Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction

Ciolek, Peter J.; Clancy, Kate; Fritz, Michael A.; Lamarre, Eric

doi:10.1016/j.amjoto.2017.03.017

Cited by 11 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The addition of a free flap, facial reinnervation and reanimation adds considerable operative time to an often lengthy extirpative procedure. As a result, the risk of postoperative complications may be increased in those patients with significant comorbidities [34, 35].…”

Section: Discussionmentioning

confidence: 99%

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Trojanowski

Szymański

Trojanowska

et al. 2019

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

PurposeEvaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution.MethodsAn analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap.ResultsTumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications.ConclusionsThe ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

show abstract

Section: Discussionmentioning

confidence: 99%

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Trojanowski

Szymański

Trojanowska

et al. 2019

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…A series of 162 H&N reconstruction patients found that diabetes conferred a relative risk of 5.36 toward free flap complications (Bozikov & Arnez, 2006). Ciolek et al found that HTN, CHF, and COPD were univariate predictors of cardiac complications in H&N free flap surgery, however, CHF was the only adjusted predictor (Ciolek, Clancy, Fritz, & Lamarre, 2017). Studies also report associations between complications in H&N reconstruction and HTN (Beausang et al, 2003), diabetes (Joo, Sun, Park, Cho, & Kim, 2010a; Joo, Sun, Park, Cho, & Kim, 2010b; Vandersteen et al, 2013), ASA classes 3 and 4 (Patel, McCluskey, Goldstein, et al, 2010), and cardiac comorbidities (Vandersteen et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction

et al. 2020

View full text Add to dashboard Cite

Background: Surgical resection of head and neck (H&N) neoplasms requiring osseous reconstruction have underdefined complication profiles. This study aimed to characterize postoperative outcomes of patients with H&N neoplasia undergoing osteocutaneous flap (OCF) or bare bone flap (BBF) reconstructions. Materials and methods: Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2005-2017 databases. Queried for diagnosis and procedural codes extracted patients with H&N neoplasms undergoing BBF or OCF reconstruction. Postoperative complications were evaluated. Multivariable regression generated adjusted odds ratios. Results: A cohort of 746 patients were identified. Of reconstructions, 24.9% (n = 186/746) were BBFs while 75.1% (n = 560/746) were OCFs. 58.1% of the BBF cohort and 59.9% of the OCF cohort experienced an all-cause complication (p = .654). Sub-stratified, 24.2% of BBF and 17.5% of OCF patients experienced a wound complication (p = .045). Regression analysis demonstrated no difference in risk for medical complications between cohorts. However, patients receiving OCFs had a decreased likelihood of developing a wound complication (OR 0.652; 95%CI 0.430-0.989; p = .044) compared to patients receiving BBFs. Conclusion: The incidence of complications following osseous reconstruction of the H&N is considerable. Although several complication outcomes do not seem to differ between BBF or OCF reconstructions, OCFs is associated with a decreased likelihood of wound complications. 1 | INTRODUCTION Benign and malignant neoplasms of the head and neck (H&N) exert significant global morbidity with H&N cancer occurring in more than 500,000 patients across the globe each year (Jemal et al., 2011). An estimated 65,000 of these new cases are annually diagnosed in the United States, of which 14,000 result in death (Cancer.net Editorial Board, n.d.). These statistics are further magnified by cutaneous malignancies localized to the H&N (Mydlarz, Weber, & Kupferman, 2015). Ultimately, the treatment of H&N neoplasms is multi-faceted and interdisciplinary involving medical, surgical, occupational, and psychological support (Wheless, McKinney, & Zanation, 2010). Surgical intervention is an integral aspect of H&N tumor management with excision dependent upon tumor location and characteristics (Carlson & McCoy, 2017; Fu, Foreman, Goldstein, & de Disclaimer: The ACS NSQIP databases are the source of information used in this study. Data extrapolated, statistical analysis performed, and conclusions reached have not been verified by the ACS NSQIP but rather are the result of the work done by authors of this study.

show abstract

“…Their univariate analysis revealed CAD to be associated with postoperative complications. Further Ciolek et al described, that ASA Classifications System fails to estimate the perioperative risk in this selected patient cohort and called for efforts addressing modifiable factors prior surgery through comprehensive preoperative pathways (Ciolek, Clancy, Fritz, & Lamarre, ). Our elaborated assessment algorithm closed the gap Ciolek et al mentioned.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical head and neck reconstruction in patients with coronary artery disease: A perioperative assessment algorithm

et al. 2019

View full text Add to dashboard Cite

Background With the rising number of patients in advanced age receiving microsurgical procedures, coronary artery disease (CAD) and its challenging management is of increasing importance. Evidence based data concerning morbidity and mortality are rare. We present our experiences with this highly selected patient population and propose a preoperative assessment algorithm. Patients and methods Between January 2006 and May 2016, a total of 57 patients with CAD received 58 free flaps. Median age of our patients was 64 years (interquartile range 57.5‐70.0). Squamous cell carcinoma was the reason for reconstruction in all cases. Defect of the buccal, gum, tongue, lip, trigone, palatal, and hypopharyngeal regions were reconstructed. Patient characteristics and comorbidities were recorded. We especially focused on the preoperative cardiac assessment and treatment of patients who were scheduled for microsurgical free tissue transfer such as medical history, cardiac risk assessment, and further cardiac testing such as Doppler‐echocardiography and myocardial perfusion assessment. Intraoperative course as well as postoperative morbidity and mortality was described. Results About 54.4% of the selected cohort received cardiac catheterization due to a clinical preoperative cardiac assessment performed individually by the cardiologist on duty. In total, 52 fasciocutaneous anterolateral thigh flaps, four osteocutaneous fibula flaps, and two radial forearm flaps were performed. The flap survival rate was 96.6%. The overall surgical complication rate was 28.1% (16 patients), mostly due to wound infections (seven cases) and partial flap necrosis (four cases). Three patients died, resulting in a mortality rate of 5.2%. Conclusion CAD patients receiving head and neck microsurgical reconstructions are still at high risk for adverse consequences due to surgery. The microsurgical community is requested to share the experience of those cases in order to develop reliable and evidence based statements of the perioperative risks and prognosis for these patients. We additionally introduce a standardized perioperative cardiac assessment and treatment algorithm for head and neck surgery patients with CAD.

show abstract

Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction

Cited by 11 publications

References 24 publications

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction

Microsurgical head and neck reconstruction in patients with coronary artery disease: A perioperative assessment algorithm

Contact Info

Product

Resources

About