The Spider Limb Positioner in subscapular system free flaps

Stevens, Jayne R.; Rosko, Andrew J.; Marchiano, Emily; Haring, Catherine T.; Chinn, Steven B.; Malloy, Kelly M.; Prince, Mark; Casper, Keith; Moyer, Jeffrey S.; Chepeha, Douglas B.; Stucken, Chaz L.; Spector, Matthew E.

doi:10.1016/j.oraloncology.2018.08.004

Cited by 17 publications

(26 citation statements)

References 9 publications

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“…However, more recent descriptions have used a supine position to eliminate the need for repositioning and allow a two-teamed approach [34][35][36] . The use of an upper extremity limb positioner (Spider Limb Positioner) to facilitate a simultaneous two teamed approach is described extensively by Stevens et al [25] . This is achieved through positioning the patient on a bean bag in a semi-decubitus position while the Spider Limb Positioner holds the arm.…”

Section: Positioningmentioning

confidence: 99%

“…It has also been used as an alternative to PMMF or trapezius flaps with improved donor site morbidity [21][22][23][24] . Previous concerns about patient positioning and its feasibility in an interdisciplinary two-teamed approach have limited its use in head and neck reconstruction, but recent descriptions have demonstrated the viability of a simultaneous harvest [25,26] .…”

Section: Introductionmentioning

confidence: 99%

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Revisiting pedicled latissimus dorsi flaps in head and neck reconstruction: contrasting shoulder morbities across mysofascial flaps

Feng¹,

Nasser²,

Rosko³

et al. 2021

PAR

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Section: Positioningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Revisiting pedicled latissimus dorsi flaps in head and neck reconstruction: contrasting shoulder morbities across mysofascial flaps

Feng¹,

Nasser²,

Rosko³

et al. 2021

PAR

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“…The Spider Limb Positioner allows for a semi lateral decubitus positioning—pelvis and thorax roughly 20–30 degrees from the horizontal—which allows both good exposure to the head and neck concurrent with sustained extremity suspension without an assistant and reliable exposure. It is not our practice to use a bean bag in contrast to other groups 10 unless we are going to employ a standard lateral decubitus position, which is not common. The patient need not and should not be in the traditional lateral decubitus position as was originally described by dos Santos 1 if a concurrent two‐team approach without repositioning is to be performed.…”

Section: Discussionmentioning

confidence: 99%

“…In 2004 Nishimura et al 8 published the first description of a modified dissection technique from the standard lateral decubitus position. Since then various groups have published their approaches to facilitate a more efficient two‐team system 9–11 …”

Section: Introductionmentioning

confidence: 99%

“…The need to mobilize the arm requires a separate assistant whose sole function is to facilitate exposure during the dissection. The Spider Limb Positioner which has been used extensively in the realm of orthopedics for shoulder and elbow surgery has gradually been introduced into the realm of reconstructive surgery 9,10 . The incorporation of the Spider Limb Positioner into our practice in 2015 has facilitated the dissection and obviated dependence on a separate assistant.…”

Section: Introductionmentioning

confidence: 99%

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Application of the Spider Limb Positioner to Subscapular System Free Flaps

et al. 2020

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Objective To demonstrate the application and surgical time savings of the Spider Limb Positioner for subscapular system free flaps in head and neck reconstructive surgery. Methods Single institution retrospective chart review and analysis of patients between 2011 and 2019 that underwent a subscapular system free flap either with or without use of the Spider Limb Positioner. One hundred five patients in total were reviewed with 53 patients in the Spider group. The surgical times were compared between the two groups. Patient‐specific information regarding average age, laterality of donor site, recipient site, gender, and flap type were reviewed. Results Forty‐one patients in both groups underwent a latissimus free flap. Twelve of 53 in the Spider group and 11/52 in the control group underwent a scapula free flap. The average age in the Spider group at the time of surgery was 64 years. The recipient sites for the Spider groups were reviewed. The free flap was ipsilateral to the defect in 81% of cases. The mean surgical time for the 105 patients without the Spider was 568 minutes versus 486 minutes with a Spider P‐value of .003478. Conclusion Use of the Spider Limb Positioner allows for a simultaneous two‐team approach during free flap elevation of the subscapular system, which eliminates both dependence on an assistant to support the arm and time consuming positioning changes during flap elevation. Level of Evidence 3 Laryngoscope, 131:525–528, 2021

