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Rysz M, Kissin F. Differences in free flaps’ reconstructions
with and without coupling device for venous
anastomosis. Otolaryngol Pol 2021; 76:6-12. [DOI: 10.5604/01.3001.0015.3207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<br><b>Introduction:</b> Introduction of the coupler devices for anastomoses of neck vessels changes planning and performance of the surgical procedures. The Rigid ring of the coupling devices keeps a vein open and less prone to occlusion. Therefore, this should improve the flap survival rate and surgery duration.</br>
<br><b>Aim:</b> The aim of the study was to point out the differences in surgery planning between couplers and sutures for venous microsurgical anastomoses.</br>
<br><b>Methods:</b> The medical records of 209 patients who underwent 212 microvascular free flap reconstructions from January 2011 till December 2017 were retrospectively analyzed; 103 received radial forearm free flap (RFFF); 43 – anterolateral thigh flap (ALTF); 51 – fibula free flap (FFF); 15 – iliac crest free flap (ICFF). In 189 cases, reconstruction was performed simultaneously with tumor resection and in 23 cases, reconstruction was secondary, after previous oncological treatment. Among 443 anastomoses, suturing was used for 212 arteries and 127 venous anastomoses, while coupling was used for 104 venous anastomoses.</br>
<br><b>Results:</b> The mean surgery duration for suturing was 452.82 min vs 358.88 min for coupling (P<0.05). Differences in flap survival and partial necrosis rates between coupling and suturing groups were not statistically significant (P>0.05). Donor vessel distribution in the neck was significantly different in both groups. Estimated costs of the surgical procedures performed with and without coupler devices were not equal.</br>
<br><b>Conclusions:</b> The use of couplers for venous anastomosis in free flap head and neck reconstructions impacts the surgery process by shortening surgery duration which leads to cost reduction.</br>
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Affiliation(s)
- Maciej Rysz
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland
| | - Filip Kissin
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland
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Impact of microsurgery skill acquisition on free flap ischaemia time and free flap outcomes. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01782-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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3
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Yeung C, Shih JG, Knox ADC, Zhygan N, Courtemanche DJ, Fish JS, Brown MH. Variable Experience in Microsurgery and Flap-Based Procedures Among Canadian Plastic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:1623-1631. [PMID: 32532696 DOI: 10.1016/j.jsurg.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/04/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
TITLE Variable experience in microsurgery and flap-based procedures among Canadian plastic surgery residents. OBJECTIVE Plastic surgery residencies are transitioning toward a competency-based education model. It is not known whether trainees can realistically achieve proficiency in microsurgical techniques during their training. This study aims to define the operative experience in the core microsurgical flap procedures among Canadian plastic surgery residents. DESIGN Microsurgical core procedural competencies (CPCs) have been described. A retrospective review was conducted, evaluating case logs recorded by graduating plastic surgery residents at 10 Canadian English-speaking training programs between 2004 and 2014. Perceived role and competence scores were also collected and analyzed. SETTING University of Toronto, Toronto, ON, Canada; University of British Columbia, Vancouver, BC, Canada. RESULTS Among 27 microsurgical CPCs, 2082 procedures were logged and each resident performed an average of 37.9 (±21.7) procedures. Anterolateral thigh flaps, radial forearm-based flaps, and digit replants were the most common; however, 10.9% to 14.5% of residents did not have any operative experience with these flaps. Most residents reported zero operative experience with many of the CPCs (10.9%-100%). Co-Surgeon (50%) and First Assistant (30%) were the most common roles. None of the graduating residents reported feeling competent enough to independently perform 50% of the microsurgery CPCs. There was no difference in perceived roles when programs with ≥5 residents were compared against programs with fewer trainees. There were weak to moderate correlations between role and self-perceived competence, and between Post Graduate Year and self-perceived competence. CONCLUSIONS There is wide variation in resident operative experience in microsurgical CPCs. Many residents graduate with little to no experience in many of the core procedures. Identifying areas of deficiency may help guide curriculum development in the new competency-based education model.
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Affiliation(s)
- Celine Yeung
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jessica G Shih
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aaron D C Knox
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Zhygan
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas J Courtemanche
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel S Fish
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell H Brown
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada.
