Objective To retrospectively review the single team's experience of oral and maxillofacialhead and neck reconstruction involving 41 soft tissue free flap procedures.Methods From 1994 to 2012,41 patients who underw...Objective To retrospectively review the single team's experience of oral and maxillofacialhead and neck reconstruction involving 41 soft tissue free flap procedures.Methods From 1994 to 2012,41 patients who underwent oral and maxillofacial-head and neck soft tissue free flap reconstruction at the Department of Oral and Maxillofacial-Head and Neck Surgical Oncology,Hospital and College of Stomatology,Xi'an Jiaotong University,were reviewed with clinicopathologic data.Results The 41 patients included 24 men and 17 women with a mean age of 54 years.A total of 41 soft tissue free flaps were performed to reconstruct different anatomical structures in the head and neck region including oral mucosa,facial bone,head and neck skin.Two types of soft tissue free flaps were used to reconstruct surgical defects,including radial forearm flap and latissimus dorsi myocutaneous flap.Radial forearm flaps were used for 37cases and latissimus dorsi-myocutaneous flaps were 4 cases.Of 41 cases,39 were successful,with an overall success rate of 95.1%.There were 2 free flap failures,including one radial forearm flap and one latissimus dorsi-myocutaneous flap(partial flap necrosis);hence,the flap success rates for radial forearm flap and latissimus dorsimyocutaneous were,respectively,97.3% and 87.5%.Conclusions Radial forearm flap and latissimus dorsi-myocutaneous flap are reliable soft tissue free flaps to repair oral and maxillofacial-head and neck area with high success rate,which resulted in good functionally and cosmetically with fewer complications both donor and recipient sites.展开更多
Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the a...Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.展开更多
The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evo...The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as “salvage” procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.展开更多
Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon’s inexperience and technique. However, ther...Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon’s inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon’s practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.展开更多
Objectives:Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery.Methods:A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstru...Objectives:Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery.Methods:A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed.Data captured included demographics,postoperative inpatient pain,pain at postoperative visits,morphine equivalent doses(MEDs)administration,medication history,and comorbidities.Data were analyzed using regression models,χ2 tests,and student’’st-tests.Results:Seventy-three percent of patients were discharged with opioid medication,with over half(53.4%)continuing to take opioids at their second postoperative visit,and over one-third(34.2%)continuing to take them around 4-month postoperatively.One out of every five(20.3%)opioid-na?ve patients chronically took opioids postoperatively.There was a poor association between inpatient postoperative pain scores and daily MEDs administered(R2=0.13,0.17,and 0.22 in postoperative Days 3,5,and 7,respectively).Neither preoperative radiotherapy nor postoperative complications were associated with an increase in opioid usage.Conclusions:For patients undergoing head and neck free flap operations,opioid medications are commonly used for postoperative analgesia.This practice may increase the chance an opioid-na?ve patient uses opioids chronically.We found a poor association between MEDs administered and patient-reported pain scores,which suggests that standardized protocols aimed at optimizing analgesia while reducing opioid administration may be warranted.Level of Evidence:3(Retrospective cohort study).展开更多
Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperativ...Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperative complications remain significant limitations.The purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques employed.Methods:This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June 2019.The parameters included in this study were patient demographics,tumor characteristics,and postoperative management,collected for at least a year after surgery.Results:In this cohort,the mean age was 76.1 years and 90%were male.All patients were treated for neoplastic skin lesions,with 70%located on the vertex and 30%located on the temporoparietal region.The mean size of defect was 52.0 cm^(2)(range:38.6 to 63.8 cm^(2)).The maximum hospital stay was two days,and no patients were readmitted within 30 days of surgery.There were no cases of wound infection or flap necrosis.All patients reported pain control with acetaminophen and ibuprofen.Four patients received adjuvant radiation,and there was no delay to receiving treatment following surgery.Conclusions:The O-Z flap is a reliable alternative for the reconstruction of non-irradiated scalp defects in the vertex and temporoparietal regions up to 63 cm^(2).This technique provides advantages for patients,including hairline preservation,shorter hospital stays,and decreased postoperative complications.展开更多
Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges,which are currently magnified by rising health care costs and limitations in system resources.Curre...Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges,which are currently magnified by rising health care costs and limitations in system resources.Current trends in the United States heavily favor the use of free tissue transfer over locoregional pedicles flaps(LRPF);however,the latter group is often undervalued,offering high utility,practicality,and cost-efficiency whilst providing equivalent results.The submental island flap and supraclavicular artery island flap are two LRPF that should be in the arsenal of the modern reconstructive surgeon.展开更多
