Health-related quality of life, surgical and aesthetic outcomes following microvascular free flap reconstructions: an 8-year institutional review

Dolan, Roisin T.; Butler, Joseph S.; Murphy, SM; Cronin, K. J.

doi:10.1308/003588412x13171221498749

Cited by 26 publications

(22 citation statements)

References 47 publications

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“…In this context, evidence indicates that timely re-exploration significantly increases the rate of compromised flap salvage; thus, close postoperative monitoring is necessary in order to detect early signs of deterioration and to revise if necessary [ 2 , 3 ]. The risk of a total loss following free microvascular tissue transfer is approximately 2–6%, mainly due to thrombotic events in the flow area of the microanastomosis [ 4 , 5 ]. A wealth of objective and subjective monitoring procedures have been reported in the past, but the current gold standard in monitoring flap perfusion is still based on a subjective clinical bedside assessment [ 1 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps

Thiem¹,

Frick²,

Goetze³

et al. 2020

Clin Oral Invest

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Objectives In reconstructive surgery, flap monitoring is crucial for early identification of perfusion problems. Using hyperspectral imaging (HSI), this clinical study aimed to develop a non-invasive, objective approach for perfusion monitoring of free and pedicled flaps. Material and methods HSI of 22 free (FF) and 8 pedicled flaps (PF) in 30 patients was recorded over time. Parameters assessed were tissue oxygenation/superficial perfusion (0–1 mm) (StO2 (0–100%)), near-infrared perfusion/deep perfusion (0–4 mm) (NIR (0–100)), distribution of haemoglobin (THI (0–100)), and water (TWI (0–100)). Measurements up to 72 h were correlated to clinical assessment. Results Directly after flap inset, mean StO2 was significantly higher in FF (70.3 ± 13.6%) compared with PF 56.2 ± 14.2% (p = 0.05), whereas NIR, THI, and TWI were similar (NIR_p = 0.82, THI_p = 0.97, TWI_p = 0.27). After 24 h, StO2, NIR, THI, and TWI did not differ between FF and PF. After 48 h, StO2, NIR, and TWI did not differ between FF and PF whereas THI was significantly increased in FF compared with PF(p = 0.001). In three FF, perfusion decreased clinically and in HSI, 36(1), 40(2), 5(3), and 61(3) h after flap inset which was followed by prompt intervention. Conclusions StO2 < 40%, NIR < 25/100, and THI < 40/100 indicated arterial occlusion, whereas venous problems revealed an increase of THI. In comparison with FF, perfusion parameters of PF were decreased after flap transfer but remained similar to FF later on. Clinical relevance HSI provides objective and non-invasive perfusion monitoring after flap transplantation in accordance to the clinical situation. With HSI, signs of deterioration can be detected hours before clinical diagnosis.

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Section: Introductionmentioning

confidence: 99%

Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps

Thiem¹,

Frick²,

Goetze³

et al. 2020

Clin Oral Invest

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“…The functionality of the foot was assessed based on American Orthopaedic Foot and Ankle Society–Ankle and Hindfoot Score (AOFAS-AHS) 4 every 6 months till 2 years, and patient satisfaction concerning aesthetics was graded on a visual analog scale of 0 to 10. 3 5 …”

Section: Methodsmentioning

confidence: 99%

“Like For Like” Reconstruction of Heel Pad with Medial Plantar Artery Flap—Functional and Aesthetic Outcomes in A Series of 19 Cases

Sundaramurthy

Mahipathy

Durairaj

et al. 2021

Indian J Plast Surg

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Heel pad loss can cause serious problems in weight-bearing and locomotion. The medial plantar artery (MPA) flap is a suitable “like for like” replacement. Nineteen patients whose heels were reconstructed with MPA flap between July 2015 and February 2020 were studied. All patients were assessed based on flap survival, functionality, and patient satisfaction. Loss of heel pad was due to diabetic ulcer (11), trauma (6), tumor (1), and unstable scar (1). The largest flap measured 9 × 7 cm. Sixteen flaps were done as fasciocutaneous flaps and three in combination with abductor hallucis muscle (AbdH). All the flaps survived. The average functional scores at 6, 12, 18, and 24 months were 86.86, 89.62, 89.38 and 97.33 based on AOSAS-AH score. Average patients' satisfaction was 8.7/10. To conclude, the MPA system is a versatile vascular axis providing “like for like” tissue for heel pad reconstruction which is reliable and durable.

