Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists
Yıl: 2021 Cilt: 59 Sayı: 2 Sayfa Aralığı: 103 - 110 Metin Dili: İngilizce DOI: 10.4274/tao.2021.2021-1-9 İndeks Tarihi: 25-05-2022
Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists
Öz: Objective: To determine flap success rate and complications in patients who underwent
microvascular free tissue reconstruction after major head and neck ablative surgery and to report
the improvement in the results.
Methods: Medical records of 124 patients who were operated on in 2012 to 2019 were
retrospectively reviewed. Indications for different free flap types, success rates and re-exploration
rates, donor site morbidities, and reasons for flap loss were analyzed. Patients were divided into
two groups to identify the effects of the anticoagulant and the antiaggregant treatments on
postoperative results.
Results: There were 127 flaps in 124 patients, including two different free flaps each in three
patients that were harvested and used in the same surgical session. Of the total 127 flaps, 82
(64.6%) were radial forearm flaps, 39 (30.7%) were fibula flaps, and 6 (4.7) were rectus abdominis
flaps. Four patients were re-explored for flap perfusion problems, and 18 patients were re-explored
for hematoma drainage (n=22/124, %17.3). The rate of hematoma and re-exploration was higher
in patients who received anticoagulant and antiaggregant treatments synchronously (p=0.02).
Three flaps were lost, and the overall success rate was 97.6%. Two patients died from perioperative
complications. No major complications were observed at the donor site; minor complications were
observed in 30 patients.
Conclusion: The success rate for the 127 flaps in 124 patients were found comparable to
those reported in the literature. These results show that successful outcomes can be achieved
with experience and a head and neck team dedicated to improving the results in microsurgical
reconstruction, and flap failure rarely occurs if perioperative care of the patients is given
meticulously.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Pulte D, Brenner H. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist 2010; 15: 994-1001. [Crossref]
- 2. Zimmaro LA, Sephton SE, Siwik CJ, Phillips KM, Rebholz WN, Kraemer HC et al. Depressive symptoms predict head and neck cancer survival: examining plausible behavioral and biological pathways. Cancer 2018; 124: 1053-60. [Crossref]
- 3. Lydiatt WM, Moran J, Burke WJ. A review of depression in the head and neck cancer patient. Clin Adv Hematol Oncol 2009; 7: 397-403. [Crossref]
- 4. Hanasono MM, Matros E, Disa JJ. Important aspects of head and neck reconstruction. Plast Reconstr Surg 2014; 134: 968e-80e. [Crossref]
- 5. Vila PM, Rich JT, Desai SC. Defining quality in head and neck reconstruction. Otolaryngol Head Neck Surg 2017; 157: 545-7. [Crossref]
- 6. Panje WR, Bardach J, Krause CJ. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg 1976; 58: 415-8. [Crossref]
- 7. Spiegel JH, Polat JK. Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 2007; 117: 485-90. [Crossref]
- 8. Kovatch KJ, Hanks JE, Stevens JR, Stucken CL. Current practices in microvascular reconstruction in otolaryngology-head and neck surgery. Laryngoscope 2019; 129: 138-45. [Crossref]
- 9. Gabrysz-Forget F, Tabet P, Rahal A, Bissada E, Christopoulos A, Ayad T. Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review. J Otolaryngol Head Neck Surg 2019; 48: 13. [Crossref]
- 10. Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 2001; 47: 385-9. [Crossref] 11. Rozen WM, Ashton MW, Pan WR, Kiil BJ, McClure VK, Grinsell D, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery 2009; 29: 16-23. [Crossref]
- 12. Gil Z, Abergel A, Leider-Trejo L, Khafif A, Margalit N, Amir A, et al. A comprehensive algorithm for anterior skull base reconstruction after oncological resections. Skull Base 2007; 17: 25-37. [Crossref]
- 13. Başaran B, Ünsaler S. Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation. Braz J Otorhinolaryngol 2020: S1808-8694(20)30071-9. [Crossref]
- 14. Coleman SS, Anson B. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet 1961; 113: 409-24. [Crossref]
- 15. Genden EM, Rinaldo A, Suárez C, Wei WI, Bradley PJ, Ferlito A. Complications of free flap transfers for head and neck reconstruction following cancer resection. Oral Oncol 2004; 40: 979-84. [Crossref]
- 16. Rosson GD, Singh NK. Devascularizing complications of free fibula harvest: peronea arteria magna. J Reconstr Microsurg 2005; 21: 533-8. [Crossref]
- 17. Futran ND, Stack BC Jr, Zaccardi MJ. Preoperative color flow Doppler imaging for fibula free tissue transfers. Ann Vasc Surg 1998; 12: 445-50. [Crossref]