基金supported by a grant fromXi'an Jiaotong University School of Medicine for Distinguished Young Scholars(KY200901)
文摘Objective To retrospectively review the single team's experience of oral and maxillofacialhead and neck reconstruction involving 41 soft tissue free flap procedures.Methods From 1994 to 2012,41 patients who underwent oral and maxillofacial-head and neck soft tissue free flap reconstruction at the Department of Oral and Maxillofacial-Head and Neck Surgical Oncology,Hospital and College of Stomatology,Xi'an Jiaotong University,were reviewed with clinicopathologic data.Results The 41 patients included 24 men and 17 women with a mean age of 54 years.A total of 41 soft tissue free flaps were performed to reconstruct different anatomical structures in the head and neck region including oral mucosa,facial bone,head and neck skin.Two types of soft tissue free flaps were used to reconstruct surgical defects,including radial forearm flap and latissimus dorsi myocutaneous flap.Radial forearm flaps were used for 37cases and latissimus dorsi-myocutaneous flaps were 4 cases.Of 41 cases,39 were successful,with an overall success rate of 95.1%.There were 2 free flap failures,including one radial forearm flap and one latissimus dorsi-myocutaneous flap(partial flap necrosis);hence,the flap success rates for radial forearm flap and latissimus dorsimyocutaneous were,respectively,97.3% and 87.5%.Conclusions Radial forearm flap and latissimus dorsi-myocutaneous flap are reliable soft tissue free flaps to repair oral and maxillofacial-head and neck area with high success rate,which resulted in good functionally and cosmetically with fewer complications both donor and recipient sites.
文摘Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.
文摘The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as “salvage” procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.
文摘Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon’s inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon’s practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.
文摘Objectives:Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery.Methods:A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed.Data captured included demographics,postoperative inpatient pain,pain at postoperative visits,morphine equivalent doses(MEDs)administration,medication history,and comorbidities.Data were analyzed using regression models,χ2 tests,and student’’st-tests.Results:Seventy-three percent of patients were discharged with opioid medication,with over half(53.4%)continuing to take opioids at their second postoperative visit,and over one-third(34.2%)continuing to take them around 4-month postoperatively.One out of every five(20.3%)opioid-na?ve patients chronically took opioids postoperatively.There was a poor association between inpatient postoperative pain scores and daily MEDs administered(R2=0.13,0.17,and 0.22 in postoperative Days 3,5,and 7,respectively).Neither preoperative radiotherapy nor postoperative complications were associated with an increase in opioid usage.Conclusions:For patients undergoing head and neck free flap operations,opioid medications are commonly used for postoperative analgesia.This practice may increase the chance an opioid-na?ve patient uses opioids chronically.We found a poor association between MEDs administered and patient-reported pain scores,which suggests that standardized protocols aimed at optimizing analgesia while reducing opioid administration may be warranted.Level of Evidence:3(Retrospective cohort study).
文摘Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperative complications remain significant limitations.The purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques employed.Methods:This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June 2019.The parameters included in this study were patient demographics,tumor characteristics,and postoperative management,collected for at least a year after surgery.Results:In this cohort,the mean age was 76.1 years and 90%were male.All patients were treated for neoplastic skin lesions,with 70%located on the vertex and 30%located on the temporoparietal region.The mean size of defect was 52.0 cm^(2)(range:38.6 to 63.8 cm^(2)).The maximum hospital stay was two days,and no patients were readmitted within 30 days of surgery.There were no cases of wound infection or flap necrosis.All patients reported pain control with acetaminophen and ibuprofen.Four patients received adjuvant radiation,and there was no delay to receiving treatment following surgery.Conclusions:The O-Z flap is a reliable alternative for the reconstruction of non-irradiated scalp defects in the vertex and temporoparietal regions up to 63 cm^(2).This technique provides advantages for patients,including hairline preservation,shorter hospital stays,and decreased postoperative complications.
文摘Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges,which are currently magnified by rising health care costs and limitations in system resources.Current trends in the United States heavily favor the use of free tissue transfer over locoregional pedicles flaps(LRPF);however,the latter group is often undervalued,offering high utility,practicality,and cost-efficiency whilst providing equivalent results.The submental island flap and supraclavicular artery island flap are two LRPF that should be in the arsenal of the modern reconstructive surgeon.
