Postoperative monitoring of microsurgical free-tissue transfers for head and neck reconstruction: a systematic review of current techniques—Part II. Invasive techniques

Abdel-Galil, Khalid; Mitchell, David A.

doi:10.1016/j.bjoms.2008.12.002

Cited by 66 publications

(43 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…So far, it can only be concluded that a small temperature difference should lead to additional examinations to rule out perfusion failure. Failure of flap perfusion can occur while the patient and surgeon are still in the operating room [1,[24][25][26]. The risk of arterial thrombus formation is highest at 15 min after clamp release and usually occurs during the first 45 min [20,21].…”

Section: Postoperative Flap Monitoring By Thermal Imagingmentioning

confidence: 99%

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Just

Chalopin

Unger

et al. 2015

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

The aim of this study is to investigate static and dynamic infrared (IR) thermography for intra- and postoperative free-flap monitoring following oropharyngeal reconstruction. Sixteen patients with oropharyngeal reconstruction by free radial forearm flap were included in this prospective, clinical study (05/2013-08/2014). Prior ("intraop_pre") and following ("intraop_post") completion of the microvascular anastomoses, IR thermography was performed for intraoperative flap monitoring. Further IR images were acquired one day ("postop_1") and 10 days ("postop_10") after surgery for postoperative flap monitoring. Of the 16, 15 transferred free radial forearm flaps did not show any perfusion failure. A significant decreasing mean temperature difference (∆T: temperature difference between the flap surface and the surrounding tissue in Kelvin) was measured at all investigation points in comparison with the temperature difference at "intraop_pre" (mean values on all patients: ∆T intraop_pre = -2.64 K; ∆T intraop_post = -1.22 K, p < 0.0015; ∆T postop_1 = -0.54 K, p < 0.0001; ∆T postop_10 = -0.58 K, p < 0.0001). Intraoperative dynamic IR thermography showed typical pattern of non-pathological rewarming due to re-established flap perfusion after completion of the microvascular anastomoses. Static and dynamic IR thermography is a promising, objective method for intraoperative and postoperative monitoring of free-flap reconstructions in head and neck surgery and to detect perfusion failure, before macroscopic changes in the tissue surface are obvious. A lack of significant decrease of the temperature difference compared to surrounding tissue following completion of microvascular anastomoses and an atypical rewarming following a thermal challenge are suggestive of flap perfusion failure.

show abstract

Section: Postoperative Flap Monitoring By Thermal Imagingmentioning

confidence: 99%

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Just

Chalopin

Unger

et al. 2015

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…Multiple methods of monitoring have been described, from simple clinical examination for evidence of adequate arterial and venous flow to invasive monitoring techniques, such as implantable Doppler or pO2 monitors. 113,114 Each technique has been shown to be effective, but there are advantages and disadvantages for each of the approaches. To date, no universally acceptable approach to monitoring has been defined.…”

Section: Postoperative Flap Monitoringmentioning

confidence: 99%

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

Dort

Farwell

Findlay

et al. 2017

JAMA Otolaryngol Head Neck Surg

395

257

View full text Add to dashboard Cite

Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

show abstract

“…The cost of our paraclinical monitoring is low; about 30 euros per day while other methods like microdialysis costs about 1200 euros per day [17].…”

Section: Discussionmentioning

confidence: 99%

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

View full text Add to dashboard Cite

Postoperative monitoring of microsurgical free-tissue transfers for head and neck reconstruction: a systematic review of current techniques—Part II. Invasive techniques

Cited by 66 publications

References 31 publications

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Contact Info

Product

Resources

About