Analytic Review of 2372 Free Flap Transfers for Head and Neck Reconstruction Following Cancer Resection

Nakatsuka, Takashi; Harii, Kiyonori; Asato, Hirotaka; Takushima, Akihiko; Ebihara, Satoshi; Kimata, Yoshihiro; Yamada, Atsushi; Ueda, Kazuki; Ichioka, Shigeru

doi:10.1055/s-2003-42630

Cited by 310 publications

(257 citation statements)

References 19 publications

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“…With the development of improved optic microscopes and fine instruments and devices for microsurgery, the patency rates of anastomosed vessels have reached more than 90% and consequently, flap survival has become the norm. 12) In general, microvascular anastomoses are performed by conventional hand suturing. 12,15) Under microscopic vision, the vessel ends of the donor site are freshened by recutting the edges and removing the adventitia 2 mm from the ends, and then the vessels are anastomosed with 9-0 or 10-0 nylon combined knotting with running microsutures to the artery and vein on the recipient side.…”

Section: Microvascular Anastomosesmentioning

confidence: 99%

“…10) Recent progress in vascular surgery techniques has made it possible to develop head and neck reconstruction using free tissue transfer for defects after surgical resection. 11,12) The advantages of free tissue transfer are to avoid the limitations of pedicle length and also to enable selection of the most appropriate tissue to replace surgical defects. At present, free tissue transfer is the standard approach for head and neck reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Current Reconstructive Techniques Following Head and Neck Cancer Resection Using Microvascular Surgery

Kanazawa

Sarukawa

Fukushima

et al. 2011

Annals of Vascular Diseases

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Various techniques have been developed to reconstruct head and neck defects following surgery to restore function and cosmetics. Free tissue transfer using microvascular anastomosis has transformed surgical outcomes and the quality of life for head and neck cancer patients because this technique has made it possible for surgeons to perform more aggressive ablative surgery, but there is room for improvement to achieve a satisfactory survival rate. Reconstruction using the free tissue transfer technique is closely related to cardiovascular surgery because the anastomosis techniques used by head and neck surgeons are based on those of cardiovascular surgeons; thus, suggestions from cardiovascular surgeons might lead to further development of this field. The aim of this article is to present the recent general concepts of reconstruction procedures and our experiences of reconstructive surgeries of the oral cavity, mandible, maxilla, oropharynx and hypopharynx to help cardiovascular surgeons understand the reconstructions and share knowledge among themselves and with neck surgeons to develop future directions in head and neck reconstruction.

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Section: Microvascular Anastomosesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current Reconstructive Techniques Following Head and Neck Cancer Resection Using Microvascular Surgery

Kanazawa

Sarukawa

Fukushima

et al. 2011

Annals of Vascular Diseases

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“…Infection particularly from contaminated fungating tumors is a major problem [20,37]. We have four cases of pseudomona that contributed to flap failure within a very short period of time highlighted in Figure 5.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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“…Free flap transfers have proved highly effective in the reconstruction of complex defects in the head and neck region [1][2][3][4][5][6][7]. Despite excellent results, postoperative thrombosis does occur and, although infrequent, causes total loss of the flap.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Anastomotic Thrombosis in 200 Head and Neck Free Flaps among Asian Patients

Makiguchi¹,

Hashikawa²,

Sugiyama³

et al. 2012

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Background: Despite excellent results from free flap transfers, postoperative thrombosis does occur and, although infrequent, causes total loss of the flap. We investigate the risk factors of anastomotic thrombosis in head and neck free flaps. Study Design, Subjects and Methods: A retrospective analysis was carried out on 200 consecutive free flaps applied to patients who underwent head and neck reconstruction. Multiple logistic regression analysis was conducted to identify risk factors of anastomotic thrombosis, taking into account twelve factors: diabetes, obesity, hypertension, hypertriglyceridemia, proteinuria, age, gender, smoking habit, habitual alcohol intake, previous chemotherapy and radiation, and hypercholesterolemia. Results: Hypertension, female gender, aging, and drinking habit were statistically significant risk factors of postoperative thrombosis. Conclusions: Our data suggest that four factors mentioned above are possible predictors of anastomotic thrombosis in free flaps used for head and neck.

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Analytic Review of 2372 Free Flap Transfers for Head and Neck Reconstruction Following Cancer Resection

Cited by 310 publications

References 19 publications

Current Reconstructive Techniques Following Head and Neck Cancer Resection Using Microvascular Surgery

Current Reconstructive Techniques Following Head and Neck Cancer Resection Using Microvascular Surgery

Anatomy of Free Flap Failures: Dissection of a Series

Risk Factors of Anastomotic Thrombosis in 200 Head and Neck Free Flaps among Asian Patients

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