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“…While 4.8% (10/207) were pharyngeal defects after resection for hypopharyngeal cancers, 2.4% (5/207) were lateral skull and neck defect (2 patients were following resection for fungating parotid/skin cancer, 1 patient for fungating ear cancer, 1 patient post electric shock temporal region skull defect and another 1 patient was post traumatic necrotic tissue loss of skull and upper posterior part of neck), 1.4% (3/207) were of maxillary defect following surgery for maxillary cancer and lastly one patient received 2 free flaps subsequently for mid facial defect following resection for aneurysm bone tumour of the face. Among the oral defect the most common defect was following resection for gingivobuccal mucosa cancer (50), followed by alveolus cancer (45), tongue cancer (30), floor of mouth cancer (15), ameloblastoma (11), oral cancer with skin involvement of through and through defect (11), cancer of lip (8), cancer of retro molar trigone (9), cancer of palate (2), giant cell tumour (GCT) of mandible (1) and lastly 4 patients of erythroleukoplakia. The study investigates the flap survival rate and look detail into the flap vascular complications individually.…”

Section: Methodsmentioning

confidence: 99%

“…1,2 Advancement in microvascular surgical technique have brought about a revolution in head and neck reconstructive surgery; as re-vascularized tissue of requirement can be harvested to tailor fit any complex composite defect created after ablative radical resection with the most optimal functional outcome and excellent aesthetic. [3][4][5][6][7][8][9] Thus many head and neck cancers what were termed inoperable earlier, have become operable today with the possibility of reconstruction. This results in better survival as it allows require radical resection for advance head and neck malignancy.…”

Section: Introductionmentioning

confidence: 99%

Microvascular free flap for head and neck reconstruction: our experiences with 218 free flaps for head and neck reconstructions

Shunyu

Chakraborty

Ronrang

et al. 2021

Int J Otorhinolaryngol Head Neck Surg

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Background: Defect following radical resection for advance head and neck cancers are complex and without doubt microvascular free flap offer the best reconstructive option. The purpose of this study is to investigate the flap survival rate and review each vascular compromised flaps.Methods: This is a reviewed of 218 microvascular free flaps done for reconstruction of 204 head and neck patients. There were 112 (51.3%) radial forearm flaps (RFF), 82 (37.6%) fibula flaps (FF) and 24 (11%) anterior lateral thigh (ALT) flaps. Results: There were 16 complete flap loss and 3 partial flap loss, giving an overall flap survival rate 91.8% (19/218) and flap survival in turn of complete loss 92.7% (16/218). In RFF, there were 7 complete and 1 partial flap loss, giving an overall flap survival rate 92.9% (8/112) and flap survival in turn of complete loss 93.8% (7/112). In FF, there were 6 complete flap loss, giving a flap survival rate 92.7% (6/82). In ALT flap, there were 3 complete and 2 partial flaps loss, giving an overall flap survival rate 79.2% (5/24) and flap survival in turn of flap complete loss 87.5% (3/24). In our series vascular flaps complications rate was 12.3% (27/218), with a salvageable rate of 29.6% (8/27). The most salvageable flap was RFF 46.6% (7/15).Conclusions: The study re-enforce the learning curve in microvascular free flap and RFF is a good flap for a beginner.

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Health-related quality of life, surgical and aesthetic outcomes following microvascular free flap reconstructions: an 8-year institutional review

Cited by 26 publications

References 47 publications

Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps

Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps

“Like For Like” Reconstruction of Heel Pad with Medial Plantar Artery Flap—Functional and Aesthetic Outcomes in A Series of 19 Cases

Microvascular free flap for head and neck reconstruction: our experiences with 218 free flaps for head and neck reconstructions

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