Management of complications and compromised free flaps following major head and neck surgery

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• 作者：Cuneyt Kucur ; Kasim Durmus ; Ismail O. Uysal…
• 关键词：Microvascular free flaps ; Head and neck reconstruction ; Dehiscence ; Vascular congestion ; Flap failure ; Radical resection ; Hyperbaric oxygen therapy
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：273
• 期：1
• 页码：209-213
• 全文大小：341 KB
• 参考文献：1.Bozec A, Poissonnet G, Chamorey E, Casanova C, Vallicioni J, Demard F et al (2008) Free-flap head and neck reconstruction and quality of life: a 2-year prospective study. Laryngoscope 118:874–880PubMed CrossRef
  2.Pohlenz P, Klatt J, Schön G, Blessman M, Li L, Schmelzle R (2012) Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 41:739–743PubMed CrossRef
  3.Eckard A, Meyer A, Laas U, Hausamen JE (2007) Reconstruction of defects in the head and neck with free flaps: 20 years experience. Br J Oral Maxillofac Surg 45:11–15CrossRef
  4.Wong CH, Wei FC (2010) Microsurgical free flap in head and neck reconstruction. Head Neck 32:1236–1245PubMed CrossRef
  5.Rosenberg AJ, Van Cann EM, Van der Bilt A, Koole R, Van Es RJ (2009) A prospective study on prognostic factors for free-flap reconstructions of head and neck defects. Int J Oral Maxillofac Surg 38:666–670PubMed CrossRef
  6.Vandersteen C, Dassonville O, Chamorey E, Poissonnet G, Nao EEM, Pierre CS et al (2013) Impact of patient comorbidities on head and neck microvascular reconstruction. A report on 423 cases. Eur Arch Otorhinolaryngol 270:1741–1746PubMed CrossRef
  7.Reiter M, Kapsreiter M, Betz CS, Harréus U (2012) Perioperative management of antithrombotic medication in head and neck reconstruction—a retrospective analysis of 137 patients. Am J Otolaryngol 33:693–696PubMed CrossRef
  8.Rinaldo A, Shaha AR, Wei WI, Silver CE, Ferlito A (2002) Microvascular free flaps: a major advance in head and neck reconstruction. Acta Otolaryngol 122:779–784PubMed CrossRef
  9.Haughey BH, Wilson E, Kluwe L, Piccirillo J, Frederikson J, Sessions D et al (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125:10–17PubMed CrossRef
  10.Hirsch DL, Bell RB, Dierks EJ, Potter JK, Potter BE (2008) Analysis of microvascular free flaps for reconstruction of advanced mandibular osteoradionecrosis: a retrospective cohort study. J Oral Maxillofac Surg 66:2545–2556PubMed CrossRef
  11.Curi MM, Oliveira dos Santos M, Feher O, Faria JC, Rodrigues ML, Kowalski LP (2007) Management of extensive osteoradionecrosis of the mandible with radical resection and immediate microvascular reconstruction. J Oral Maxillofac Surg 65:434–438PubMed CrossRef
  12.Yu P, Chang DW, Miller MJ, Reece G, Robb GL (2009) Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction. Head Neck 31:45–51PubMed CrossRef
  13.Arce K, Bell RB, Potter JK, Buehler MJ, Potter BE, Dierks EJ (2012) Vascularized free tissue transfer for reconstruction of ablative defects in oral and oropharyngeal cancer patients undergoing salvage surgery following concomitant chemoradiation. Int J Oral Maxillofac Surg 41:733–738PubMed CrossRef
  14.Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG (2001) Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 47:385–389PubMed CrossRef
  15.Kimata Y, Sakuraba M, Namba Y, Hayashi R, Ebihara S (2005) Functional reconstruction with free flaps following ablation of oropharyngeal cancer. Int J Clin Oncol 10:229–233PubMed CrossRef
  16.Bui DT, Cordeiro PG, Hu Q, Disa JJ, Pusic A, Mehrara BJ (2007) Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 119:2092–2100PubMed CrossRef
  17.Ulkür E, Yüksel F, Açikel C, Celiköz B (2002) Effect of hyperbaric oxygen on pedicle flaps with compromised circulation. Microsurgery 22:16–20PubMed CrossRef
  18.Qi Z, Gao CJ, Wang YB, Ma XM, Zhao L, Liu FJ et al (2013) Effects of hyperbaric oxygen preconditioning on ischemia-reperfusion inflammation and skin flap survival. Chin Med J (Engl) 126:3904–3909
  19.Stevens DM, Weiss DD, Koller WA, Bianchi DA (1996) Survival of normothermic microvascular flaps after prolonged secondary ischemia: effects of hyperbaric oxygen. Otolaryngol Head Neck Surg 115:360–364PubMed CrossRef
  20.Gampper TJ, Zhang F, Mofakhami NF, Morgan RF, Amiss R, Hoard MA et al (2002) Beneficial effect of hyperbaric oxygen on island flaps subjected to secondary venous ischemia. Microsurgery 22:49–52PubMed CrossRef
  21.Gal TJ, Yueh B, Futran ND (2003) Influence of prior hyperbaric oxygen therapy in complications following microvascular reconstruction for advanced osteoradionecrosis. Arch Otolaryngol Head Neck Surg 129:72–76PubMed CrossRef
  22.Helmers R, Milstein DM, van Hulst RA, de Lange J (2014) Hyperbaric oxygen therapy accelerates vascularization in keratinized oral mucosal surgical flaps. Head Neck 36:1241–1247PubMed
  23.Dabb RW, Malone JM, Leverett LC (1992) The use of medicinal leeches in the salvage of flaps with venous congestion. Ann Plast Surg 29:250–256PubMed CrossRef
  24.Koch Cody A, Olsen Steven M, Moore Eric J (2012) Use of the medicinal leech for salvage of venous congested microvascular free flaps of the head and neck. Am J Otolaryngol 33:26–30PubMed CrossRef
  25.Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D et al (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 130:962–966PubMed CrossRef
  26.Dassonville O, Poissonnet G, Chamorey E, Vallicioni J, Demard F, Santini J et al (2008) Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol 265:85–95PubMed CrossRef
  27.Spiegel JH, Polat JK (2007) Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 117:485–490PubMed CrossRef
  
