1
|
Üstün GG, Kaplan GO, Sert G, Uzun H. Flap loss in head and neck reconstruction: Is there a singular cause for failure? J Plast Reconstr Aesthet Surg 2024; 91:353-359. [PMID: 38442516 DOI: 10.1016/j.bjps.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
Despite the high success rates reported in head and neck reconstruction, free flap failures continue to persist. Understanding the factors associated with flap loss and improving overall success are paramount. This study aimed to comprehensively assess the factors influencing flap revision and free tissue transfer survival in head and neck reconstruction. The study included 70 patients with defects in the lower two-thirds of the head and neck region and underwent reconstruction using free flaps. Patient age, gender, smoking status, comorbidities and data on the location and aetiology of the defect, the specific type of flap employed, the recipient artery and vein chosen, instances of revision and the overall success of the flap were collected. The investigation aimed to establish correlations between these variables as well as flap success and revision rates. No statistically significant differences were observed in arterial and venous anastomosis revision rates, or flap survival, in relation to variables such as age, gender, flap type, smoking status, comorbidities, recipient artery or vein and the number of vein anastomoses. The malignant tumour group exhibited a lower requirement for arterial revision and a higher flap survival rate compared to the benign tumour group. This study underscores the comparable safety profiles of perforator-based and conventional flaps in head and neck reconstruction. Furthermore, it reveals that patient characteristics are not contraindications for free tissue transfer. Additionally, the quantity of the veins and choice of recipient vessels are flexible and do not significantly impact flap success. The higher rates of flap success in patients with malignant aetiology requires further investigation.
Collapse
Affiliation(s)
- Galip Gencay Üstün
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey.
| | - Güven Ozan Kaplan
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
| | - Gökhan Sert
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
| | - Hakan Uzun
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
| |
Collapse
|
2
|
Choi JW, Alshomer F, Kim YC. Evolution and current status of microsurgical tongue reconstruction, part II. Arch Craniofac Surg 2022; 23:193-204. [PMID: 36373253 PMCID: PMC9663260 DOI: 10.7181/acfs.2022.00857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 01/25/2023] Open
Abstract
Tongue reconstruction remains a major aspect of head and neck reconstructive procedures. Surgeons planning tongue reconstruction should consider several factors to optimize the overall outcomes. Specifically, various technical aspects related to tongue reconstruction have been found to affect the outcomes. Multidisciplinary teams dedicated to oncologic, reconstructive, and rehabilitative approaches play an essential role in the reconstructive process. Moreover, operative planning addressing certain patient-related and defect-related factors is crucial for optimizing functional speech and swallowing, as well as quality of life outcomes. Furthermore, tongue reconstruction is a delicate process, in which overall functional outcomes result from proper flap selection and shaping, recipient vessel preparation and anastomosis, surgical approaches to flap insetting, and postoperative management. The second part of this review summarizes these factors in relation to tongue reconstruction.
Collapse
Affiliation(s)
- Jong-Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Feras Alshomer
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Chul Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Influence of biological sex on intra- and postoperative course of microvascular free flap reconstructive surgery in the head and neck region: A retrospective analysis involving 215 patients. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
4
|
Iacoviello P, Bacigaluppi S, Callegari S, Rossello C, Antonini A, Gramegna M, Da Rold M, Signorini G, Verrina G. Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience. Front Surg 2022; 9:912010. [PMID: 35846955 PMCID: PMC9280031 DOI: 10.3389/fsurg.2022.912010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFor head and neck reconstructive procedures, free flap survival depends on microsurgical and anatomical choices besides multimodal clinical management. The aim of the present study is to identify relevant variables for flap survival in our initial consecutive series.MethodsA single-center, novel reconstructive team consecutive surgical series was revised. The outcome was analyzed in terms of flap survival observing variables considered more relevant: flap type, recipient artery, vein(s), and graft interposition were discussed for facial thirds to be reconstructed. Statistical analysis was performed with Chi-square, Mann–Whitney, and Odds ratio.ResultsA total of 118 free flaps were performed in 115 microsurgical procedures (93.9% for malignancies) on 109 patients, with a flap survival rate of 91.5%. For reconstruction of the middle and lower third of the face, the facial artery was privileged, because it was already transected during lymph node dissection in order to save the superior thyroid artery for further microsurgical needs. Flap failure was 50% venous. Double vein anastomosis was not related to flap survival. Deep venous drainage (as the internal jugular vein system) required fewer revisions. Half of the re-explorations saved the flap. Grafts were a risk for flap survival. Bony flaps were more critical.ConclusionAt comparable reconstructive quality, flap choice should avoid a vascular graft. The facial artery is a preferable recipient vessel, since it saves other arteries both in the case of an arterial revision and in the case of recurrence, for further free flap reconstruction. For venous anastomosis, a deep venous recipient is safer, since it offers the possibility to choose the level of anastomosis optimizing the vascular pedicle geometry. A close postsurgical flap monitoring is advisable up to 7 days postoperatively to allow for timely flap salvage.
