Identifying perioperative volume-related risk factors in head and neck surgeries with free flap reconstructions – An investigation with focus on the influence of red blood cell concentrates and noradrenaline use

Grill, F; Wasmaier, Maria; Mücke, Thomas; Ritschl, Lucas M.; Wolff, Klaus‐Dietrich; Schneider, Gerhard; Loeffelbein, Denys J.; Kadera, Vojta

doi:10.1016/j.jcms.2019.12.001

Cited by 17 publications

(17 citation statements)

References 32 publications

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“…ASA score and duration of the operation were found to be independent risk factors for operative revisions [ 76 ]. In literature, ASA-Rating is correlated with a higher number of postoperative complications after microvascular reconstructions [ 80 , 81 ] and the overall survival [ 82 ]. We calculated the relation between ‘Age at flap transfer’ and BMI and found an evenly distributed pattern.…”

Section: Discussionmentioning

confidence: 99%

Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years

Knitschke

Sonnabend

Bäcker

et al. 2021

Cancers

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Fibula free flap (FFF) is widely used in head and neck reconstructive surgery and is considered as a standard and therapy of choice after ablative cancer surgery. The aim of this retrospective monocenter study was to determine the success rates of fibula free flaps for jaw reconstruction after ablative tumor surgery. The disease course of patients who underwent jaw reconstructive surgery with FFF from January 2002 to June 2020 was evaluated regarding the flap success rate. Flap failure was analyzed in detail and categorized into two groups: partial flap failure (PFF) and total flap failure (TFF). A total of 180 free fibular flaps were performed over the last 19 years and a total of 36 flap failures were recorded. TFF occurred in n = 20 (56.6%) and PFF in n = 16 cases (44.4%) cases. No statistically significant differences were found concerning patients’ age at flap transfer, sex, BMI, ASA-Score, preoperative non-virtual or virtual surgical planning (non-VSP vs. VSP), and time of reconstruction (immediately vs. delayed). Duration of hospitalization shows statistically significant differences between both groups (p = 0.038), but no differences concerning operating time and duration on Intensive Care Unit (ICU). Partial flap failure appears to be underreported in literature. Sub- and complete failure of the skin paddle leads to clinical complaints like uncovered bone segments and plate exposure. Partial or complete FFF failure lead to infections on the recipient site and prolonged wound healing and therefore may cause a delay of the beginning of adjuvant radiation therapy (RT). PFF of hard tissue can be induced by RT.

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Section: Discussionmentioning

confidence: 99%

Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years

Knitschke

Sonnabend

Bäcker

et al. 2021

Cancers

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“…The latter parameter is a well-known, susceptible variable for NAM therapy in cases of BCLP. 14 , 27 , 28 Garfinkle et al 11 reported a long-term stability of their good results through to the age of 12 years. We did not include the columella length in this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…This parameter is nevertheless known to be positively influenced by NAM treatment, especially in cases of BCLP. 11 , 27 Suri et al 29 reported that infants who received NAM therapy had longer columella and better-aligned alveolar segments than those who received only feeding plate therapy. In their study, other nostril dimensions were not significantly different, comparable to our results.…”

Section: Discussionmentioning

confidence: 99%

“…But regarding this not negligible aspect of treatment in young patients with CLP, we have already described our experiences previously with the time of analysis at the end of NAM therapy. 14 , 27 Lastly, a potential treatment bias might be evident in the analyzed patients because of the parents’ decision-making, considering the financial implications of such treatment. In Germany, NAM therapy is not (fully) covered by the health insurance providers.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Photographic, Retrospective Analysis of Nonsyndromic Cleft Noses Treated with or without NAM

Wolff

Grill

Ritschl

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Long-term results and efficacy of nasoalveolar molding (NAM) on the perinasal region are reported controversially in the literature. With this study, we demonstrate our experiences, contribute to the ongoing discussion, and describe our decision-making when NAM is indicated or not. Methods: Conventional pre- and postinterventional photographs of patients with nonsyndromic unilateral and bilateral cleft lip and palate (UCLP and BCLP) were analyzed. The 2 independent raters were blinded to therapy (NAM versus non-NAM), and 7 parameters were measured. Intraclass correlation coefficient for intra- and interrater reliability was calculated. The Mann–Whitney U test was performed to compare therapy- and appearance-matched pairs. Finally, 30 specialists in cranio-maxillofacial surgery performed a subjective, blinded rating of matched NAM and non-NAM cases. Results: Thirty-six patients, 16 UCLP and 20 BCLP, were enrolled. The intraclass correlation coefficients for intra- and interrater reliability were excellent for all measurements, except for nasal sill (0.77 intrarater and 0.80 interrater). Height-to-width ratio (P = 0.012) was significantly different in the comparison of non-NAM and NAM-treated severe cases with UCLP. Thirty blinded raters evaluated NAM-treated cases with severe UCLP better than matched non-NAM cases. Non-NAM-treated cases with moderate UCLP and BCLP were rated better than matched NAM cases. Conclusions: Children with severe UCLP may benefit from NAM therapy in the sense of better symmetry and a more homogenous appearance. Patients with moderate UCLP and BCLP did not benefit, and the risk of the burden of care increased.

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“…5,20 Others reported that colloids are safe to use in flap surgery. 14,21,22 Fluid resuscitation using small volumes may be insufficient to correct hypotension, resulting in an increased risk for complications, especially in patients with preoperative comorbidities. 13,23 An individualized GDFT can therefore be a beneficial fluid management strategy in autologous breast reconstructions.…”

Section: Fluid Resuscitationmentioning

confidence: 99%

Liberal versus Modified Intraoperative Fluid Management in Abdominal-flap Breast Reconstructions. A Clinical Study

Sjöberg

Numan

Weerd

2021

Plastic and Reconstructive Surgery - Global Open

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Background: The outcome of reconstructive microsurgery is influenced by the intraoperative anesthetic regimen. The aim of this study was to compare the impact on the intra- and postoperative complication rates of our modified fluid management (MFM) protocol with a previously used liberal fluid management protocol in abdominal-flap breast reconstructions. Methods: This retrospective study analyzed adverse events related to secondary unilateral abdominal-flap breast reconstructions in two patient cohorts, one with a liberal fluid management protocol and one with a MFM protocol. In the MFM protocol, intravenous fluid resuscitation was restricted and colloid use was minimized. Both noradrenaline and propofol were implemented as standard in the MFM protocol. The primary endpoints were surgical and medical complications, as observed intraoperatively or postoperatively, during or shortly after the hospital stay. Results: Of the 214 patients included in the study, 172 patients followed the MFM protocol. Prior radiotherapy was more frequent in the MFM protocol. Surgical procedures to achieve venous superdrainage were more often used in the MFM cohort. Intraoperative as well as postoperative complications occurred significantly more frequently in the liberal fluid management cohort and were specifically associated with partial and total flap failures. Prior radiotherapy, additional venous drainage, or choice of inhalation agent did not have an observable impact on outcome. Conclusions: The incidence of adverse events during and after autologous breast reconstructive procedures was reduced with the introduction of an MFM protocol. Strict intraoperative fluid control combined with norepinephrine and propofol was both beneficial and safe.

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Identifying perioperative volume-related risk factors in head and neck surgeries with free flap reconstructions – An investigation with focus on the influence of red blood cell concentrates and noradrenaline use

Cited by 17 publications

References 32 publications

Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years

Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years

Comparative Photographic, Retrospective Analysis of Nonsyndromic Cleft Noses Treated with or without NAM

Liberal versus Modified Intraoperative Fluid Management in Abdominal-flap Breast Reconstructions. A Clinical Study

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