• 作者单位：Cuneyt Kucur (1) (2)
  Kasim Durmus (1)
  Ismail O. Uysal (1) (3)
  Matthew Old (1)
  Amit Agrawal (1)
  Hassan Arshad (1)
  Theodoros N. Teknos (1)
  Enver Ozer (1)
  
  1. Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA
  2. Department of Otolaryngology Head and Neck Surgery, University of Dumlupinar, Kutahya, Turkey
  3. Department of Otolaryngology Head and Neck Surgery, University of Cumhuriyet, Sivas, Turkey
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Otorhinolaryngology
  Neurosurgery
  Head and Neck Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-4726

文摘

Microvascular free flaps are preferred for most major head and neck reconstruction surgeries because of better functional outcomes, improved esthetics, and generally higher success rates. Numerous studies have investigated measures to prevent flap loss, but few have evaluated the optimal treatment for free flap complications. This study aimed to determine the complication rate after free flap reconstructions and discusses our management strategies. Medical records of 260 consecutive patients who underwent free flap reconstructions for head and neck defects between July 2006 and June 2010 were retrospectively reviewed for patient and surgical characteristics and postoperative complications. The results revealed that microvascular free flaps were extremely reliable, with a 3.5 % incidence of flap failure. There were 78 surgical site complications. The most common complication was neck wound infection, followed by dehiscence, vascular congestion, abscess, flap necrosis, hematoma, osteoradionecrosis, and brisk bleeding. Twenty patients with poor wound healing received hyperbaric oxygen therapy, which was ineffective in three patients who eventually experienced complete flap loss. Eleven patients with vascular congestion underwent medicinal leech therapy, which was effective. Among the 78 patients with complications, 44 required repeat surgery, which was performed for postoperative brisk bleeding in three. Eventually, ten patients experienced partial flap loss and nine experienced complete flap loss, with the latter requiring subsequent pectoralis major flap reconstruction. Microvascular free flap reconstruction represents an essential and reliable technique for head and neck defects and allows surgeons to perform radical resection with satisfactory functional results and acceptable complication rates.