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4
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Zaid W, Schlieve T. The Early Effects of Coronavirus Disease-2019 on Head and Neck Oncology and Microvascular Reconstruction Practice: A National Survey of Oral and Maxillofacial Surgeons Enrolled in the Head and Neck Special Interest Group. J Oral Maxillofac Surg 2020; 78:1859-1868. [PMID: 32745533 PMCID: PMC7366104 DOI: 10.1016/j.joms.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The coronavirus disease-2019 (COVID-19) pandemic has affected healthcare systems across the nation. The purpose of this study is to gauge the early effects of the COVID-19 pandemic on head and neck oncology and reconstructive surgery (HNORS) practice and evaluate their practice patterns especially ones that might be impacted by COVID-19 and compare them to the current literature. METHODS This study is a cross-sectional study that surveyed fellowship-trained oral and maxillofacial surgeons in HNORS. This cohort of surgeons was contacted via a generated email list of surgeons enrolled in the American Association of Oral and Maxillofacial Surgeons pathology special interest group. An electronic survey contained 16 questions to assess the COVID-19 effect on HNORS practice and capture their practice patterns from mid-March to mid-April 2020. Statistical analysis was performed to analyze counts, percentages, and response rates. RESULTS We had a 60% response rate (39 of 64); 72% of our responders worked at academic institutions, 18% marked themselves as hybrid academic/private practice, and only 10% were considered hospital-based surgeons. Only 8% of the survey respondents were requested to pause head and neck cancer surgery, whereas 24% were requested to pause free flap surgery during the pandemic. Fifty-five percent agreed that the head and neck and reconstructive surgery should be conducted during a pandemic. Finally, 45% thought that two weeks was a reasonable delay for head and neck cancer cases, whereas 29% thought they should not be delayed for any amount of time. Regarding practice patterns, microvascular reconstruction was the favored method (100%). Respondents generally admitted patients to an intensive care unit postoperatively (92%) and were kept on a ventilator (53%). CONCLUSION The COVID-19 pandemic had a small impact on the surgical treatment of patients with head and neck oncology. Most HNORS surgeons are practicing in accordance with recently published literature.
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Affiliation(s)
- Waleed Zaid
- Associate Professor, Department of Oral and Maxillofacial Surgery, Site Director of Oral and Maxillofacial Surgery - Baton Rouge, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA.
| | - Thomas Schlieve
- Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Dallas, TXl, Residency Program Director, Division of Oral and Maxillofacial Surgery, Dallas, TX, Director of Oral and Maxillofacial Surgery, Parkland Memorial Hospital, Dallas, TX, Director of Oral and Maxillofacial Surgery, Texas Health Presbyterian- Dallas, Dallas, TX
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5
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Cho MJ, Halani SH, Davis J, Zhang AY. Achieving balance between resident autonomy and patient safety: Analysis of resident-led microvascular reconstruction outcomes at a microsurgical training center with an established microsurgical training pathway. J Plast Reconstr Aesthet Surg 2020; 73:118-125. [DOI: 10.1016/j.bjps.2019.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/09/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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The Anterolateral Thigh Perforator Flap in an Innovative Microsurgery Training Method. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e1974. [PMID: 30881788 PMCID: PMC6414106 DOI: 10.1097/gox.0000000000001974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022]
Abstract
The road to becoming a good and confident microsurgeon requires love for your work, patience, and good training facilities. Safe and effective training procedures for young microsurgeons during their plastic surgery residency are necessary and should be applied under standardized conditions. We present an innovative microsurgical training method for plastic surgery residents in the operation theater concerning the anterolateral thigh perforator flap (ALT). In a 2-team approach, the ALT flap harvesting begins parallel to tumor resection. Although the tumor excision team still works in the tumor region, and after the reconstructive team has successfully completed the ALT dissection, residents can work distally to the origin of the perforator vessel (which supplies the flap). Their training involves dissection and anastomosis of the continuation of the descending branch, distally to the perforator supplying the flap. Since 2015, eight operations have been performed with this innovative method with the participation of upcoming microsurgeons. A written informed consent is given to all patients. Our study resulted in the improvement of microsurgical skills of the young microsurgeons. There is no impact to the ALT perforator flap or to the operative time. This training procedure can be safely applied as a training method during plastic surgery residency under standardized conditions. We have the joy of seeing our resident's progress through their high success rates in microsurgery. We recommend this innovative procedure as an adequate teaching method during residency to promote the future of our specialty, and we hope that our students will become even better than their teachers.