Collapse
Affiliation(s)
- Paolo Iacoviello
- Department of Maxillofacial and Plastic Reconstructive Surgery, E.O. Ospedali Galliera, Genoa, Italy
- Correspondence: Susanna Bacigaluppi Paolo Iacoviello
| | - Susanna Bacigaluppi
- Department of Neurosurgery, E.O. Ospedali Galliera, Genoa, Italy
- Department of Neurosurgery and Neurotraumatology, IRCCS Policlinico San Martino, Genoa, Italy
- DINOGMI, Neurosurgery and Neurotraumatology, University of Genoa, Genoa, Italy
- Correspondence: Susanna Bacigaluppi Paolo Iacoviello
| | - Simone Callegari
- Burn Unit and Plastic Surgery, Villa Scassi Hospital, Genoa, Italy
| | | | | | - Marco Gramegna
- Department of Maxillofacial and Plastic Reconstructive Surgery, E.O. Ospedali Galliera, Genoa, Italy
| | - Mariano Da Rold
- Department of Maxillofacial and Plastic Reconstructive Surgery, E.O. Ospedali Galliera, Genoa, Italy
| | - Giuseppe Signorini
- Department of Maxillofacial and Plastic Reconstructive Surgery, E.O. Ospedali Galliera, Genoa, Italy
| | - Giuseppe Verrina
- Department of Maxillofacial and Plastic Reconstructive Surgery, E.O. Ospedali Galliera, Genoa, Italy
| |
Collapse
|
5
|
Free Flap Outcome in Irradiated Recipient Sites: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open 2022; 10:e4216. [PMID: 35356041 PMCID: PMC8939917 DOI: 10.1097/gox.0000000000004216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/22/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
The impact of previous radiotherapy on free flap outcome is still a subject of debate. Clinical investigations have come to divergent conclusions and the true effect of radiotherapy (XRT) on flap survival is not definitely known. Most studies investigating the factor often have their methodological limitations such as lack of statistical power as a consequence of the overall low failure rates together with few irradiated cases. This study will attempt to address the question whether previous radiotherapy is associated with a significantly higher incidence of flap failure or not.
Collapse
|
6
|
Mata Ribeiro L, Tsao CK, Hung YL, Chu CH, Lin LC, Lin MH, Peng C, Cheong DCF, Hung SY, Liao CT. Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps. J Reconstr Microsurg 2022; 38:654-663. [PMID: 35213928 DOI: 10.1055/s-0042-1743165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Superficial temporal vessels have been used successfully as recipient vessels for head and neck reconstruction. This study evaluates the impact of several treatment variables on flap failure and take-back rate when using these recipient vessels. METHODS We conducted a retrospective study of all microsurgical reconstructions using superficial temporal vessels as recipient vessels in a period of 10 years. Variables collected included previous treatments (radiotherapy, chemotherapy, neck dissection, free flap reconstruction), type of flaps used (soft tissue, osteocutaneous), and vessel size discrepancy between donor and recipient vessels. RESULTS A total of 132 patients were included in the study. The flap success rate was 98.5%. The take-back rate was 10.6%. The most frequent reason for take-back was venous congestion secondary to thrombosis. None of the studied variables was associated with flap failure. Reconstructions using osteocutaneous flaps and vein diameter discrepancy (ratio ≥ 2:1) had significantly higher take-back rates. CONCLUSION Flaps with a significant size discrepancy between donor and recipient veins (ratio ≥ 2:1) and fibula flaps (compared with soft tissue flaps) were associated with a higher risk of take-back. It is crucial to minimize venous engorgement during flap harvest and anastomosis, and limit vein redundancy during flap in-setting.
