Factors influencing survival of free‐flap in reconstruction for cancer of the head and neck: A literature review

Abstract

Microvascular free tissue transfer is a reliable technique for head and neck reconstruction with success rates of 90–99%. Currently, there is no consensus concerning antithrombotic agents, antibiotics, or monitoring techniques. Therefore, the aim of this study was to review current literature dealing with microvascular free‐tissue transfer and factors influencing the outcome. In addition to excellent microsurgical techniques, coupling devices are a promising new technique, but are not useful in all arteries. Antibiotics should be given in three doses, as a more lengthy dosage time seems to have no advantage. The risk for elderly patients can be best assessed by the American Society of Anesthesiologists (ASA) score, but early mobilization, including intense chest physiotherapy, is important. Anticoagulation can be considered in cases of small vessels, significant size mismatch, vein graft, or vessels of poor quality. Monitoring should be done hourly during the first 24 hours and then every 4 hours for the next 2 postoperative days. © 2010 Wiley‐Liss, Inc. Microsurgery, 2010.

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

“…However, the validity of these risk factors is controversial in the current literature [7,[25][26][27]. Our study also demonstrated a significantly lower rate of SSI in patients treated with penicillins and a significantly higher rate of SSI in patients treated with clindamycin.…”

“…Nevertheless, the complications associated with free flap reconstruction can be devastating [6][7][8]. Surgical site infection (SSI), one of the most common complications, may lead to vessel thrombosis and, eventually, to flap loss [6].…”

Microsurgical Reconstruction of the Oral Cavity and Oropharynx After Cancer Ablation

“…In this setting, the transfer of healthy tissue with a reliable blood supply is of major significance for improving healing. The impact of radiotherapy on flap success rate seems to be negligible (Kruse et al, 2010). The addition of chemotherapy to radiotherapy in the adjuvant treatment doesn't have a significant impact on the success rate, with results comparable to that after radiotherapy alone (Kostrzewa et al, 2010).…”

Intra and postoperative evaluations of microcirculation and micro-rheological parameters in a rat model of musculocutaneous flap ischemia-reperfusion

“…Reconstruction of large defects on the body requires flap surgeries [1][2][3] . The method of choice for reconstructive surgery is always depending on the region involved; however the common interest of such procedures is the flap survival rate 1,4 .…”

“…The method of choice for reconstructive surgery is always depending on the region involved; however the common interest of such procedures is the flap survival rate 1,4 . Intraoperative and postoperative monitoring of the microcirculation is a reliable tool for assessment of flap viability after an unavoidable ischemiareperfusion (I/R) injury 5,6 .…”