Microvascular Free Flaps: a Major Advance in Head and Neck Reconstruction

Rinaldo, Alessandra; Shaha, Ashok R.; Wei, William I.; Silver, Carl E.; Ferlito, Alfio

doi:10.1080/003655402/000028041

Cited by 44 publications

(40 citation statements)

References 31 publications

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“…6 Recent advances in microsurgical techniques have ushered in a new era for reconstruction following head and neck cancer ablative surgery. 7 Microvascular free tissue transfer (of so-called flaps) enables reconstruction of major defects that were irreparable earlier, as well as markedly improving function and cosmesis. 8 Thus, surgeons can undertake aggressive surgical resections of large tumours, secure in the knowledge that the resulting tissue defect can be filled with healthy autologous flap tissue harvested from any appropriate part of the body.…”

Section: Introductionmentioning

confidence: 99%

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

et al. 2008

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Transfer of healthy autologous tissue as a microvascular free flap facilitates reconstruction during ablative cancer surgery. In addition to filling surgical defects, free flaps might concentrate viral vectors at the tumour bed and mediate local therapeutic effects. We evaluated the magnitude, topography and duration of luciferase gene expression after plasmid and adenoviral delivery in rat superficial inferior epigastric (SIE) flaps. For plasmid delivery, luciferase expression was significantly increased by all transduction routes (topical, intraflap injection, intravascular) ( Po0.01) at day 1, but not at day 7. The spread of luciferase expression was significantly different between the 4 groups at 1 day ( P ¼ 0.026) and was greatest for flaps transduced by intravascular injection. For adenoviral transduction, total radiance was significantly different between the transduced groups at 1, 14 and 28 days (Po0.05 for all comparisons). The highest levels of radiance were seen in the intravascular group. There was a statistically significant difference in the spread of light emission between the 3 groups at 1 ( P ¼ 0.009) and 14 (P ¼ 0.013) days, but this was no longer evident at 28 days. Intravascular adenoviral delivery yields high-level, diffuse and durable gene expression in rat SIE flaps and is suitable for examination in therapeutic models.

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Section: Introductionmentioning

confidence: 99%

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

et al. 2008

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“…Free tissue reconstruction is now the standard of care for head and neck defects. Compared with local flap and regional flaps, free tissue offers clear advantages, including a robust blood supply, multiple potential donor sites, and the possibility of a large supply of tissue [2]. These advantages, together with the improvement in surgical techniques and instrumentation, has pushed success rates to greater than 95% [2][3][4][5][6], making free flap reconstruction the first choice in addressing defects in the head and neck.…”

mentioning

confidence: 99%

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

Khariwala

Pierce

et al. 2016

Surgical Infections

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Background: Free tissue reconstruction has become the standard of care for most major defects in the head and neck. Surgical site infection (SSI) can lead to vessel thrombosis and eventual flap loss. The use of antibiotics after free tissue reconstruction has not been studied in the current environment of heightened bacterial antibiotic resistance. We compared the use of short-term and longer-term antibiotics in a series of patients receiving free tissue reconstructions. Methods: A retrospective review was performed of 147 patients receiving 149 free flaps who were treated with either short-course (£2 d; n = 149 [43%]) or long-course (>2 d; n = 85 [57%])) post-operative antibiotics from 2009 to 2014. The outcomes examined were infection, return to the operating room, length of hospital stay, and patient death up to six weeks post-surgery. In addition, risk factors associated with SSI were explored. Results: Surgical site infection, flap dehiscence, flap loss, and length of stay were not different in the two groups. However, those receiving long-course antibiotics had a significantly higher rate of pneumonia (24.7% vs. 10.9%; p = 0.03), although they had a lower rate of urinary tract infection (0.0% vs 9.4%, respectively; p = 0.01). Body mass index remained a statistically significant risk factor in the multivariable analysis (p = 0.005). Conclusion: Prolonged antibiotic use after free flap reconstruction of head and neck defects does not appear to prevent SSI better than short-course treatment in this population. Moreover, long-course antibiotic use was associated with a higher risk of pneumonia.

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“…10 In this series, the exposure for the parascapular donor flap ipsilateral to the defect allowed for patient placement in slight rotation at 30 to 45 off the supine plane at the beginning of the case. Specifically, the patient is placed on a deflated bean bag, and the arm on the donor side, which is ipsilateral to the defect, is completely prepped into the field, including the entire scapula, head, and neck.…”

Section: Case Reportmentioning

confidence: 99%

Parascapular free flaps in skin malignancies

Marcum

Browne

2011

The Laryngoscope

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This study was a retrospective review of a case series of nine patients, aged 40 to 83 years, presenting to the head and neck cancer department at Wake Forest Baptist Medical Center, with a diagnosis of head and neck cutaneous squamous cell carcinoma (SCC), requiring reconstruction after surgical resection. In this group of patients, parascapular fasciocutaneous free flaps proved to be a safe, reliable, and cosmetically effective choice for reconstruction of head and neck skin cancer defects. Choosing donor tissue from a relatively non-sun exposed area can prevent potential development of new malignancies that may arise from donor sites using sun-exposed skin. We discuss the benefits and versatility of the parascapular fasciocutaneous free flap and our experience in using this flap to reconstruct complex surgical defects.

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Microvascular Free Flaps: a Major Advance in Head and Neck Reconstruction

Cited by 44 publications

References 31 publications

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

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

Parascapular free flaps in skin malignancies

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