Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

Lodders, Johannes N.; Parmar, S.; Stienen, Niki L.M.; Martin, Timothy J.; Karagozoglu, K.H.; Heymans, Martijn W.; Nandra, Baljeet; Forouzanfar, Tymour

doi:10.4317/medoral.20657

Cited by 24 publications

(16 citation statements)

References 25 publications

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“…Despite free flaps having good overall survival, complications are fairly common and are reported to be as high as 28%-50%. 3,4,[9][10][11] We found both early and late postoperative complications that required intervention in a quarter of the patients. The overall survival of all free flaps was 181/191(95%).…”

Section: Discussionmentioning

confidence: 84%

“…[3][4][5][6][7][8] However, despite good survival rates, overall free flap morbidity is reported to be as high as 28%-50%. 3,4,[9][10][11] Common failures of these flaps include thrombosis of the arterial or venous anastomosis, infection, development of a fistula, wound dehiscence, haematoma, and haemorrhage. 6,12,13 re-exploration to salvage the flap and prevent necrosis.…”

Section: Introductionmentioning

confidence: 99%

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Complications and loss of free flaps after reconstructions for oral cancer

Marttila

Thorén

Törnwall

et al. 2018

British Journal of Oral and Maxillofacial Surgery

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The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005-2010. The patients' clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n = 86, 45%) and the anterolateral thigh free flap (ALTFF) (n = 48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n = 25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41-50 years (p = 0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p = 0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Complications and loss of free flaps after reconstructions for oral cancer

Marttila

Thorén

Törnwall

et al. 2018

British Journal of Oral and Maxillofacial Surgery

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“…Other reported studies could not confirm the predictive value of tobacco use regardless of the negative influence tobacco use exerts on the general healing process. 9,22 Both operating time [12][13][14][15]23,24 and high age 5,9,10,12,25 are previously correlated with higher complications rates. Operating time partially reflects the complexity and extent of the surgical procedure and could explain the increased complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…31,32 Both factors have shown to be valuable predictors for postoperative complications and thus could be the key to reduce morbidity. [12][13][14][15]23,24 During our study, no kind of VSP was used; however, since 2013, we preoperatively bend the plate osteosynthesis on a three-dimensional printed mandible to facilitate reconstruction and reduce operating time. Although the qualitative results are optimistic regarding VSP, robust evidence is lacking regarding quantifiable outcomes such as flap fail, postoperative complications, and hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Complications and Risk after Mandibular Reconstruction with Fibular Free Flaps in Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study

Lodders

Schulten

Visscher

et al. 2016

J reconstr Microsurg

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Background We retrospectively analyzed the incidence and types of postoperative complications after mandibular continuity reconstructions with fibular free flaps (FFF) in patients with oral squamous cell carcinoma (OSCC) and identified potential risk factors for postoperative complications. Methods Data were retrieved from the medical records in the Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands from April 1995 to September 2013, and were statistically analyzed. Results In this study, 85 patients were included in whom 86 FFFs were used for mandibular reconstruction. Thirty-seven patients (43%) developed ≥ 1 surgical complication and 9 patients (10.5%) developed ≥ 1 systemic complication. Three patients (3.5%) developed total flap failure and six patients (7.0%) developed partial flap failure. Surgical complications were correlated with tobacco use, partial glossectomy, type of mandibular defect, and anatomic staging. Systemic complications were associated with age > 60 years and Charlson comorbidity index > 2. Hospitalization > 30 days was associated with type of mandibular defect. Conclusions The use of the FFF for reconstructing mandibular continuity defects in OSCC patients may be associated with postoperative complications. Patients with coexisting medical conditions and anterior mandibular defects have an increased risk for developing complications. Patients who undergo segmental mandibular resection including a partial glossectomy could have a reduced risk for complications.

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“…Based on the availability of a long pedicle with a suitable vessel diameter, low donor site morbidity and versatility in design the ALT flap is favored for reconstructive microsurgery. Its adoption ranges from reconstruction of the head and neck, upper and lower extremities, and the trunk and breast (7)(8)(9)(10)(11), and momentum is gathering on the use in tongue reconstruction (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

et al. 2019

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Introduction: Surgery to resect intra-oral malignancy is a well-established mode of primary treatment. The tissue requirement in this area is for a thin, pliable flap with minimal bulk and this has historically been provided by free tissue transfer with a radial forearm free flap (RFFF). More recently, a role for the anterolateral thigh free flap (ALTFF) has been described, although in populations with a westernized diet, body habitus may preclude use of an ALTFF due to flap thickness, relative to a radial forearm free flap. Methods: An analysis of data was performed retrospectively for 90 consecutive patients with intra-oral malignancy, requiring immediate soft tissue reconstruction by the senior author, at Addenbrooke's Hospital between July 2008 and April 2016. Cases requiring bony reconstruction were excluded. Data on patient age, sex, indication for surgery, tumor location and defect type, complications, success rates, and length of stay were recorded. Results: The majority of patients received an ALTFF (n = 56) with 38% receiving a RFFF (n = 34). Surgical resection took place in the floor of the mouth most frequently. These were closed with ALTFF and RFFF in 41 and 28 occasions, respectively. A success rate of 97% was observed in the RFFF group; 1 flap developed partial necrosis and required complete revision. In the ALTFF group, there was a 100% flap success rate. ALTFF usage resulted in a reduction in the number of intraoperative (p = 0.021) in addition a reduction in the number of days in ITU (p = 0.01) and post-operative clinic visits (p = 0.025). Conclusion: We present a series that used predominately the ALTFF to reconstruct intra-oral defects following resection of squamous cell carcinoma in a Western population. The results demonstrate that this treatment can produce at least as comparable results as to the use of a RFFF repair in this population, whilst avoiding the donor site morbidity and aesthetic compromise of a RFFF.

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Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

Cited by 24 publications

References 25 publications

Complications and loss of free flaps after reconstructions for oral cancer

Complications and loss of free flaps after reconstructions for oral cancer

Complications and Risk after Mandibular Reconstruction with Fibular Free Flaps in Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study

Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

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