Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps

Zhang, C.; Sun, Jian; Han, Zhaolong; Xu, Liqun; Ji, Tong; He, Yue; Yang, Wenjun; Hu, Yan; Yang, Xiaomei; Zhang, Z.

doi:10.1016/j.ijom.2015.02.017

Cited by 73 publications

(41 citation statements)

References 8 publications

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“…The authors also noted a statistically higher incidence of reexploration for fibula flaps compared to soft tissue‐only flaps, which is consistent with the reported literature . Another recent study evaluating 4640 head and neck free flaps from People's Ninth Hospital in Shanghai presented similar findings . Once again, venous thrombosis was the most common major complication requiring exploration in 223 incidences with only 41 patients requiring exploration for arterial crisis.…”

Section: Discussionsupporting

confidence: 81%

Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14‐year review

Chang

2017

Head & Neck

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Section: Discussionsupporting

confidence: 81%

Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14‐year review

Chang

2017

Head & Neck

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“…In general, WHD occur in approximately 4 to 34% of patients undergoing microvascular free flap surgery and 8 to 21% are reported to occur in fibular free flaps. [19][20][21][22][23][24] Our results indicate an incidence of WHD of 28.57% in the conventional group and 43.75% in the CAD/CAM-assisted group (p ¼ 0.498). The discrepancy between others and our relatively high incidence can probably be explained by the different definition authors have used to describe WHD.…”

Section: Discussionmentioning

confidence: 53%

Functional Outcome of CAD/CAM-Assisted versus Conventional Microvascular, Fibular Free Flap Reconstruction of the Mandible: A Retrospective Study of 30 Cases

Ritschl

Mücke

Fichter

et al. 2017

J reconstr Microsurg

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Different advantages of virtually planned and guided mandibular reconstructions have been described. Functional analyses and comparisons with conventionally reconstructed patients. We retrospectively analyzed 30 cases of mandibular reconstructions that involved virtually planned or conventional microvascular, fibular free flaps that occurred between April 2011 and December 2014 at a single center. The results were also compared with a healthy cohort of 30 participants. Axiographic measurements were performed postoperatively, and uni- and multivariate regressions analyses were performed to determine the association between possible predictor variables on functional outcome. Operation time, hospital stay, number of osteotomies, incidence of postoperative temporomandibular joint pain, noise, and tension did not differ significantly between the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) groups (each > 0.05). Mouth opening and protrusion and laterotrusion also did not differ significantly (each > 0.05) but were significantly reduced compared with the healthy group. Univariate analysis showed a significant influence of postoperative irradiation on mouth opening and laterotrusion in the conventional group ( = 0.047 and = 0.028). In addition, multivariate analysis showed a significant influence of indication and number of osteotomies on laterotrusion ( = 0.005 and = 0.043). Uni and multivariate analyses revealed a significant influence of indication, preoperative irradiation, and number of osteotomies on protrusion and mouth opening in the CAD/CAM group ( = 0.016, = 0.044, and = 0.028). CAD/CAM-assisted reconstructions of the mandible give comparable functional results with those of the conventional technique, but no functional superiority has been established. Nevertheless, the integration of virtual planning and guided surgery is definitely of significant value but should be indicated individually case by case.

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“…The presented results differ from other reports. 6,9 This can be attributed to several factors. First, strict definitions were set for complete and partial failure.…”

Section: Discussionmentioning

confidence: 99%

Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting

Verhelst

Dons

Bever

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. A retrospective analysis was conducted of all FFFs performed over a 20-year period at a low-volume single tertiary center to identify risk factors and postoperative complications. A total of 129 FFFs were included (122 mandible, 7 maxilla). Complete flap failure occurred in 12.4% and partial flap failure in 7.8% of patients. A significant relation was found between younger age and flap failure, and most failures were associated with venous thrombosis. In-hospital surgical complications occurred in 60.5%, in-hospital medical complications in 49.6%, and out-of-hospital complications in 77.5% of patients. The in-hospital reintervention rate was 27.1%, and including salvaged flaps, flap survival rate was 87.6%. Osteomyocutaneous FFF failure (complete 12.4%; partial 7.8%) is an important clinical reality in a low-volume head and neck reconstruction center resulting in an in-hospital reintervention rate of 27.1%. Postoperative complications are frequent, both surgical and out-hospital complications. These results provide a better understanding of the limitations of the FFF in a low-volume center and can be used to optimize care in this kind of setting.

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Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps

Cited by 73 publications

References 8 publications

Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14‐year review

Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14‐year review

Functional Outcome of CAD/CAM-Assisted versus Conventional Microvascular, Fibular Free Flap Reconstruction of the Mandible: A Retrospective Study of 30 Cases

Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting

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