Analysis of Salvage Operation in Head and Neck Microsurgical Reconstruction

Abstract

In this study, we examined salvage operations after reexploration in head and neck reconstruction and analyzed ways to solve problems. Free flap reconstruction of the head and neck lesion was carried out for 513 cases in our hospital over the past 12 years. Twenty-one cases of reexploration were caused by postoperative thrombosis (4.1%). We could only salvage seven cases (33.3%) of 21 cases from flap thrombosis. All seven cases were included in the category of venous thrombosis, and they were undertaken within 3 days postoperatively. Our results have shown that once thrombosis occurs, there is little possibility of flap salvage, particularly 3 days after operation and in infectious cases. When no flow phenomena are observed and no flap salvage is deemed possible, aggressive treatment such as a second free flap or next pedicle flap should be chosen as soon as possible to avoid any delay in postoperative treatment.

Short‐stay hospital admission after free tissue transfer for head and neck reconstruction

“…However, in patients for whom airway compromise and fistula formation are less of a concern, discharge by postoperative day 3 may be a safe option. Overwhelmingly, the literature demonstrates that when free flaps fail, the majority do so within the first 48 to 72 hours; furthermore, chances at salvage are greatest during the first 3 days postoperatively . Patients included in this study were monitored until postoperative day 2 on average, at which point the greatest risk of flap failure had passed.…”

“…Overwhelmingly, the literature demonstrates that when free flaps fail, the majority do so within the first 48 to 72 hours; furthermore, chances at salvage are greatest during the first 3 days postoperatively. [17][18][19][20][21][22] Patients included in this study were monitored until postoperative day 2 on average, at which point the greatest risk of flap failure had passed. The single flap failure in this group occurred approximately 2 weeks out, at which point salvage was beyond consideration.…”

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

“…Mean re-exploration time for salvage cases was 1.3 days compared with 3.9 days for those not salvaged. (16) Kind et al (17) suggested that a miniature doppler ultrasonic probe attached directly to the outflow vein of the flap may lead to a significant improvement in the salvage rates of free flaps. They identified 20 instances of vascular compromise in 147 free flaps using this technique with a salvage rate of 100%.…”

Salvage surgery for oropharyngeal squamous cell carcinomas: A retrospective study from 2005 to 2013

“…The incidence of postoperative complications is high: between 45% and 53.6% of cases, with an occurrence that is correlated to the tumor stage . Functional sequelae are also frequent despite the progress that has been made in head and neck reconstruction . The complications resulting from prior radiotherapy are added to those resulting from the salvage surgery.…”

“…6,7 Functional sequelae are also frequent despite the progress that has been made in head and neck reconstruction. 8,9 The complications resulting from prior radiotherapy are added to those resulting from the salvage surgery. Therefore, due to the sequelae and a poor prognosis, the majority of patients do not recover their preoperative performance status.…”