Management of free flap failure in head and neck surgery

Copelli, Chiara; Tewfik, Karim; Cassano, Lazzaro; Pederneschi, N.; Catanzaro, S.; Manfuso, Alfonso; Cocchi, R

doi:10.14639/0392-100x-1376

Cited by 44 publications

(21 citation statements)

References 19 publications

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“…Many prior studies were unable to identify the etiology of flap failure, as the artery and vein were thrombosed once flap compromise was detected. 3,10 It is likely that infection, hemorrhage, and fistula may be common causes of flap failure; however, identification of these as the true cause of flap failure is difficult and likely underreported since these processes are more complex to identify. Preoperative radiation may also contribute to increasing the risk of flap failure.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Free tissue transfer has been shown to generally have similar success rates, in terms of flap survival, when compared with regional and local flaps. 3-5 The average success rate at most large institutions for free tissue transfer is 95%. 6,7 While many studies evaluate risk factors associated with flap failure (eg, limited operative experience, perioperative decision making, and prior radiation therapy), few investigate the subsequent management after failed flaps.…”

mentioning

confidence: 99%

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Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta‐analysis

Walia¹,

Lee²,

Jackson³

et al. 2021

Otolaryngol.--head neck surg.

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Objective To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management. Data Sources Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019. Review Methods Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications. Results A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies, I2 = 12.8%). There was no difference in hospitalization length after secondary reconstruction between free tissue transfer and locoregional flaps or conservative management (relative risk of hospitalization ≥2 weeks, 96%; 95% CI, 0.80-1.14; n = 3 studies, I2 = 0). The pooled relative risk of perioperative complications following free tissue transfer was 0.60 when compared with locoregional flap or conservative management (95% CI, 0.40-0.92; n = 5 studies, I2 = 0). Conclusion Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta‐analysis

Walia¹,

Lee²,

Jackson³

et al. 2021

Otolaryngol.--head neck surg.

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“…Free flap surgery is executed by the Maxillofacial Surgeons for the reconstruction of complex head and neck defects and facial reanimation. The anterolateral thigh and radial forearm free flaps are the most commonly performed procedures at our institution, 50 and 49 flaps on average per year, respectively according to a recent case review [17]. Additionally, the Head and Neck Department performs urgent/emergent consultations (i.e., maxillofacial traumas, vertigo, inflammatory diseases, foreign bodies, airway obstructions, sudden hearing loss, epistaxis, etc.…”

Section: Introductionmentioning

confidence: 99%

Managing head and neck cancer patients during the COVID-19 pandemic: the experience of a tertiary referral center in southern Italy

Longo

Trecca

D’Ecclesia

et al. 2021

Infect Agents Cancer

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Background The medical community has been deeply involved in fighting the Coronavirus disease 2019 (COVID-19) pandemic and, as a consequence, the care of non-COVID-19 patients has been impacted. However, the treatment of head and neck cancer patients is not deferrable, and an integrated strategy is required. The aim of the current article is to present the experience in the management of head and neck patients during the COVID-19 pandemic at the research hospital “Casa Sollievo della Sofferenza”. This review contains replicable and widely usable instructions on how to avoid delays in the diagnosis and treatment of head and neck tumors and to ensure a gradual return to elective procedures. Main text The Head and Neck Department of the research hospital “Casa Sollievo della Sofferenza” includes an Otolaryngology and a Maxillofacial Surgery Unit, both of which deal with the diagnosis and treatment of benign and malignant pathologies of the head and neck, as well as urgent/emergent consultations and surgical procedures that necessitate time sensitive operative management, such as cochlear implantation (CI). Given these premises and the complexity of the Department, the “COVID-19 organizing protocol” of the research hospital “Casa Sollievo della Sofferenza” was divided into two phases in accordance with the different stages of the pandemic and the priority of treatment. Special attention was given to the medical surveillance of health care workers and hospitalized patients, to the organization of the outpatient clinic and the operating setting as well as to the implementation of telehealth systems. Conclusions The COVID-19 pandemic is going to be a long-term situation with lasting effects on the public health and the entire society. Therefore, an efficient health care system has to adopt a double strategy: always being ready for a “new wave” of the pandemic and not forgetting non-COVID-19 patients, among whom head and neck cancer patients represent a priority. More than 1 year since the first outbreak in Wuhan, this review offers a unique and helpful perspective that incorporates awareness of the disease.

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“… 1 The flap success rate at many major microsurgery centers is > 95%. 2 In a pursuit to decrease the complication rates and improve the flap survival rate, reconstructive surgeons have imbibed various strategies throughout their careers. One such technological advancement is a mechanical anastomotic coupler device (MACD) for venous anastomosis.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction—An Analysis of 1694 Venous Anastomoses

Arora

Mishra

Bhoye

et al. 2021

Indian J Plast Surg

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Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

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Management of free flap failure in head and neck surgery

Cited by 44 publications

References 19 publications

Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta‐analysis

Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta‐analysis

Managing head and neck cancer patients during the COVID-19 pandemic: the experience of a tertiary referral center in southern Italy

Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction—An Analysis of 1694 Venous Anastomoses

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