Collapse
Affiliation(s)
- Luís Mata Ribeiro
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, São José Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Liang Hung
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Hui Chu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Ching Lin
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mo-Han Lin
- Center of Tissue Engineering, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi Peng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
| | - David Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
7
|
Miller H, Bush K, Delancy M, Leo ND, Joshi H, Saracco B, Adams A, Gaughan J, Bonawitz S. Effect of preoperative radiation on free flap outcomes for head and neck reconstruction: An updated systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 75:743-752. [PMID: 34810143 DOI: 10.1016/j.bjps.2021.09.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is an ongoing debate about whether neoadjuvant radiation therapy is associated with higher rates of postoperative complications after head and neck reconstruction. Herle et al. conducted a systematic review in 2014 of 24 studies, finding higher complication rates in irradiated fields. We sought to perform an exhaustive updated systematic review and meta-analysis. METHODS We conducted an updated systematic review of the literature, as outlined in our protocol, which was registered on PROSPERO. Databases included Medline, Embase, Cochrane Central, and Web of Science. There were no limits placed on the date range, place of publication, or origin. Exclusion criteria included patients less than 18 years of age, studies with less than 20 participants (n < 20), case studies, skull base reconstructions, and local tissue rearrangements. The combined results of the studies and relative risks (RR) were calculated. RESULTS 53 studies were included for analysis, including 5,086 free flaps in an irradiated field, and 9,110 free flaps in a non-irradiated field. Of the 53 studies, 21 studies overlapped with those discussed in Herle et al.'s study, with a total of 32 additional studies. Neoadjuvant radiation was found to be a statistically significant risk factor for postoperative complications (RR 1.579, P < 0.001), total flap failure (RR, 1.565; P < 0.001), and fistula (RR, 1.810; P < 0.001). Our work reaffirmed the findings of the Herle et al. STUDY CONCLUSION Preoperative radiation was associated with a statistically significant increase in the risk of total flap failure, fistula, and total complications but not partial flap failure. These high-morbidity complications must be taken into consideration when determining which patients should receive neoadjuvant radiation therapy.
Collapse
Affiliation(s)
- Henry Miller
- Department of Surgery, Cooper University Hospital, Camden NJ, United States.
| | - Kathryn Bush
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Matthew Delancy
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Nicholas De Leo
- Department of Surgery, Cooper University Hospital, Camden NJ, United States
| | - Hansa Joshi
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Benjamin Saracco
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Amanda Adams
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - John Gaughan
- Cooper Research Institute, Cooper University Hospital, Camden NJ, United States
| | - Steven Bonawitz
- Department of Surgery, Cooper University Hospital, Camden NJ, United States
| |
Collapse
|
8
|
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>
Collapse
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
| |
Collapse
|
9
|
Iyer H, Joharifard S, Le-Nguyen A, Dubois J, Ghali R, Borsuk DE, Lallier M. Microsurgical and Endovascular Management of Congenital Iliac Aneurysms in the Neonatal Period: Two Cases and a Literature Review. EJVES Vasc Forum 2021; 52:41-48. [PMID: 34522908 PMCID: PMC8424503 DOI: 10.1016/j.ejvsvf.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Congenital aneurysms of major arteries are very rare diagnoses and prognosis can be poor if treatment is not initiated rapidly. This is the presentation of two cases of infants with congenital iliac aneurysms who underwent treatment in the neonatal period. The report then proceeds with a literature review of paediatric iliac aneurysms. Report Case 1: A female neonate was diagnosed antenatally with right common iliac (CIA) and internal iliac (IIA) artery aneurysms. Embolisation on day of life (DOL) eight was impossible because of partial thrombosis. The infant was subsequently observed for several months and the aneurysm was injected percutaneously with thrombin on DOL 78. A small residual aneurysm was coil embolised at five months of age. Satisfactory results were observed at one year follow up. Case 2: A female neonate was diagnosed antenatally on routine third trimester ultrasound with voluminous, bilateral CIA aneurysms. The patient underwent surgery on DOL 9 for aneurysm resection and microsurgical vascular reconstruction. The intervention was successful with triphasic flow through the anastomoses on colour Doppler ultrasound at six week follow up. Discussion Ten cases of congenital iliac aneurysms have been reported previously, with just two diagnosed in the neonatal period and eight undergoing surgical intervention. Definitive management to avoid aneurysm rupture or thrombosis should be timed carefully, and sometimes delayed with watchful waiting, to maximise success and minimise complications. Surgery is the key treatment modality, but endovascular intervention can be considered in selected cases. Congenital iliac aneurysms should be addressed at the safest time for the patient. Following resection, primary microvascular anastomosis is the ideal reconstructive technique, but other options for neonates have been described. Endovascular treatment should be considered for anatomically amenable saccular aneurysms.