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Wolff KD, Rau A, Kolk A. Perforator flaps from the lower leg for intraoral reconstruction: Experience of 131 flaps. J Craniomaxillofac Surg 2018; 46:338-345. [DOI: 10.1016/j.jcms.2017.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/11/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022] Open
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8
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Safety and Suitability of Finger Replantations as a Residency Training Procedure. Ann Plast Surg 2017; 78:431-435. [DOI: 10.1097/sap.0000000000000945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sweeny L, Rosenthal EL, Light T, Grayson J, Petrisor D, Troob SH, Greene BJ, Carroll WR, Wax MK. Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck. Otolaryngol Head Neck Surg 2017; 156:627-635. [PMID: 28322117 DOI: 10.1177/0194599817691746] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective To compare outcomes after microvascular reconstructions of head and neck defects between overlapping and nonoverlapping operations. Study Design Retrospective cohort study. Setting Tertiary care center. Subjects and Methods Patients undergoing microvascular free tissue transfer operations between January 2010 and February 2015 at 2 tertiary care institutions were included (n = 1315). Patients were divided into 2 cohorts by whether the senior authors performed a single or consecutive microvascular reconstruction (nonoverlapping; n = 773, 59%) vs performing overlapping microvascular reconstructions (overlapping; n = 542, 41%). Variables reviewed were as follows: defect location, indication, T classification, surgical details, duration of the operation and hospitalization, and complications (major, minor, medical). Results Microvascular free tissue transfers performed included radial forearm (49%, n = 639), osteocutaneous radial forearm (14%, n = 182), anterior lateral thigh (12%, n = 153), fibula (10%, n = 135), rectus abdominis (7%, n = 92), latissimus dorsi (6%, n = 78), and scapula (<1%, n = 4). The mean duration of the overlapping operations was 21 minutes longer than nonoverlapping operations ( P = .003). Mean duration of hospitalization was similar for nonoverlapping (9.5 days) and overlapping (9.1 days) cohorts ( P = .39). There was no difference in complication rates when stratified by overlapping (45%, n = 241) and nonoverlapping (45%, n = 344) ( P = .99). Subset analysis yielded similar results when minor, major, and medical complications between groups were assessed. The overall survival rate of free tissue transfers was 96%, and this was same for overlapping (96%) and nonoverlapping (96%) operations ( P = .71). Conclusions Patients had similar complication rates and durations of hospitalization for overlapping and nonoverlapping operations.
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Affiliation(s)
- Larissa Sweeny
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eben L Rosenthal
- 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Tyler Light
- 3 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Jessica Grayson
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel Petrisor
- 3 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Scott H Troob
- 3 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Benjamin J Greene
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William R Carroll
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark K Wax
- 3 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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10
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Hirche C, Kneser U, Xiong L, Wurzer P, Ringwald F, Obitz F, Fischer S, Harhaus L, Gazyakan E, Kremer T. Microvascular free flaps are a safe and suitable training procedure during structured plastic surgery residency: A comparative cohort study with 391 patients. J Plast Reconstr Aesthet Surg 2016; 69:715-21. [DOI: 10.1016/j.bjps.2016.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/11/2016] [Accepted: 01/24/2016] [Indexed: 12/17/2022]
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11
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Eight free flaps in 24 hours: a training concept for postgraduate teaching of how to raise microvascular free flaps. Br J Oral Maxillofac Surg 2015; 54:35-9. [PMID: 26628198 DOI: 10.1016/j.bjoms.2015.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/29/2015] [Indexed: 11/20/2022]
Abstract
Microvascular free flaps are complex but important tools in oral and maxillofacial surgery (OMFS), and though techniques to raise flaps are challenging surgeons often have little structured training. In this study we have evaluated a structured, three-day, hands-on, practical training course on raising flaps. Five human, Thiel-embalmed cadavers were used for training in how to raise the following flaps: radial forearm, anterolateral thigh, lateral arm, fibular, latissimus dorsi, scapular, iliac crest, and rectus abdominis. The total duration of the course was 24 hours over three days. All participants were asked to evaluate the design and conduct of the course, their own learning curve, and general questions about their knowledge of how to raise flaps and microsurgery. There was a significant increase in participants' assessments of how they raised all free flaps, except the lateral arm flap (4.74 (0.68) compared with 2.42 (0.81); p=0.052) before and after the course. The radial forearm flap was thought to be the most relevant in clinical practice (n=40; 75%), followed by the anterolateral thigh (n=5; 9%) and fibular (n=4; 8%) flaps. Comparisons between residents and consultants showed unsurprising differences in experience with microsurgery and self-assessment in raising particular free flaps before the course. We have shown that a structured, hands-on course using a well-established simulation model can significantly improve postgraduate surgeons' skills in raising free flaps.
