Perioperative factors that influence the outcome of microsurgical reconstructions in craniomaxillofacial surgery

Preidl, Raimund; Wehrhan, Falk; Schlittenbauer, Tilo; Neukam, Friedrich Wilhelm; Stockmann, Philipp

doi:10.1016/j.bjoms.2015.03.007

Cited by 14 publications

(24 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

mentioning

confidence: 99%

“…In the era of organ preservation with concurrent chemoradiotherapy, free flap reconstruction has demonstrated decreased fistula rates and has also proven to be useful in the management of long-term sequelae such as osteoradionecrosis. 2 Although there is an abundance of studies assessing free flap failure rates, [3][4][5] there is a paucity of studies looking at overall medical and surgical complication rates and their predictors. 6 Our previous work has demonstrated that the most important predictor of increased length of stay, readmission, and unplanned return to the operating room (OR) is any medical or surgical complication.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures

Eskander

Kang

Tweel

et al. 2018

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective To (1) determine the overall complication rate, wound healing, and wound infection complications and (2) identify preoperative, intraoperative, and postoperative predictors of these complications. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (2006-2012) were assessed. Multivariable logistic regression assessed the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results Of the 515 patients identified, 54% had a complication predicted by longer operating room (OR) time, higher comorbidity index, and oral cavity and pharyngeal tumor sites. Predictors of wound-healing complications (15%) were longer OR time, volume of crystalloid given intraoperatively, and oral cavity and pharyngeal tumor sites. Predictors of wound infection (12%) were younger age, diabetes mellitus, and malnutrition. Conclusions Wound healing and infectious complications account for most complications in patients with head and neck cancer undergoing free flap reconstruction. Clean contaminated wounds are a significant predictor of wound complications. Advanced OR time, advanced age, and comorbidity status, including diabetes mellitus and malnutrition, are other important predictors. Crystalloid administration is also an important predictor of wound-healing complications, and this warrants further study.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures

Eskander

Kang

Tweel

et al. 2018

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…Although the caliber of the superficial vessels can be small, especially the distal part, further dissection proximal into the cranial pole of the parotid gland in front of the tragus can be performed to obtain a bigger caliber for vascular anastomosis (6). The temporal vessels are superior to the facial vessels for anastomosis due to the fact that in case of facial recipient vessels and according to the chosen microvascular flap often a interposition vein graft is required, which is known to be a risk factor for flap survival (28, 29). Further, we are able to perform both microvascular anastomoses of the comitant veins to the ST V. Herein we anastomose the better draining comitant vein orthograde to ST V to achieve a drainage to the deep venous system.…”

Section: Discussionmentioning

confidence: 99%

A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach

et al. 2019

View full text Add to dashboard Cite

Reconstructions of complex scalp after ablative resection or by post-traumatic tissue loss, can present difficulties regarding recipient vessel selection, functional, and aesthetic outcome. The harvesting method for many microvascular free flaps requires a need for changing patients position during surgery and makes a simultaneous interdisciplinary two-team approach complicated, which is a major disadvantage regarding safety and operation time. The ideal flap for scalp reconstruction has yet to be described, although the microvascular latissimus dorsi flap is frequently referred to as the first choice in this context, especially after resection of large defects. The purpose of this study is to compare two different microvascular free flaps for a simultaneous scalp reconstruction in an interdisciplinary two-team approach applying a standardized algorithm. All consecutively operated complex scalp defects after ablative surgery from April 2017 until August 2018 were included in this retrospective study. The indications were divided into neoplasm or wound healing disorder. Two microvascular flaps (latissimus dorsi or parascapular flap) were used to cover the soft tissue component of the resulting defects. Seventeen patients met the inclusion criterion and were treated in an interdisciplinary two-team approach. Skull reconstruction with a CAD/CAM implant was performed in 10 cases of which four were in a secondary stage. Nine patients received a parascapular flap and eight patients were treated with latissimus dorsi flap with split thickness skin graft. Anastomosis was performed with no exception to the temporal vessels. One parascapular flap had venous insufficiency after 1 week followed by flap loss. One latissimus dorsi flap had necrosis of the serratus part of the flap. All other flaps healed uneventful and could be further treated with adjuvant therapy or CAD/CAM calvarial implants. Regarding overall complications, flap related complications, flap loss, and inpatient stay no statistical differences were seen between the diagnosis or type of reconstruction. The parascapular flap seems to be a good alternative for reconstruction of complex tumor defects of the scalp besides the latissimus dorsi flap. Stable long-term results and little donor site morbidity are enabled with good aesthetic outcomes and shorter operation time in an interdisciplinary two-team approach.

show abstract

“…Tissue edema, ruddiness and tension can impact the survival of free flaps if pressure is applied over anastomoses. Additional factors such as intraoperative thrombosis, pre-existing vascular disease, or other perioperative patient risk factors can lead to proximal exposure of the pedicle or vein grafts [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

Skin grafting the vascular pedicle: a useful technique to avoid microvascular collapse in free tissue transfer for limb salvage

Kovar¹,

Diamond²,

Iorio³

2019

PAR

View full text Add to dashboard Cite

Aim: Free tissue transfer is essential for extremity reconstruction following traumatic injuries, oncologic resection, and diabetic complications. However, given the circumferential shape of the arm and leg, a small amount of ongoing edema can prevent a tension-free closure. Additionally, intraoperative thrombosis, vascular disease can lead to proximal exposure of the pedicle or vein grafts. This study evaluates the outcomes of microvascular transfers that utilized a skin graft for closure over the pedicle, in comparison with a matched cohort with a tension-free primary closure. Methods: A retrospective review was completed of all patients that underwent free flap reconstruction of an extremity defect from January 2014 to December 2017 at a single academic institution. Flaps that utilized skin grafting for closure were compared to those closed primarily. Adjunct operative procedures, demographics, and complications were evaluated. Results: A total of 71 patients fulfilled the inclusion criteria. The 11 flaps in 10 patients underwent skin grafting over the pedicle. The two cohorts were comparable in age, gender, BMI, and co-morbidities, excluding renal disease which was present in 40% (n = 4) of skin grafted group compared to 6.5% (n = 4) in the primary closure group. Flap area, operative time, and anastomosis technique were comparable between the two groups. There was no significant difference in the rates of post-operative complications including partial flap loss, complete flap loss, infection. Mean follow up time in the skin grafting group was 14.2 months and 20.2 months for the primary closure group. Conclusion: As per the principal, a tension-free closure is paramount to preventing tissue complications including direct compression of a microvascular pedicle. However, with ongoing tissue edema skin grafting should be considered as a reliable technique to ensure both protection of the pedicle as well as prevention of direct compression without additional complications and comparable post-operative outcomes.

show abstract

Perioperative factors that influence the outcome of microsurgical reconstructions in craniomaxillofacial surgery

Cited by 14 publications

References 25 publications

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures

A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach

Skin grafting the vascular pedicle: a useful technique to avoid microvascular collapse in free tissue transfer for limb salvage

Contact Info

Product

Resources

About