Outcomes after free tissue transfer for composite oral cavity resections involving skin

Alvi, Sameer; Hamill, Chelsea S.; Lepse, Jason P.; Ayala, M.A.; Girod, Douglas A.; Tsue, Terance T.; Shnayder, Yelizaveta; Kakarala, Kiran

doi:10.1002/hed.25062

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…Finally, the SAI flap has been described as a secondary flap for skin coverage in patients undergoing another free or rotational flap for reconstruction of the primary defect. 13,39 We have found the SAI flap to be quite useful for coverage of a secondary cutaneous defect in at least three patients. When primary neck closure cannot be achieved with the primary flap, a SAI flap can be harvested quickly and reliably to fill the defect.…”

Section: Flap Characteristicsmentioning

confidence: 97%

Supraclavicular Artery Island Flap: Critical Appraisal and Comparison to Alternate Reconstruction

et al. 2020

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Objectives/Hypothesis: The supraclavicular artery island (SAI) flap may be a good option for selected head and neck reconstruction due to its reliability, ease of harvest, and favorable color match. The objective of this study was to examine the rates of complications for the SAI flap in head and neck oncologic reconstruction, with examination of risk factors and comparisons to alternative flaps often considered the gold-standard soft-tissue flaps for head and neck reconstruction: the pectoralis myocutaneous (PMC), radial forearm free flap (RFFF), and anterolateral thigh (ALT) flaps.Study Design: Retrospective cohort study. Methods: Consecutive SAI flaps were compared to PMC, RFFF, and ALT flaps (non-SAI flap group), all performed by the senior author from 2010 to 2018. The non-SAI flaps were included if an SAI flap could have been performed as an alternate flap. The groups were compared based on demographics, flap dimensions, site of reconstruction, operating time, total hospital stay, total hospital costs, and complications.Results: One hundred seven SAI flaps and 194 non-SAI flaps were identified. SAI flaps were used less commonly than non-SAI flaps for mucosal defects (P < .001). The SAI flap dimensions were narrower but longer than non-SAI flaps (P < .001). SAI flaps had higher rates of total complications, partial flap necrosis, flap dehiscence at the recipient site, fistula, donor site dehiscence, and minor complications compared to non-SAI flaps (all P < .05). SAI flaps had higher rates of total complications, recipient site dehiscence, fistula, and minor complications in both the oral cavity and all mucosal sites compared to non-SAI flaps (all P < .05). SAI flaps for mucosal reconstruction were associated with higher rates of total complications (54% vs. 34%, P = .04), flap dehiscence at the recipient site (32% vs. 14%, P = .03), and major complications (21% vs. 5%, P = .02), compared to cutaneous reconstruction. Complications were equivalent between SAI flaps and non-SAI flaps for cutaneous reconstruction (all P > .05). Multivariate analysis showed that SAI flaps were associated with any postoperative complication (odds ratio [OR]:

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Section: Flap Characteristicsmentioning

confidence: 97%

Supraclavicular Artery Island Flap: Critical Appraisal and Comparison to Alternate Reconstruction

et al. 2020

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“…the potential for radius fracture), the limited amount of bone available for harvest, and the risk of bone devascularization following osteotomies have led to limitations in its use [14]. Further, the OCRFF does not reliably provide sufficient bone for dental implants, although Gonzalez-Castro et al [60] demonstrated that double barrelled OCRFF would accommodate dental implants [59]. Comparing multiple types of osteocutaneous free flaps Kearns et al [61] determined that the OCRFF is associated with higher rates of delayed healing (approximately 20%) compared with scapular (<10%) and iliac flaps (5%).…”

Section: Alternatives To Fibula Free Flap In Segmental Mandibular Rec...mentioning

confidence: 99%

“…In addition to mandibular reconstruction following tumor extirpation, OCRFF has also been successfully used for reconstructing bone defects in ORN with no reported flap failures and 100% postoperative ORN stabilization [58]. Benefits of the OCRFF include a long vascular pedicle, which is less susceptible to PAD than the peroneal vessels, as well as the ability to harvest a large, potentially sensate skin paddle [59].…”