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12
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Li R, Zhang R, He W, Qiao Y, Li W. The Use of Venous Coupler Device in Free Tissue Transfers for Oral and Maxillofacial Reconstruction. J Oral Maxillofac Surg 2015; 73:2225-31. [DOI: 10.1016/j.joms.2015.06.153] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/07/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
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13
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Meier JC, Remenschneider AK, Gray ST, Holbrook EH, Gliklich RE, Metson R. The impact of surgical trainee participation on sinus surgery outcomes. Laryngoscope 2015; 126:316-21. [PMID: 26360316 DOI: 10.1002/lary.25504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the effect of otolaryngology trainee participation on clinical outcomes in patients who undergo endoscopic sinus surgery (ESS) for chronic rhinosinusitis. STUDY DESIGN Secondary analysis of prospectively collected data. METHODS Patients enrolled in a sinus surgery outcomes study between May 2011 and March 2013 were stratified into two groups--those who were operated on by an attending alone and those operated on by an attending with a trainee present (resident, fellow, or both). Patients completed quality of life (QOL) surveys including the Chronic Sinusitis Survey (CSS), 22-item Sino-Nasal Outcome Test (SNOT-22), and EuroQol 5-dimension survey preoperatively and 1 year postoperatively. Operative time, estimated blood loss (EBL), complication rates, and survey scores were compared between groups. RESULTS The study population consisted of 452 patients. The attending alone (n = 119) and trainee (n = 333) groups were statistically comparable in terms of patient demographics, disease severity, and extent of surgery. Mean operative time was significantly shorter in the attending-alone group (80.0 vs. 90.6 minutes, P < .01). Mean EBL (105 mL attending vs. 117 mL trainee, P = .39) and complication rates (3.3% attending vs. 0.6% trainee, P = .07) were similar between groups. Observed changes in QOL measures following ESS were comparable between groups, although absolute improvement in the SNOT-22 scores (19.0 attending vs. 24.5 trainee, P = .05) did show a trend toward greater improvement in the trainee group. CONCLUSIONS Trainee participation in ESS is associated with prolongation in surgical time; however, such participation was not found to adversely affect patient safety or clinical outcomes. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Josh C Meier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eric H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Richard E Gliklich
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ralph Metson
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Klosterman T, Siu E, Tatum S. Free flap reconstruction experience and outcomes at a low-volume institution over 20 years. Otolaryngol Head Neck Surg 2015; 152:832-7. [PMID: 25953911 DOI: 10.1177/0194599815573726] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Assess the efficacy of free flap reconstruction performed at a low-volume program and evaluate how volume and outcomes have changed over 20 years. STUDY DESIGN Case series with chart review. SETTING Tertiary academic medical center. SUBJECTS AND METHODS A retrospective chart review was performed at a tertiary care academic program on all free tissue flaps from the primary reconstructive surgeon over 20 years (1993-2013). In total, 136 procedures were obtained from operative notes, billing codes, and chart databases. Outcome variables included procedure success and complications. Patients stayed in general intensive care unit and hospital floor units. RESULTS Flap success was 92.6% of all cases. In the past 13 years, 70 flaps were performed with 3 failures (96% success rate). Take-back rate was 16% of total cases with a flap recovery rate of 60%. Postoperative failure occurred after 72 hours in 60% of cases. Nearly 60% of patients experienced a complication of any type or severity. Twenty percent had a flap complication while maintaining viability, with half of these being partial dehiscence. Systemic complications affected 20% of all cases. The average hospital stay for noncomplicated patients was 13 days. There was 1 postoperative mortality. Fibula and radial forearm were the most common flaps at 44% and 26%, respectively. CONCLUSION Free flap reconstruction of the head and neck can be performed by appropriately skilled surgeons with acceptable outcomes in low-volume settings. Success rate appears to increase as clinical experience is gained.