Collapse
Affiliation(s)
- Hari Iyer
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Shahrzad Joharifard
- Department of Surgery, Division of Paediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Annie Le-Nguyen
- Department of Surgery, Division of General Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Josée Dubois
- Department of Radiology, Radiation-Oncology and Nuclear Medicine, Division of Paediatric Interventional Radiology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Rafik Ghali
- Department of Surgery, Division of Vascular Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Daniel E Borsuk
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Michel Lallier
- Department of Surgery, Division of Paediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| |
Collapse
|
10
|
Tanaka K, Suesada N, Homma T, Mori H, Okazaki M. Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes. J Reconstr Microsurg 2021; 38:41-46. [PMID: 34187061 DOI: 10.1055/s-0041-1729883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although there are several potential recipient vessels in the neck, those in the temporal region are limited. In skull base reconstruction, there are difficulties associated with the anastomosing recipient vessels in the neck region since long nutrient vessels are needed in the flap. We evaluated the reliability of temporal vascular anastomosis by comparing surgical outcomes between reconstructive methods and examined which surgical procedures may achieve better results. METHODS We examined the medical records of free tissue transfer cases between April 2007 and March 2018. Seventy-three surgeries were performed in the temporal region, including skull base reconstruction in 48, head and neck reconstruction (without skull base) in 16, and secondary surgery for head deformities in nine cases. In total, 445 neck surgeries were performed. Postoperative complications were retrospectively analyzed. RESULTS The postoperative complication rates were 8.2 and 2.7% for all temporal and neck surgeries, respectively. There were no arterial complications in the temporal region and all of the six postoperative anastomotic complications were due to venous thrombosis. In contrast, there were 12 cases of vascular anastomotic complications, with six cases each of arterial and venous thrombosis in the neck. In the temporal region, the complication rate was 2.1% for skull base reconstruction, 11% for secondary revision, and 25% in head and neck reconstruction. The corresponding values for middle temporal vein (MTV) usage rates were 54, 22, and 25%. In skull base reconstruction, a coronal incision was made in all cases. A more frequent use of the MTV was associated with a reduced complication rate. CONCLUSION The low complication rate in the temporal region was attributed to the wide surgical field and low tension of anastomotic vessels. Multiple venous anastomoses, including those of the MTV, are recommended to prevent complications.
Collapse
Affiliation(s)
- Kentaro Tanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuko Suesada
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsutomu Homma
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
11
|
Sievert M, Koch M, Goncalves M, Richter D, Tamse R, Mueller SK, Gostian AO, Traxdorf M, Harréus U, Iro H. [Thrombosis of sewn vs. coupled anastomoses in microvascular head and neck reconstructions]. Laryngorhinootologie 2020; 100:453-459. [PMID: 32927485 DOI: 10.1055/a-1253-8392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The Anastomotic Coupling Device for microvascular anastomoses has become widely used in free tissue transplantation. This study compares the thrombosis rate and flap failure as a function of the anastomosis technique at a large head and neck cancer center. MATERIAL AND METHODS Retrospective analysis of all patients receiving free flap reconstructions in the period 2001-2019. Reconstruction type, recipient vessels, number of venous anastomoses, coupler size, and operation time were investigated. We compared the rates of venous thrombosis between hand sewn and coupled anastomoses, as well as the rate of flap failure. RESULTS A total of 403 free flap reconstructions were performed for over 17 years. The venous anastomosis was sewn in 113 flaps in single suture technique, and in 290 cases, coupler device was used. The rate of venous thrombosis requiring immediate surgical revision was 6.2 % (7/113) in the sewn group compared to 7.6 % in the coupled group (22/290; p = 0.627). With an overall success rate of 95.0 % (383/403), the rate of flap failure was 3.6 % (4/113) and 5.5 % (16/290; p = 0.421), respectively. Surgical time is comparable with 680 ± 144 minutes in the hand-sewn group and 688 ± 167 minutes in the coupled group (p = 0.678). CONCLUSIONS With similar success rates, the coupler device is an effective alternative to venous anastomosis in single suture technique. Due to the generally low rate of pedicle thrombosis in both groups, we cannot separate the influence of the anastomosis technique from possible interfering variables.
Collapse
Affiliation(s)
- Matti Sievert
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Michael Koch
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Miguel Goncalves
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Daniel Richter
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Rosalie Tamse
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Sarina K Mueller
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Antoniu-Oreste Gostian
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Maximilian Traxdorf
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Uli Harréus
- Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Gesichtschirurgie, Asklepios-Stadtklinik Bad Tölz, Deutschland
| | - Heinrich Iro
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| |
Collapse
|