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Perioperative Outcomes in Patients Who Underwent Fibula, Osteocutaneous Radial Forearm, and Scapula Free Flaps

Bollig

Walia

Pipkorn

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceStudies comparing perioperative outcomes of fibula free flaps (FFFs), osteocutaneous radial forearm free flaps (OCRFFFs), and scapula free flaps (SFFs) have been limited by insufficient sample size.ObjectiveTo compare the perioperative outcomes of patients who underwent FFFs, OCRFFFs, and SFFs.Design, Setting, and ParticipantsThis cohort study assessed the outcomes of 1022 patients who underwent FFFs, OCRFFFs, or SFFs for head and neck reconstruction performed at 1 of 6 academic medical centers between January 2005 and December 2019. Data were analyzed from September 17, 2021, to June 9, 2022.Main Outcomes and MeasuresPatients were stratified based on the flap performed. Evaluated perioperative outcomes included complications (overall acute wound complications, acute surgical site infection [SSI], fistula, hematoma, and flap failure), 30-day readmissions, operative time, and prolonged hospital length of stay (75th percentile, &gt;13 days). Patients were excluded if data on flap type or clinical demographic characteristics were missing. Associations between flap type and perioperative outcomes were analyzed using logistic regression, after controlling for other clinically relevant variables. Adjusted odds ratios (aORs) with 95% CIs were generated.ResultsPerioperative outcomes of 1022 patients (mean [SD] age, 60.7 [14.5] years; 676 [66.1%] men) who underwent major osseous head and neck reconstruction were analyzed; 510 FFFs (49.9%), 376 OCRFFFs (36.8%), and 136 SFFs (13.3%) were performed. Median (IQR) operative time differed among flap types (OCRFFF, 527 [467-591] minutes; FFF, 592 [507-714] minutes; SFF, 691 [610-816] minutes). When controlling for SSI, FFFs (aOR, 2.47; 95% CI, 1.36-4.51) and SFFs (aOR, 2.95; 95% CI, 1.37-6.34) were associated with a higher risk of flap loss than OCRFFFs. Compared with OCRFFFs, FFFs (aOR, 1.77; 95% CI, 1.07-2.91) were associated with a greater risk of fistula after controlling for the number of bone segments and SSI. Both FFFs (aOR, 1.77; 95% CI, 1.27-2.46) and SFFs (aOR, 1.68; 95% CI, 1.05-2.69) were associated with an increased risk of 30-day readmission compared with OCRFFFs after controlling for Charlson-Deyo comorbidity score and acute wound complications. Compared with OCRFFFs, FFFs (aOR, 1.78; 95% CI, 1.25-2.54) and SFFs (aOR, 1.96; 95% CI, 1.22-3.13) were associated with a higher risk of prolonged hospital length of stay after controlling for age and flap loss.Conclusions and RelevanceFindings of this cohort study suggest that perioperative outcomes associated with OCRFFFs compare favorably with those of FFFs and SFFs, with shorter operative times and lower rates of flap loss, 30-day readmissions, and prolonged hospital length of stay. However, patients undergoing SFFs represented a more medically and surgically complex population than those undergoing OCRFFFs or FFFs.

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The Spider Limb Positioner in subscapular system free flaps

Cited by 17 publications

References 9 publications

Revisiting pedicled latissimus dorsi flaps in head and neck reconstruction: contrasting shoulder morbities across mysofascial flaps

Revisiting pedicled latissimus dorsi flaps in head and neck reconstruction: contrasting shoulder morbities across mysofascial flaps

Application of the Spider Limb Positioner to Subscapular System Free Flaps

Perioperative Outcomes in Patients Who Underwent Fibula, Osteocutaneous Radial Forearm, and Scapula Free Flaps

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