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Affiliation(s)
| | - Eric Siu
- SUNY Upstate Medical Center, Syracuse, New York, USA
| | - Sherard Tatum
- SUNY Upstate Medical Center, Syracuse, New York, USA
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Kansy K, Mueller AA, Mücke T, Kopp JB, Koersgen F, Wolff KD, Zeilhofer HF, Hölzle F, Pradel W, Schneider M, Kolk A, Smeets R, Acero J, Hoffmann J. Microsurgical reconstruction of the head and neck--current concepts of maxillofacial surgery in Europe. J Craniomaxillofac Surg 2014; 42:1610-3. [PMID: 24954764 DOI: 10.1016/j.jcms.2014.04.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Microvascular surgery following tumour resection has become an important field of oral maxillofacial surgery (OMFS). This paper aims to evaluate current microsurgical practice in Europe. METHODS The questionnaire of the DOESAK collaborative group for Microsurgical Reconstruction was translated into English, transformed into an online based survey and distributed to 200 OMFS units with the aid of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS). RESULTS 65 complete and 72 incomplete questionnaires were returned. Hospitals from the United Kingdom, France, Italy, the Netherlands, Spain, Belgium, Greece, Slovenia and Lithuania participated. 71% of contributing centres were university hospitals, 87% out of these perform microvascular tumour surgery at least on a two-weekly base. Overall complication rate was at around five percent. Most frequently used transplants were the radial forearm flap and the fibular flap. The perioperative management varied widely. Success factors for flap survival, however, were uniformly rated, with the surgical skill being the most important factor, followed by the quality of postoperative management. Medication seems to play a less important role. CONCLUSION Within Europe microvascular surgery is a common and safe procedure for maxillofacial reconstructive surgery in the field of OMFS. While there is a major accordance for the surgical procedure itself and the most frequently used flaps, perioperative management shows a wide variety of protocols with low presumed impact on surgical outcome.
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Affiliation(s)
- Katinka Kansy
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Andreas Albert Mueller
- Department of Oral and Maxillofacial Surgery, Universitätsspital Basel, University of Basel, Basel, Switzerland
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Munich, Germany
| | - Jean-Baptiste Kopp
- Department of Oral and Maxillofacial Surgery, Universitätsspital Basel, University of Basel, Basel, Switzerland
| | - Friederike Koersgen
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Klaus Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Munich, Germany
| | - Hans-Florian Zeilhofer
- Department of Oral and Maxillofacial Surgery, Universitätsspital Basel, University of Basel, Basel, Switzerland
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, Aachen University Hospital, Aachen, Germany
| | - Winnie Pradel
- Department of Oral and Maxillofacial Surgery, Dresden University Hospital, Dresden, Germany
| | - Matthias Schneider
- Department of Oral and Maxillofacial Surgery, Dresden-Neustadt Hospital, Dresden, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Munich, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, Hamburg University Hospital, Hamburg-Eppendorf, Germany
| | - Julio Acero
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal, University of Alcala, Madrid, Spain
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Outcome of microvascular free flaps in a high-volume training centre. J Craniomaxillofac Surg 2014; 42:1178-83. [PMID: 24661422 DOI: 10.1016/j.jcms.2014.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/13/2013] [Accepted: 02/10/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Microvascular free tissue transfer allows major ablative defects following oncologic surgical and traumatic reasons to be reliably reconstructed in the head and neck region. A retrospective analysis of the microvascular flap procedures which were performed within one year in a high volume training centre was performed. PATIENTS AND METHODS The microvascular free flap procedures of the year 2011 were reviewed and followed up until the 31st December 2012. The type and indication of the reconstructive procedure, operation time, operating team, experience and level of training of the surgeons involved, postoperative IMC (intermediate care unit) and/or ICU (intensive care unit) time, inpatient time, flap revisions, further postoperative complications, preoperative and postoperative radiation of the patients, the placement of dental implants were studied. RESULTS From 1st of January 2011 to 31st of December, 2011, the data of 101 patients with 103 microvascular free flap procedures were analysed of which 72% (84 flaps) were harvested by residents. The patients ranged in age from 14 to 89 years (mean age 59 years, 71 males and 40 females). The mean operation time was 591 min with the longest operation times for scapular flaps (744 min) and the shortest operation times for ALT flaps (455 min). Mean inpatient time was 34.2 days with a minimal time for the fibular flaps of 27.2 days and a maximum of 45.7 days for the latissimus dorsi flaps. 24 flaps (23.3%) in total had to be revised with bleeding being the main cause of immediate revisions (41.7% of all revisions). 5 flaps (4.85% of all flaps) were lost despite a revision procedure meaning a successful revision rate in 79.2% of all revisions. CONCLUSION Microvascular reconstruction procedures are safe and should be considered as standard procedures for reconstruction of large defects especially in high volume training centres. Intensive flap monitoring and early revisions maximize the flap outcome.
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