Outcomes following head neck free flap reconstruction requiring interposition vein graft or vascular bridge flap

Abstract

Background Interposition vein grafts (IVG) and vascular bridge flaps (VBF) have been exploited as vascular conduit in challenging head and neck reconstructions. Methods A retrospective review was conducted on 6025 flaps. The effect of patients' characteristics and length of IVG on flap compromise and loss were analyzed. Comparison between IVG and VBF was performed. Results The flap compromise and loss rates for the overall group were 8.2% and 3.2%, respectively. An IVG was used in 309 free flaps. The average length of the vein grafts was 6.9 ± 4.2 cm. An unplanned return to the operation room occurred in 32 cases (10.4%) and failure of the flap in 12 patients (3.9%). Binary logistic regression found a significant association between flap compromise and loss rates and length of IVG, hypertension, prior radiation, and neck dissection. In the multiple regression model, length of IVG and prior radiation significantly influenced the outcomes. Thirty‐nine patients underwent reconstruction with a long IVG (>10 cm). Twenty‐six patients underwent surgical reconstruction with radial forearm flap as a VBF. The rate of flap compromise was higher in the group with a long IVG (P = .01). Conclusions In head and neck free flap reconstruction, the length of IVGs and history of radiotherapy are associated with flap compromise and loss. In case of long distance between the pedicle and the recipient site, the use of a VBF bridge should be considered as a safe alternative.

Use of the Facial Artery for Free Functioning Muscle Transfers: An Alternative Pedicle for Salvage in Brachial Plexus Lesions with Vascular Injuries

“…However, the alternative would have involved interposition of a vein graft for the artery with an additional risk of failure of the procedure. 33 So, we chose to suture the gracilis muscle to the bellies of the SCM and trapezius at the apex of the posterior triangle of the neck. This insertion point was used in the first two patients (►Fig.…”

Reconstruction of the Nose: Management of Nasal Cutaneous Defects According to Aesthetic Subunit and Defect Size. A Review

“…Microvascular free flaps are the gold standard in head and neck reconstruction, and they have proven to be highly reliable and effective in total and subtotal nasal reconstruction; however, those techniques are beyond the scope of the present review [19][20][21][22][23].…”

Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration

“…The drawbacks associated with head and neck surgery could be often demanding, and dealing with intestinal conduits is even more challenging for the plastic surgeon (Chen & Tang, 2000;Paolino et al, 2020;Potenza et al, 2018). Both surgical and functional outcomes could be really disappointing if the surgery is carried out by unexperienced surgeons; all the reconstructive strategies should be mastered to face any possible complications both at the recipient and donor site (Di Taranto et al, 2019;Maruccia et al, 2020). Free jejunum flap transfer requires attention to flap length and duration of intra-and post-operatively ischemia (Arnež et al, 2019;Manrique et al, 2017;Trignano et al, 2018).…”

“…The patients go through reiterated choking episodes with augmented risk of aspiration pneumonia. The lack of food gratification leads to social segregation; so, ironically, despite recent advances in microsurgical reconstruction (Di Taranto et al, 2019;Losco et al, 2019) and specially in the treatment of head and neck malignancies, patients report a poor quality of life (Ciudad et al, 2017;Jensen, Lambertsen, & Grau, 2007;Luke Tan, 2010;Paolino, Didona, Macrì, Calvieri, & Mercuri, 2018).…”