- 18. Manaster BJ, Coleman DA, Bell DA. Magnetic resonance imaging of vascular anatomy before vascularized fibular grafting. J Bone Joint Surg Am 1990; 72: 409-14. [Crossref]
- 19. Shu J, Santulli G. Update on peripheral artery disease: epidemiology and evidence-based facts. Atherosclerosis 2018; 275: 379-81. [Crossref]
- 20. Hidalgo DA, Jones CS. The role of emergent exploration in freetissue transfer: a review of 150 consecutive cases. Plast Reconstr Surg 1990; 86: 492-8; discussion 499-501. [Crossref]
- 21. Schwabegger AH. Flap re-exploration. In: Wei FC, Mardini S, editors. Flaps and Reconstructive Surgery. 1st edition. Saunders - Elsevier Publishers; 2009. p.125-36. [Crossref]
- 22. Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007;119: 2092-100. [Crossref]
- 23. Esclamado RM, Carroll WR. The pathogenesis of vascular thrombosis and its impact in microvascular surgery. Head Neck 1999; 21: 355-62. [Crossref]
- 24. Davies DM. A world survey of anticoagulation practice in clinical microvascular surgery. Br J Plast Surg 1982; 35: 96-9. [Crossref] 25. Khouri RK. Avoiding free flap failure. Clin Plast Surg 1992; 19: 773-81. [Crossref]
- 26. Johnson PC, Barker JH. Thrombosis and antithrombotic therapy in microvascular surgery. Clin Plast Surg 1992; 19: 799-807. [Crossref]
- 27. Pugh CM, Dennis RH 2nd, Massac EA. Evaluation of intraoperative anticoagulants in microvascular free- flap surgery. J Nat Med Assoc 1996; 88: 655-7. [Crossref]
- 28. Ritter EF, Cronan JC, Rudner AM, Serafin D, Klitzman B. Improved microsurgical anastomotic patency with low molecular weight heparin. J Reconstr Microsurg 1998; 14: 331-6. [Crossref]
- 29. Collaborative overview of randomised trials of antiplatelet therapy--II: Maintenance of vascular graft or arterial patency by antiplatelet therapy. Antiplatelet Trialists’ Collaboration. BMJ 1994; 308: 159-68. [Crossref]
- 30. Corbitt C, Skoracki RJ, Yu P, Hanasono MM. Free flap failure in head and neck reconstruction. Head Neck 2014; 36: 1440-5. [Crossref]
| APA | Başaran B, ÜNSALER S, Kesimli M, ASLAN İ (2021). Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. , 103 - 110. 10.4274/tao.2021.2021-1-9 |
| Chicago | Başaran Bora,ÜNSALER SELİN,Kesimli Mustafa Caner,ASLAN İsmet Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. (2021): 103 - 110. 10.4274/tao.2021.2021-1-9 |
| MLA | Başaran Bora,ÜNSALER SELİN,Kesimli Mustafa Caner,ASLAN İsmet Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. , 2021, ss.103 - 110. 10.4274/tao.2021.2021-1-9 |
| AMA | Başaran B,ÜNSALER S,Kesimli M,ASLAN İ Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. . 2021; 103 - 110. 10.4274/tao.2021.2021-1-9 |
| Vancouver | Başaran B,ÜNSALER S,Kesimli M,ASLAN İ Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. . 2021; 103 - 110. 10.4274/tao.2021.2021-1-9 |
| IEEE | Başaran B,ÜNSALER S,Kesimli M,ASLAN İ "Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists." , ss.103 - 110, 2021. 10.4274/tao.2021.2021-1-9 |
| ISNAD | Başaran, Bora vd. "Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists". (2021), 103-110. https://doi.org/10.4274/tao.2021.2021-1-9 |
| APA | Başaran B, ÜNSALER S, Kesimli M, ASLAN İ (2021). Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. Turkish archives of otorhinolaryngology , 59(2), 103 - 110. 10.4274/tao.2021.2021-1-9 |
| Chicago | Başaran Bora,ÜNSALER SELİN,Kesimli Mustafa Caner,ASLAN İsmet Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. Turkish archives of otorhinolaryngology 59, no.2 (2021): 103 - 110. 10.4274/tao.2021.2021-1-9 |
| MLA | Başaran Bora,ÜNSALER SELİN,Kesimli Mustafa Caner,ASLAN İsmet Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. Turkish archives of otorhinolaryngology , vol.59, no.2, 2021, ss.103 - 110. 10.4274/tao.2021.2021-1-9 |
| AMA | Başaran B,ÜNSALER S,Kesimli M,ASLAN İ Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. Turkish archives of otorhinolaryngology . 2021; 59(2): 103 - 110. 10.4274/tao.2021.2021-1-9 |
| Vancouver | Başaran B,ÜNSALER S,Kesimli M,ASLAN İ Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. Turkish archives of otorhinolaryngology . 2021; 59(2): 103 - 110. 10.4274/tao.2021.2021-1-9 |
| IEEE | Başaran B,ÜNSALER S,Kesimli M,ASLAN İ "Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists." Turkish archives of otorhinolaryngology , 59, ss.103 - 110, 2021. 10.4274/tao.2021.2021-1-9 |
| ISNAD | Başaran, Bora vd. "Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists". Turkish archives of otorhinolaryngology 59/2 (2021), 103-110. https://doi.org/10.4274/tao.2021.2021-1-9 |