Section: Introductionmentioning

confidence: 99%

Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty

Rubin

Sayre

Kovatch

et al. 2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Options for segmental mandibular reconstruction in patients poorly suited to undergo fibula free flap (FFF). Recent findings Although FFF is the current ‘gold standard’ for segmental mandibular reconstruction, other reconstructive options must be considered when FFF is contraindicated or disfavoured and/or patient frailty precludes a lengthy anaesthetic. In addition to various nonvascularized and soft tissue only reconstructions, excellent osseous free flap alternatives for functional segmental mandibular reconstruction may be employed. The subscapular system free flaps (SSSFF) may be ideal in frail and/or elderly patients, as SSSFF allows for early mobility and does not alter gait. In extensive and/or symphyseal defects, functional mandibular reconstruction in lieu of a free flap is extremely limited. Pedicled segmental mandibular reconstructions remain reasonable options, but limited contemporary literature highlights unpredictable bone graft perfusion and poor long-term functional outcomes. Summary There are several excellent free flap alternatives to FFF in segmental mandibular reconstruction, assuming adequate cervical recipient vessels are present. On the basis of the current literature, the optimal mandibular reconstruction for the medically frail, elderly and/or patients with extreme vessel-depleted necks is limited and debatable. In qualifying (i.e. limited, lateral) defects, soft tissue only reconstructions should be strongly considered when osseous free flaps are unavailable.

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“…5-7 The first intraoral reconstruction used a radial forearm free flap (FF) in 1983, and since then, this technique has expanded to include other common harvest sites, such as the scapula, fibula, or anterolateral thigh flaps. 8-10…”

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confidence: 99%

“…Advanced OCC requiring extensive resection can result in challenging defects, for which microvascular free tissue transfers have become standard for reconstructions for functional and aesthetic benefit, utilizing fasciocutaneous, myocutaneous, or osteocutaneous autologous tissue 5–7 . The first intraoral reconstruction used a radial forearm free flap (FF) in 1983, and since then, this technique has expanded to include other common harvest sites, such as the scapula, fibula, or anterolateral thigh flaps 8–10 …”

mentioning

confidence: 99%

Socioeconomic Influences on Short‐term Postoperative Outcomes in Patients With Oral Cavity Cancer Undergoing Free Flap Reconstruction

Lee

Fernando²,

Malenke³

et al. 2021

Otolaryngol.--head neck surg.

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Objective To evaluate the associations between median household income (MHI) and area deprivation index (ADI) on postoperative outcomes in oral cavity cancer. Study Design Retrospective review (2000-2019). Setting Single-institution tertiary medical center. Methods MHI and ADI were matched from home zip codes. Main postoperative outcomes of interest were length of tracheostomy use, length of hospital stay, return to oral intake, discharge disposition, and 60-day readmissions. Linear and logistic regression controlled for age, sex, race, body mass index, tobacco and alcohol use history, primary tumor location, disease staging at presentation, and length of surgery. A secondary outcome was clinical disease staging (I-IV) at time of presentation. Results The cohort (N = 681) was 91.3% White and 38.0% female, and 51.7% presented with stage IV disease. The median age at the time of surgery was 62 years (interquartile range [IQR], 53-71). The median MHI was $47,659 (IQR, $39,324-$58,917), and the median ADI was 67 (IQR, 48-79). ADI and MHI were independently associated with time to return of oral intake (β = 0.130, P = .022; β = −0.092, P = .045, respectively). Neither was associated with length of tracheostomy, hospital stay, discharge disposition, or readmissions. MHI quartiles were associated with a lower risk of presenting with more advanced disease (Q3 vs Q1: adjusted odds ratio, 0.56 [95% CI, 0.32-0.97]). Conclusion MHI is associated with oral cavity cancer staging at the time of presentation. MHI and ADI are independently associated with postoperative return to oral intake following intraoral tumor resection and free flap reconstruction.

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Outcomes after free tissue transfer for composite oral cavity resections involving skin

Abstract: The osteocutaneous RFFF provides a valuable reconstructive option for complex composite resection defects involving skin. When 2 flaps are required, the SCAIF is a viable alternative to a second free flap or pectoralis flap.

Cited by 5 publications

References 31 publications

Supraclavicular Artery Island Flap: Critical Appraisal and Comparison to Alternate Reconstruction

Supraclavicular Artery Island Flap: Critical Appraisal and Comparison to Alternate Reconstruction

Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty

Socioeconomic Influences on Short‐term Postoperative Outcomes in Patients With Oral Cavity Cancer Undergoing Free Flap Reconstruction

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