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Han SH, Kim YC, Kwon TK, Lee DY. Cumulative sum analysis for the learning curve of free flap reconstruction in head and neck cancer patients. Clin Exp Otorhinolaryngol 2022; 15:177-182. [PMID: 35249319 PMCID: PMC9149234 DOI: 10.21053/ceo.2021.01053] [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: 06/03/2021] [Accepted: 09/02/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Owing to the functional and structural complexity of the head and neck area, the reconstruction of defects in these areas is challenging. Free flap surgery has become standard for the reconstruction of the head and neck with improvements in microvascular surgery. The aim of this study was to use the cumulative sum (CUSUM) method to evaluate the learning curve for free-flap head and neck reconstruction performed by a single surgeon. Methods We retrospectively reviewed the medical records of 47 patients who underwent free-flap reconstruction from 2017 to 2021. The clinical demographics and surgical outcomes were analyzed. The total operation time was analyzed using the CUSUM method, which is an analytical approach for visualizing patterns in data by converting raw data into an accumulation of deviations from the average value. Results CUSUM analysis showed two phases of the learning curve: phase 1 (cases 1–22) and phase 2 (cases 23–47). The operative time in phase 1 (579.9±128.2 minutes) was significantly longer than that in phase 2 (418.6±80.9 minutes) (P<0.001). The re-exploration rate was higher in phase 1 (31.8%) than in phase 1 (4%) (P=0.018). The flap failure rate was higher in phase 1 (9.1%) than in phase 1 (4%), but this difference was not statistically significant (P=0.593). Conclusion The learning curve of free-flap head and neck reconstruction seems to stabilize after approximately 20 cases.
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Zhu WY, Choi WS, Wong MCM, Pu JJ, Yang WF, Su YX. The Learning Curve of Computer-Assisted Free Flap Jaw Reconstruction Surgery Using 3D-Printed Patient-Specific Plates: A Cumulative Sum Analysis. Front Oncol 2021; 11:737769. [PMID: 34604076 PMCID: PMC8481918 DOI: 10.3389/fonc.2021.737769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022] Open
Abstract
Background Computer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution. Methods In a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis. Results From December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p < 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively. Conclusion Our results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8–17 cases.
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Affiliation(s)
- Wang-Yong Zhu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Wing Shan Choi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - May Chun Mei Wong
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Wei-Fa Yang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
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3
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Is Brachytherapy Feasible After Head and Neck Cancer Reconstructive Surgery? Preliminary Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractThe purpose of the study was to evaluate the influence of interstitial postoperative brachytherapy for the vitality and quality of flaps used for reconstruction of tissue defects after head and neck cancer salvage resection. We aimed at presenting six consecutive patients with recurrent squamous cell carcinoma in head and neck region who underwent salvage surgery and tissue reconstruction with a regional or free flap followed by brachytherapy. Reconstruction was performed with a free radial forearm flap in 2 cases, with a free thigh flap in 2 cases, and with a myocutaneous lateral upper arm flap in the next 2 cases. In all patients, pulsed-dose-rate brachytherapy was used with a median value of 0.7 Gy (range 0.6–0.8 Gy) per pulse and a median total dose of 20 Gy (range 20–40 Gy). In the analyzed group, there were no serious wound and flap complications after brachytherapy. In one case, peripheral skin necrosis was noticed. No revision surgery was needed but only surgical debridement of the necrotic margins. All wounds healed within 14 days after surgery as well as donor sites which healed within 4 weeks. Based upon our data, pulsed-dose-rate brachytherapy seems to be a safe option that can be performed at the site of reconstruction in immediate postoperative period with minimal wound complications and with no impact on flap survival. Further clinical study based on larger patient series is needed to present statistically proven results.
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Xu S, Wang K, Liu K, Liu Y, Huang Y, Zhang Y, Wang X, Xu Z, Liu S, Liu J. Predictive Nomogram for the Necessity of Tracheotomy During Oral and Oropharyngeal Cancer Surgery. Laryngoscope 2020; 131:E1489-E1495. [PMID: 33016340 DOI: 10.1002/lary.29121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/23/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The individualized risk of airway obstruction after head and neck cancer surgery is unclear, especially oral and oropharyngeal cancer. The study aimed to establish an individualized predictive model for the necessity of temporary tracheotomy in these patients. METHODS Patients who underwent oral and oropharyngeal cancer surgery from 1999 to 2019 were retrospectively reviewed. A nomogram was developed and validated in patients treated from 1999 to 2009 and 2010 to 2019, respectively. RESULTS In total, 1551 patients were included. Oropharyngeal cancer, large tumor, midline crossing, preoperative radiation, mandibulectomy, flap reconstruction, and neck dissection were independent risk factors of postoperative airway obstruction in the training group (n = 707). A nomogram incorporating these factors had a C-index of 0.931 and was validated in the testing group (n = 844) (C-index, 0.918). Good calibration curves were observed in both groups. CONCLUSIONS The nomogram successfully predicted the individual risk of postoperative airway obstruction for patients with oral and oropharyngeal cancer. LEVEL OF EVIDENCE 4. Laryngoscope, 131:E1489-E1495, 2021.
