Donor site morbidity of composite free flaps in head and neck surgery: a systematic review of the prospective literature

Russell, Julie; Pateman, Kelsey; Batstone, Martin

doi:10.1016/j.ijom.2020.12.009

Cited by 19 publications

(9 citation statements)

References 27 publications

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“…Well‐documented risk factors known to correlate with free flap compromise including prior radiotherapy, smoking status, and bony reconstructions were present in both groups 32–35 . Donor site wound complication rates were similar for both groups and were in keeping with what has been previously described for this free flap donor region 36 . From a functional perspective, the DASH questionnaire showed no difference between the simultaneous or sequential flap harvest.…”

Section: Discussionsupporting

confidence: 82%

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

et al. 2021

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Background The scapula free flap is a versatile option in head and neck reconstruction but is less amenable to simultaneous harvest and ablation. Methods Retrospective series (2015–2021) of consecutive scapula flaps. Cases categorized as simultaneous versus sequential, compared for operative time, oncological and patient‐reported outcomes. Results Seventy consecutive scapula free flaps were performed (n = 21 simultaneous, n = 49 sequential). Mandible reconstruction was performed in 51.0% and 61.9% of sequential and simultaneous cases, respectively; 49.0% and 38.1% addressed bony maxillary defects. Simultaneous surgery reduced operative time by 37.9% (151 min, p < 0.00001) and there were fewer tracheostomies performed (p < 0.005). Rates of positive margins and free flap compromise were equivalent (n = 1, 4.8% vs. n = 2, 4.1%). There was no difference in patient‐reported outcomes. Conclusions This series demonstrates feasibility, efficacy, and outcomes of bony scapula reconstruction of maxillofacial defects comparing simultaneous and sequential approaches. Benefits of the two‐team approach are highlighted including decreased operative time.

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Section: Discussionsupporting

confidence: 82%

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

et al. 2021

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“…In the last two years, three systematic reviews were published summarizing the ndings regarding donorsite morbidity after head and neck reconstruction of the last 20 years 20,28,29 . Despite the abundance of existent publications, 21,34,38−50 only few studies are available, which investigate the impact of graft volume on donor-site morbidity after mandibular reconstruction using DCIA grafts 34,51,52 .…”

Section: Discussionmentioning

confidence: 99%

“…Chronic pain, gait disturbances and neurosensory de cits are only a few of the known adverse effects described in the context of DCIA graft reconstructions. 20,28,29 However, to date only few studies investigate donor-site morbidity after CAD/CAM driven DCIA graft harvesting. As CAD/CAM techniques have been in routine clinical use for only a decade and OSCC patients face limited long-term survival rates, data investigating the donor-site morbidity by physical follow-up is di cult to acquire.…”

mentioning

confidence: 99%

Orthopedic rehabilitation after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts – a cross sectional study

Brandenburg

Voss

Mischkowsky

et al. 2022

Preprint

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Background: Computer Assisted Design and Computer Assisted Manufacturing (CAD/CAM) has revolutionized oncologic surgery of the head and neck. A multitude of benefits of this technique has been described, but there are only few reports of donor site comorbidity following CAD/CAM surgery. Methods: This study investigated comorbidity of the hip following deep circumflex iliac artery (DCIA) graft raising using CAD/CAM techniques. A cross-sectional examination was performed to determine range of motion, muscle strength and nerve disturbances. Furthermore, correlations between graft volume and skin incision length with postoperative orthopedic rehabilitation were assessed using Spearman's rank correlation, linear regression and analysis of variance (ANOVA).Results: Fifteen patients with a mean graft volume of 21.2 ± 5.7 cm3 and a mean incision length of 228.0 ± 30.0 mm were included. Patients reported of noticeable physical limitations in daily life activities (12.3 ± 11.9 weeks) and athletic activities (38.4 ± 40.0 weeks in mean) following surgery. Graft volume significantly correlated with the duration of the use of walking aids (R = 0.57; p = 0.033) and impairment in daily life activities (R = 0.65; p = 0.012). The length of the scar of the donor-site showed a statistically significant association with postoperative iliohypogastric nerve deficits (F = 4.4, p = 0.037). Patients with anaesthaesia of a peripheral cutaneous nerve had a larger mean scar length (280 ± 30.0 mm) than subjects with hypaesthesia (245 ± 10.1 mm) or no complaints (216 ± 27.7 mm). Conclusions: Despite sophisticated planning options in modern CAD/CAM surgery comorbidity of the donor site following microsurgery is still a problem. This study is the first to investigate comorbidity after DCIA graft raising in a patient group treated exclusively with CAD/CAM techniques. The results indicate that a minimal invasive approach in terms of small graft volumes and small skin incisions could help to reduce postoperative symptomatology.Trial registration: Retrospectively registered at the German Clinical Trials Register (DRKS-ID: DRKS00029066); registration date: 23/05/2022.

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“…Current literature report controversial results regarding donor-site morbidity after harvesting of DCIA graft and is mostly based on retrospective reviews of medical records. Chronic pain, gait disturbances and neurosensory deficits are only a few of the known adverse effects described in the context of DCIA graft reconstructions [ 20 , 28 , 29 ]. However, to date only few studies investigate donor-site morbidity after CAD/CAM driven DCIA graft harvesting.…”

Section: Introductionmentioning

confidence: 99%

Donor site morbidity after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts: a cross sectional study

et al. 2023

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Background Computer Assisted Design and Computer Assisted Manufacturing (CAD/CAM) have revolutionized oncologic surgery of the head and neck. A multitude of benefits of this technique has been described, but there are only few reports of donor site comorbidity following CAD/CAM surgery. Methods This study investigated comorbidity of the hip following deep circumflex iliac artery (DCIA) graft raising using CAD/CAM techniques. A cross-sectional examination was performed to determine range of motion, muscle strength and nerve disturbances. Furthermore, correlations between graft volume and skin incision length with postoperative donor site morbidity were assessed using Spearman's rank correlation, linear regression and analysis of variance (ANOVA). Results Fifteen patients with a mean graft volume of 21.2 ± 5.7 cm3 and a mean incision length of 228.0 ± 30.0 mm were included. Patients reported of noticeable physical limitations in daily life activities (12.3 ± 11.9 weeks) and athletic activities (38.4 ± 40.0 weeks in mean) following surgery. Graft volume significantly correlated with the duration of the use of walking aids (R = 0.57; p = 0.033) and impairment in daily life activities (R = 0.65; p = 0.012). The length of the scar of the donor-site showed a statistically significant association with postoperative iliohypogastric nerve deficits (F = 4.4, p = 0.037). Patients with anaesthaesia of a peripheral cutaneous nerve had a larger mean scar length (280 ± 30.0 mm) than subjects with hypaesthesia (245 ± 10.1 mm) or no complaints (216 ± 27.7 mm). Conclusions Despite sophisticated planning options in modern CAD/CAM surgery, comorbidity of the donor site following iliac graft harvesting is still a problem. This study is the first to investigate comorbidity after DCIA graft raising in a patient group treated exclusively with CAD/CAM techniques. The results indicate that a minimal invasive approach in terms of small graft volumes and small skin incisions could help to reduce postoperative symptomatology. Trial registration Retrospectively registered at the German Clinical Trials Register (DRKS-ID: DRKS00029066); registration date: 23/05/2022

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Donor site morbidity of composite free flaps in head and neck surgery: a systematic review of the prospective literature

Cited by 19 publications

References 27 publications

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

Orthopedic rehabilitation after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts – a cross sectional study

Donor site morbidity after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts: a cross sectional study

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