Head and neck free-flap salvage

Olinde, Lindsay; Farber, Nicole I; Kain, Joshua J.

doi:10.1097/moo.0000000000000739

Cited by 4 publications

(6 citation statements)

References 66 publications

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“…The majority of the literature would say this happens around 10% of the time. 3,4 The majority of pedicle severance was due to traumatic disruption with a bone saw at a site distal from the proximal pedicle confluence. Being a retrospective review, we were unable to determine how much of the vessel was injured and how much of the injured vessel was removed to allow anastomosis of normal vessels.…”

Section: Resultsmentioning

confidence: 99%

“…This number is higher than what is typically reported in the literature. 3,4 All vascular compromise occurred at the proximal end of the flap. Disruptions distal to this point that required vascular anastomosis remained patent.…”

Section: Resultsmentioning

confidence: 99%

“…The flap may be compromised by vascular insufficiency that if recognized and corrected in the operating room in a timely fashion results in high salvage rates and overall survival. The majority of the literature would say this happens around 10% of the time 3,4 …”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes following intraoperative pedicle disruption in fibula free flaps

et al. 2023

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Objectives Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following accidental severance of the peroneal vessels. Methods Multi‐institutional retrospective chart review from 2000 to 2020. Results Of 2975 harvested fibula free flaps, 26 had a history of pedicle severance during surgical reconstruction. Reasons for intraoperative pedicle severance included transection during muscular dissection 10/26 (39%), accidental severance with the bone saw 12/26 (46%), and other 4/26 (15.6%). The surgeon responsible for pedicle severance included residents 5/26 (19%), fellows 10/26 (39%), attendings 10/26 (39%), and unknown 1/26 (3.9%). The pedicle artery and vein were severed 10/26 (39%), artery 8/26 (31%), and vein 8/26 (31%). Truncated pedicle vessels were used 3/26 (11.7%), intraoperative anastomoses were performed 23/26 (89%). Postoperative revision in the OR within 7 days of surgery was required 6/26 (23%); 4 flaps were salvaged and 2 flaps failed, both arterial thrombosis. Flap failure was attributed to vascular thrombosis. Long‐term flap survival and successful reconstructions were reported 24/26 (92%). Conclusion Accidental severance of fibula free flap pedicle vessels can be corrected with intraoperative repair, without affecting long‐term flap survival or reconstructive outcomes. Protecting the flap vessels while using the bone saw and during intramuscular dissection prevents accidental severance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical outcomes following intraoperative pedicle disruption in fibula free flaps

et al. 2023

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“…At the initial diagnosis, the majority of these tumors have an advanced stage ( 1 , 2 ). Extensive soft or bone tissue resection is required, and free flap reconstruction is generally the preferred method ( 3 ); however, postoperative complications may develop frequently ( 4 ). One complication is orocutaneous fistula (OCF), which could cause significantly negative effects such as delays in adjuvant therapy initiation and oral feeding and voice rehabilitation, as well as increase in treatment costs, length of hospital stay, and risk of carotid blowout ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

Predictors predisposing to orocutaneous fistula occurrence following free flap reconstruction

Yuan

et al. 2022

Front. Oncol.

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ObjectivesTo explore the possible risk factors of orocutaneous fistula (OCF) development in free flap reconstruction of the tongue/floor of the mouth (TFOM).MethodsData of patients who underwent free flap reconstruction of the TFOM were retrospectively analyzed. The association between clinicopathologic variables and OCF occurrence was analyzed using univariate and multivariate analyses.ResultsAltogether, 469 patients were enrolled. OCF occurred in 43 patients with a rate of 9.2%. The univariate analysis revealed the negative effects of smoking, preoperative albumin level, cachexia, T4 stage, neck dissection, entire resection of the floor of the mouth (FOM), segmental mandibulectomy, and surgical site infection on OCF occurrence. The multivariate analysis confirmed the independence of cachexia (p<0.001, 4.386[1.883–9.472]), tumor stage (p<0.001, 2.738[1.482–6.629]), entire FOM resection (p<0.001, 6.332[2.110–14.432]), and surgical site infection (p<0.001, 5.376[1.998–11.218]) in affecting the OCF development.ConclusionsOCF development following free flap reconstruction of the TFOM was relatively uncommon, but significantly associated with presence of cachexia, T4 stage, entire FOM resection, and surgical site infection.

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“…Most of these tumors present in advanced stages at initial diagnosis ( 1 , 2 ). Surgery is the preferred therapeutic approach, and defects caused by surgical excision are usually repaired using free flaps ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Orocutaneous Fistula Formation in Free Flap Reconstruction for Oral Squamous Cell Carcinoma

Fang

Yuan

et al. 2022

Front. Oncol.

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ObjectiveThe aim of this study is to identify the risk factors associated with orocutaneous fistula (OCF) formation after free flap reconstruction for oral squamous cell carcinoma (SCC).MethodsPatients undergoing free flap reconstruction for oral SCC were retrospectively enrolled. The relationship between clinicopathologic variables and OCF formation was analyzed by univariate and multivariate analyses.ResultsA total of 87 OCFs occurred in 856 patients. Univariate analysis revealed cachexia, tumor at the tongue/floor of the mouth (TFOM), T4 stage, preoperative hemoglobin level, pull-through procedure, preoperative albumin level, and surgical site infection were associated with the formation of OCF. Multivariate analysis confirmed the independence of cachexia, TFOM, T4 stage, and surgical site infection in predicting OCF development. Conventional wound care could achieve successful fistula closure in 82.4% of the patients with a median time of 28 days.ConclusionsOCF formation was common after free flap reconstruction. The presence of cachexia, TFOM tumor site, T4 stage, and surgical site infection significantly increased the risk of OCF formation. Although it required a long period, conventional wound care can obtain satisfactory outcomes in OCF management.

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Head and neck free-flap salvage

Cited by 4 publications

References 66 publications

Clinical outcomes following intraoperative pedicle disruption in fibula free flaps

Clinical outcomes following intraoperative pedicle disruption in fibula free flaps

Predictors predisposing to orocutaneous fistula occurrence following free flap reconstruction

Orocutaneous Fistula Formation in Free Flap Reconstruction for Oral Squamous Cell Carcinoma

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