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Affiliation(s)
- Siyuan Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kai Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kan Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ying Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye Zhang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhengang Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Ban MJ, Na G, Ko S, Kim J, Heo NH, Choi EC, Park JH, Kim WS. Externally Monitored Versus Conventional Buried Flaps in Laryngopharyngeal Reconstruction. Clin Exp Otorhinolaryngol 2020; 14:407-413. [PMID: 32900154 PMCID: PMC8606284 DOI: 10.21053/ceo.2020.00234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps. Methods In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups. Results The mean operative time for reconstruction was 115 minutes (interquartile range, 85–150 minutes) and 142 minutes (interquartile range, 95–180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18–30 days) and 27 days (interquartile range, 20–41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15–21 days) and 18 days (interquartile range, 15–34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases. Conclusion The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.
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Affiliation(s)
- Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Gina Na
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sungchul Ko
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Joohyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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Lin P, Kuo P, Kuo SCH, Chien P, Hsieh C. Risk factors associated with postoperative complications of free anterolateral thigh flap placement in patients with head and neck cancer: Analysis of propensity score‐matched cohorts. Microsurgery 2020; 40:538-544. [DOI: 10.1002/micr.30587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/26/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Pi‐Chieh Lin
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Pao‐Jen Kuo
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Spencer C. H. Kuo
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Peng‐Chen Chien
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Ching‐Hua Hsieh
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
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Lin Y, He JF, Zhang X, Wang HM. Intraoperative factors associated with free flap failure in the head and neck region: a four-year retrospective study of 216 patients and review of the literature. Int J Oral Maxillofac Surg 2019; 48:447-451. [DOI: 10.1016/j.ijom.2018.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 12/15/2022]
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8
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Is the Medial Sural Artery Perforator Flap a New Workhorse Flap? A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019; 143:393e-403e. [DOI: 10.1097/prs.0000000000005204] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Marttila E, Thorén H, Törnwall J, Viitikko A, Wilkman T. Complications and loss of free flaps after reconstructions for oral cancer. Br J Oral Maxillofac Surg 2018; 56:835-840. [DOI: 10.1016/j.bjoms.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE To report the case of a 68-year-old woman with a skin basal cell carcinoma on the nasal dorsum. After excision, the soft tissue defect was reconstructed using a rectangular advancement flap. However, 2 days later skin necrosis was observed. This report was issued to advise how to avoid and manage skin necrosis after regional flap placement. METHODS This is a retrospective study. RESULTS Superficial skin necrosis recovered completely after proper medical management. CONCLUSIONS When planning an advancement flap, care should be taken to design the flap properly and not to injure flap blood supply to avoid skin necrosis. In addition, surgeons should be aware of the difference between superficial and total flap necrosis.
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11
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Yao Z, Huang K, Luo S, Sun L, Zhou H, Wu S, Xiao J. [Reconstruction of oral and maxillofacial soft tissue defects with anterolateral thigh (myocutaneous) flap assisted by computed tomography angiography]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:702-708. [PMID: 29798652 DOI: 10.7507/1002-1892.201612132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects. Methods Between January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T 2N 0M 0, 3 cases as T 2N 1M 0, 1 case as T 2N 2M 0, 4 cases as T 3N 0M 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, 2 cases as T 4N 1M 0, and 1 case as T 4N 2M 0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly. Results CTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N 1M 0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation. Conclusion The anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.
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Affiliation(s)
- Zhihao Yao
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Kui Huang
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Shihong Luo
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Libo Sun
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Hangyu Zhou
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Shuangjiang Wu
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Jingang Xiao
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000,
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Free tissue flaps in head and neck reconstruction: clinical application and analysis of 93 patients of a single institution. Braz J Otorhinolaryngol 2017; 84:416-425. [PMID: 28571928 PMCID: PMC9449187 DOI: 10.1016/j.bjorl.2017.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/25/2017] [Accepted: 04/15/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates. Objective To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions. Methods This was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients’ demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed. Results The patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up. Conclusion Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.
