015) to evaluate complications, assess factors associated with them, and analyse their impact on outcome. Preoperative and perioperative data, and surgical and medical complications were recorded, and the impact of the complications on duration of hospital stay and survival were assessed. A total of 86 (63%) patients had complications. Compared with those who did not, they had a higher rate of alcohol abuse (21/86, compared with 5/50, p=0.039), longer operations (median (IQR) 565 (458-653 compared with 479 (418-556) minutes, p<0.001), and greater intraoperative loss of blood (725 (400-1150) compared with 525 (300-800) ml, p=0.042). Complications were more common in patients who had fibular flaps and T4 disease (22/86 compared with 4/50, p=0.010; 47/80 compared with 16/47, p=0.015, respectively). Those who had complications also stayed in hospital longer (median (IQR) 9 (7-12) compared with 15 (10-21) days, p<0.001). Cumulative mortality was higher in patients with late complications (those that occurred after the fourth postoperative day) (61% compared with 36%, p=0.004). In conclusion, complications in more than half the patients were related to alcohol abuse, a more complicated intraoperative course, and fibular flaps. Complications were associated with a longer hospital stay, and survival was higher in those who did not have late complications than in those who did.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Lahtinen

Koivunen

Ala‐Kokko

et al. 2018

British Journal of Oral and Maxillofacial Surgery

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“…Take‐back rates increased 7.2 times for transfused patients. Take‐back percentage varies in the HN literature, ranging from 2% to 16% . Hematoma formation causing flap take‐back leads to acute blood loss itself or additional blood loss from the subsequent surgery, making transfusion more likely.…”

Section: Discussionmentioning

confidence: 99%

“…Take-back percentage varies in the HN literature, ranging from 2% to 16%. 5,7,8 Hematoma formation causing flap take-back leads to acute blood loss itself or additional blood loss from the subsequent surgery, making transfusion more likely. Indeed, even intraoperative transfusion has been associated flap take-back.…”

Section: Discussionmentioning

confidence: 99%

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

et al. 2018

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Objective Blood product utilization is monitored to prevent unnecessary transfusions. Head‐and‐neck pedicled flap reconstruction transfusion‐related outcomes were assessed. Methods One hundred and thirty‐six pedicled flap patients were reviewed: 64 supraclavicular artery island flaps (SCAIF), 57 pectoralis major (PM) flaps, and 15 submental (SM) flaps. Outcome parameters included flap‐related complications, medical complications, length of stay (LOS), and flap survival. Multivariable logistic regression analyses were performed. Multivariable logistic regression analyses were performed to adjust for relevant pre‐ and perioperative factors. Results Of all head‐and‐neck pedicled flap patients included in our analyses (n = 136), 40 (29.4%) received blood transfusions. The average pretransfusion hematocrit (Hct) was 24.3% ± 0.5%, with 2.65 ± 0.33 units transfused and a posttransfusion Hct increase of 5.0% ± 0.6%. Transfusion rates differed with PM (47.4%), SCAIF (17.2%), and SM (13.3%) flaps (P < 0.005). Patients undergoing PM reconstruction trended toward higher transfusion requirements (PM 2.89 ± 0.47 units, SC 2.18 ± 0.28 units, and SM 2.00 ± 0.0 units), with transfusion occurring later in the postoperative course (4.9 ± 1.3 days vs. 2.4 ± 0.1 days for all other flaps; P = 0.08). Infection, dehiscence, fistula, or medical complications were not different. Transfusion thresholds of Hct < 21 versus Hct < 27 exhibited no difference in LOS, flap‐survival, or medical/flap‐related complications. Conclusion Transfusion is not associated with surgical or medical morbidity following head and neck pedicled flap reconstruction. There were no differences in outcomes between transfusion triggers of Hct < 21 versus Hct < 27, suggesting that a more conservative transfusion trigger may not precipitate adverse patient complications. Our data recapitulate findings in free flap patients and warrant further investigation of transfusion practices in head and neck flap reconstruction. Level of Evidence 4. Laryngoscope, 128:E409–E415, 2018

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Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery

Crippen

Patel

Filimonov

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Smoking is a highly prevalent risk factor among patients with head and neck cancer. However, few studies have examined the association of this modifiable risk factor on postoperative outcomes following microvascular reconstruction of the head and neck.OBJECTIVE To analyze the risk associated with smoking in patients undergoing free flap surgery of the head and neck.DESIGN, SETTING, AND PARTICIPANTS In this retrospective, population, database study, the National Quality Improvement Program data sets from 2005 to 2014 were queried for all cases of head and neck surgery involving free flap reconstruction in the United States. The 2193 cases identified were stratified into smoking and nonsmoking cohorts and compared using χ 2 and binary logistic regression analyses. Pack-years of smoking data were used to assess the degree of risk associated with a prolonged history of smoking. All analyses were conducted between January 2018 and June 2018.MAIN OUTCOMES AND MEASURES Smoking and nonsmoking cohorts were compared for rates of demographic characteristics, comorbidities, and complications. Following correction for differences in patient demographics and comorbidities, smoking and nonsmoking cohorts were compared for rates of postoperative complications. Complication rates were further assessed within the smoking cohort by number of pack years smoked. RESULTSOf the 2193 patients identified as having undergone free flap reconstruction of the head and neck, 624 (28.5%) had a history of recent smoking. After accounting for differences in demographic variables and patient comorbidities using regression analyses, smoking status was found to be independently associated with wound disruption (odds ratio, 1.74; 95% CI, 1.17-2.59; P = .006) and unplanned reoperation (odds ratio, 1.50; 95% CI, 1.15-1.95; P = .003). An analysis by pack-years of smoking showed that a longer smoking history was significantly associated with higher rates of numerous comorbidities but not with a corresponding increase in rates of complications.CONCLUSIONS AND RELEVANCE Smokers undergoing free flap reconstruction of the head and neck may be at significantly higher risk of postoperative wound disruption and subsequent reoperation. These risks were independent of pack-years of smoking history, suggesting that both risks were associated with perioperative smoke exposure, and preoperative smoking cessation may be of benefit.LEVEL OF EVIDENCE NA.

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Free Flap Reconstruction Experience and Outcomes at a Low‐Volume Institution over 20 Years

Abstract: Free flap reconstruction of the head and neck can be performed by appropriately skilled surgeons with acceptable outcomes in low-volume settings. Success rate appears to increase as clinical experience is gained.

Cited by 28 publications

References 24 publications

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

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

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery

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