Reconstruction of defects in the head and neck with free flaps: 20 years experience

Eckardt, A.; Meyer, A.; Laas, U.; Hausamen, Jarg-Erich

doi:10.1016/j.bjoms.2005.12.012

Cited by 95 publications

(67 citation statements)

References 35 publications

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“…The surgical failure is certain if no salvage surgery is performed. This salvage treatment must be done as quickly as possible because the survival rate which varies between 0% and 100%) [4,15]. Group 4 (transient ligation of the vascular pedicle) corresponds to the period of ischemia between the cut of the vascular pedicle, the positioning and the time of the micro-vascular anastomosis.…”

Section: Discussionmentioning

confidence: 99%

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Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

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Section: Discussionmentioning

confidence: 99%

“…There are multiple causes: infection, dehiscence of sutures, compression or vascular thrombosis. Vascular thrombosis are the most frequent complications and represent 15-73% [3][4][5]. The majority of these complications occurred within the first 24 postoperative hours.…”

Section: Introductionmentioning

confidence: 99%

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

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“…A large number of studies have focused on the development of a novel method in the surgical treatment of head and neck cancer [10] and its postoperative reconstruction [11,12]. Previously, we have reported a modified technique for the reconstruction after total PLE, using the combination of gastric pull-up reconstruction with free jejunal transfer [13].…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Functional Outcomes following Free Jejunal Flap Reconstruction for Head and Neck Cancer

Song¹,

Zhu²,

Dong

et al. 2017

ORL

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Aim: To evaluate the morbidity and fundamental functional outcomes (swallow and speech) after free jejunal flap (FJF) reconstruction following total pharyngolaryngo-esophagectomy (PLE) in China. Methods: 18 patients with FJF reconstruction after total PLE were retrospectively reviewed. Scheduled barium swallow test was performed 7-10 days postoperatively. Rehabilitation of swallowing and speech for patients was assessed by the Performance Status Scale for Head and Neck Cancer Patients. Results: 8 patients died of tumor recurrence and 2 patients died of other reasons (cerebrovascular disease and respiratory disease, respectively). The 1-year, 2-year, and 3-year survival rates were 70.5, 49.4, and 33.8%, respectively. 83.3% of all patients could tolerate soft chewable foods, such as cooked vegetables, fish, hamburger, and small pieces of meat. 2 patients with early stenosis at upper anastomotic sites were with good swallowing function; while 2 patients with early stenosis at lower anastomotic sites were found to have difficulty in oral diet. 2 (11.1%) patients with larynx-preserving pharyngo-esophagectomy showed no compromise in speech. Only 2 (11.1%) patients underwent primary tracheoesophageal puncture for inserting an indwelling voice prosthesis for speech, and both patients achieved functional tracheoesophageal speech. The remaining 14 (77.8%) patients with total PLE did not resume functional speech. Conclusion: Postoperative barium swallow examination is helpful to predict long-term anastomotic stenosis. Good functional swallow rehabilitation is achieved following FJF reconstruction after total PLE or a larynx-preserving procedure. However, the speech outcomes are not satisfactory. It raises the demand of enhancement of functional recovery so that quality of life can be improved for these patients in China.

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“…Insufficient blood supply mostly leads to direct postoperative failure of reconstruction, accounting for 5-10% of the patients [6,7,8,9,10,11]. Ischemia for more than 3 h causes irreversible damage to the jejunum, making the salvage with thrombectomy and reanastomosis impossible and requiring a secondary reconstruction [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…However, total necrosis of the graft sometimes occurs and remains a major complication, mainly due to insufficient blood supply [6,7,8,9,10,11]. Choices of subsequent secondary reconstruction have been reported less frequently compared with the widely reported success rate of free jejunal transfer [12,13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

Salvage Procedures after Total Necrosis of a Free Jejunal Graft

Song

Zhu

Wang

et al. 2015

ORL

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Purpose of the Study: To determine the appropriate salvage method after total necrosis of a jejunal graft after reconstruction of total laryngopharyngoesophagectomy or a larynx-preserving operation, considering the complexity of medical service in China. Procedures: We reviewed 5 patients with a mean age of 61 years who developed total jejunal graft necrosis and underwent reconstruction of a free jejunal transfer in our hospital. The total number and choice of salvage procedures, the symptoms and the results of salvage for the 5 patients have been reviewed. Results: Four of the 5 patients survived. One of them underwent gastric pull-up reconstruction and recovered well. One patient died due to severe infection after the loss of the jejunal graft and secondary gastric pull-up reconstruction. A temporary external fistula was formed in 3 patients after the initial jejunal graft necrosis, 2 of which underwent fistula repair 6 and 5 months later, while one went on long-term gastric tube feeding. Conclusion: Our results suggest that a temporary external fistula formation is an optional secondary salvage procedure after total necrosis of an initial jejunal graft, considering the relatively low quality of medical service in China.

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Reconstruction of defects in the head and neck with free flaps: 20 years experience

Cited by 95 publications

References 35 publications

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Morbidity and Functional Outcomes following Free Jejunal Flap Reconstruction for Head and Neck Cancer

Salvage Procedures after Total Necrosis of a Free Jejunal Graft

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