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13
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Weckx A, Loomans N, Lenssen O. Perforator free flaps in head and neck reconstruction: a single-center low-volume experience. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:429-435. [DOI: 10.1016/j.oooo.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/05/2016] [Accepted: 11/25/2016] [Indexed: 11/25/2022]
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Cherubino M, Turri-Zanoni M, Battaglia P, Giudice M, Pellegatta I, Tamborini F, Maggiulli F, Guzzetti L, Di Giovanna D, Bignami M, Calati C, Castelnuovo P, Valdatta L. Chimeric anterolateral thigh free flap for reconstruction of complex cranio-orbito-facial defects after skull base cancers resection. J Craniomaxillofac Surg 2016; 45:87-92. [PMID: 27919596 DOI: 10.1016/j.jcms.2016.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 09/26/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022] Open
Abstract
Complex cranio-orbito-facial defects after skull base cancers resection entail a functional and esthetic reconstruction. The introduction of endoscopic assisted techniques for excision surgery with the advances in reconstructive surgery and anesthesiology allowed to improve the management of such critical patients. We report a series of chimeric anterolateral thigh (ALT) flaps used to reconstruct complex cranio-orbital-facial defects after skull base surgery. A retrospective review of patients that underwent cranio-orbito-facial reconstruction using a chimeric ALT flap from March 2013 to October 2015 at a single tertiary care referral Institute was performed. All patients were affected by locally-advanced malignant tumor and the resulting defects involved the skull base in all cases. The ALT flaps were perforator-based flaps with different components: fascia, skin and muscle. The different flap territories had independent vascular supply and were independent of any physical interconnection except where linked by a common source vessel. Ten patients were included in the study. Three patients underwent adjuvant radiotherapy and to chemotherapy. The mean hospitalization time was 21 days (range, 8-24 days). One failure was observed. After a mean follow-up of 12.4 months, 3 patients died of the disease, 2 are alive with disease, while 5 patients (50%) are currently alive without evidence of disease. Chimeric ALT flap is a reliable and versatile reconstructive option for complex cranio-orbito-facial defects resulting from skull base surgery. The chimeric flap composed of different territories proved to be adequate for a patient-tailored three-dimensional reconstruction of the defects as well as able to resist to the postoperative adjuvant treatments.
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Affiliation(s)
- Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy.
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Marco Giudice
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Igor Pellegatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Federico Tamborini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Francesca Maggiulli
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Luca Guzzetti
- Division of Anaesthesia, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy.
| | - Danilo Di Giovanna
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Carolina Calati
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
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Karimi E, Ardestani SHS, Jafari M, Hagh AB. Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers. Clin Exp Otorhinolaryngol 2016; 9:370-373. [PMID: 27337950 PMCID: PMC5115141 DOI: 10.21053/ceo.2015.01781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/04/2016] [Accepted: 01/27/2016] [Indexed: 11/24/2022] Open
Abstract
Objectives Free flaps are widely used to reconstruct head and neck defects. Despite the improvement in the surgical techniques and the surgeons’ experiences, flap failures still occur due to thrombotic occlusion after small vessels anastomosis. To reduce the possibility of flap loss as a result of thrombotic occlusion, various anticoagulants have been used. In this study we decided to evaluate a new protocol for anticoagulation therapy and its effect on flap survival and complications. Methods In this interventional study, 30 patients with head and neck cancer underwent surgical defects were reconstructed by microvascular free flap between 2013 and 2014. In the postoperative period patients have taken aspirin (100 mg/day) for 5 days and enoxaparin (40 mg/day subcutaneously) for 3 days. The flap survival was followed for three weeks. Results Given that there was no complete necrosis or loss of flap, the free flap success rate was as much as 100%. The need for re-exploration occurred in 3 patients (10%). Only in one patient the need for re-exploration was due to problem in venous blood flow. Conclusion The aspirin-enoxaparin short-term protocol may be a good choice after free flap transfer in reconstruction of head and neck surgical defects.
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Affiliation(s)
- Ebrahim Karimi
- Department of Otolaryngology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehrdad Jafari
- Otolaryngology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Bagheri Hagh
- Department of Otolaryngology, Baqiyatallah University of Medical Sciences, Tehran, Iran
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