Identification of Independent Risk Factors for Complications: A Retrospective Analysis of 163 Fibular Free Flaps for Mandibulofacial Reconstruction

Wu, Haixuan; Liu, Funing; Ji, Fengtao; Guo, Mingyan; Wang, Youyuan; Cao, Minghui

doi:10.1016/j.joms.2017.12.026

Cited by 18 publications

(17 citation statements)

References 22 publications

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“…Preoperative anemia has been shown to be an independent risk factor for postoperative morbidity and mortality in a wide range of surgical fields including neurologic, orthopedic, cardiac, general, colorectal, and reconstructive surgery. [1][2][3][4][5][6][7][8][9][10] Anemia is of particular concern in head and neck surgery given high rates of preoperative chronic anemia, a highly comorbid population, and the substantial metabolic demand of reconstructions. 4 Within head and neck surgery, anemia has been associated with decreased survival in laryngeal cancer 3 and oropharyngeal cancers.…”

Section: Introductionmentioning

confidence: 99%

Preoperative anemia displays a dose‐dependent effect on complications in head and neck oncologic surgery

et al. 2019

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Introduction Anemia's effect on head and neck surgical complications is unknown. Methods Head and neck cancer operations were acquired from the 2006 to 2013 American College of Surgeons National Surgical Quality Improvement Program databases. Anemia was defined as <39% or <36% hematocrit in men and women, respectively. Multivariable logistic regression analyses were performed. Results Major head and neck surgery patients had a 44.2% anemia incidence (n = 527 of 1193). Anemic patients had increased complication rates (27.1%) and mortality (2.1%) vs non‐anemic patients at 19.8% (P = .003) and 0.5% (P = .009), respectively. There was a significant difference in morbidity odds with hematocrit >27% (odds ratio [OR] = 1.09) vs <27% (OR = 4.22). Complication odds were further increased with hematocrit between 24% and 27% (OR = 8.94). There were increased rates of wound dehiscence (6.6% vs 2.7%, P < .001), pneumonia (8.5% vs 4.7%, P = .006), and myocardial infarction (1.7% vs 0.3%, P = .01) in anemic vs non‐anemic patients. Conclusion Anemia was associated with increased morbidity at hematocrit <27%. An inverse dose‐dependent effect of decreasing hematocrit was observed for overall morbidity.

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Section: Introductionmentioning

confidence: 99%

Preoperative anemia displays a dose‐dependent effect on complications in head and neck oncologic surgery

et al. 2019

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“…These factors are likely to lead to vascular damage and excessive bleeding during surgery. According to previous studies, free flap reconstruction of irradiated maxillofacial defects showed a lower success rate than that observed for non-irradiated defects [37][38][39]. In patients who have received radiotherapy at a dose over 60 Gy in the maxillofacial area, it is recommended to use recipient vessels outside the irradiated area to decrease the possibility of postoperative complications [39].…”

Section: Discussionmentioning

confidence: 99%

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

Byun

Lim

Yang

et al. 2020

JCM

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Introduction. The objective of this study was to evaluate a surgical technique and to present the results of delayed reconstruction of palatomaxillary defects using fibula free flap (FFF). Methods. A review was conducted for nine patients who underwent palatomaxillary reconstruction using FFF. Primary disease, type of reconstruction, defect area, fibula segment length and number of osteotomies, radiotherapy, and implant installation after FFF reconstruction were analyzed. Results. All nine patients underwent delayed reconstruction. The fibula shaft was osteotomized into two segments in seven patients and three segments in one patient with bilateral Brown’s revised classification IV/d defect. One case was planned by using a computer-aided design computer-aided manufacturing (CAD/CAM) system with a navigation system. The mean length of the grafted fibula bone was 68.06 mm. Dental implant treatment was performed in six patients. Six patients received radiation therapy, and there were no specific complications related to the radiation therapy. In one case, the defect was reconstructed with FFF flow-through from a radial forearm free flap. Conclusion. This clinical study demonstrated that the fibula flap is an ideal donor-free flap in a palatomaxillary defect. Delayed reconstruction using an FFF can reduce the complication and failure rates.

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“…However, according to the literature, technical errors and certain pre-existing conditions are associated with a higher tendency to flap failure, namely alcohol abuse, radiotherapy and diabetes mellitus. 6,7,47 Other characteristics, such as advanced age and gender, have not been linked to an increased risk of free flap failure. 24,[48][49][50] Nevertheless, the importance of meticulous attention to perioperative management of comorbidities, hemoglobin and albumin levels, anticoagulation, fluid and electrolytes, as well as flap monitoring cannot be overstated.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Study of 114 Free Flaps for Head and Neck Oncological Reconstruction in a Portuguese Tertiary Cancer Center

Silva

Caixeirinho²,

Vilares³

et al. 2022

Acta Med Port

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Introduction: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted.Results: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived.Discussion: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world.Conclusion: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.

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Identification of Independent Risk Factors for Complications: A Retrospective Analysis of 163 Fibular Free Flaps for Mandibulofacial Reconstruction

Cited by 18 publications

References 22 publications

Preoperative anemia displays a dose‐dependent effect on complications in head and neck oncologic surgery

Preoperative anemia displays a dose‐dependent effect on complications in head and neck oncologic surgery

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

Retrospective Study of 114 Free Flaps for Head and Neck Oncological Reconstruction in a Portuguese Tertiary Cancer Center

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