Donor Site Morbidity and Quality of Life after Microvascular Head and Neck Reconstruction with a Chimeric, Thoracodorsal, Perforator-Scapular Flap Based on the Angular Artery (TDAP-Scap-aa Flap)

Abstract

Extensive defects in the head and neck area often require the use of advanced free flap reconstruction techniques. In this study, the thoracodorsal perforator-scapular free flap technique based on the angular artery (TDAP-Scap-aa flap) was postoperatively evaluated regarding the quality of life and the donor site morbidity using the standardized SF-36 and DASH questionnaires (short form health 36 and disabilities of the arm, shoulder and hand scores). Over a five-year period (2016–2020), 20 selected cases (n = 20) requiring both soft and hard tissue reconstruction were assessed. On average, the harvested microvascular free flaps consisted of 7.8 ± 2.1 cm hard tissue and 86 ± 49.8 cm2 soft tissue components. At the donor site (subscapular region), only a mild morbidity was observed (DASH score: 21.74 ± 7.3 points). When comparing the patients’ postoperative quality of life to the established values of the healthy German norm population, the observed SF-36 values were within the upper third (>66%) of these established norm values in almost all quality-of-life subcategories. The mild donor site morbidity and the observed quality of life indicate only a small postoperative impairment when using the TDAP-Scap-aa free flap for the reconstruction of extensive maxillofacial defects.

Innovations with the scapula and subscapular system for head and neck microvascular reconstruction

“…Decreased donor site morbidity, compared to a fibula flap, is a strength of the subscapular system [38,39] . Activities of daily living are not significantly impacted in patients undergoing scapula free flap reconstruction [29,40] (with the exception of physical quality of life impairments as measured by the UW-QoL physical domain) [38] . Disabilities of the arm, shoulder, and hand (DASH) questionaries completed 10-14 months after surgery had a mean score of 21.74 ± 7.30, which is significantly higher than a normal population but still lies within the very mild to mild rating of donor site morbidity [41] .…”

A review for non-antibiotic treatment of Helicobacter pylori: new insight

“…According to a recent thorough meta-analysis of 132 research (53,934 personyears) from 45 nations or regions, the global yearly reinfection rate of H. pylori was 3.1%, which has been generally consistent over the previous three decades but varied across different locations (Hu et al, 2017). One of the most important causes of treatment failure is multiple resistance to common drugs, which may repeat the course of treatment several times or use alternative drugs (Shah et al, 2021;Wallner et al, 2022). Some studies worldwide have shown that prevalence primary multidrug-resistant (MDR) H. pylori is increasing (Karbalaei et al, 2022).…”

The impact of COVID‐19 on oral squamous cell carcinoma's diagnostic stage—A retrospective study

“…This delay in tumor diagnosis is predominately affiliated to the difficulty the patient has in perceiving signs and symptoms and interpreting them as harmful (Panzarella et al, 2014). Advanced tumor stage, however, leads to an extended surgical resection requiring microvascular reconstruction, which is often followed by radio‐ and/or chemotherapy (Wallner et al, 2022). In these cases, an impaired 5‐year survival rate (e.g., positive N status) and therapy‐associated toxicities (e.g., xerostomia, impaired quality of life, and osteoradionecrosis) have to be considered when planning treatment (De Felice et al, 2014).…”

“…This delay in tumor diagnosis is predominately affiliated to the difficulty the patient has in perceiving signs and symptoms and interpreting them as harmful (Panzarella et al, 2014). Advanced tumor stage, however, leads to an extended surgical resection requiring microvascular reconstruction, which is often followed by radio-and/or chemotherapy (Wallner et al, 2022).…”

“…In future research projects, similar studies should be conducted in other countries to further evaluate the impact of the COVID-19 pandemic on oral health.The results of this study report the profound impact of the COVID-19 pandemic on TNM stage and tumor volume of OSCC over a 4-year timeframe. A more advanced T stage leads to more advanced surgical treatment (e.g., extended tumor resection, free flap reconstruction)(Wallner et al, 2022). When comparing the incidence of chemoradiotherapy in OSCC patients between the "pre-COVID-19" and the "COVID-19" group, a substantial increase in adjuvant radiotherapy following the onset of the pandemic was observed.…”