Vascularized free tissue transfer for reconstruction of ablative defects in oral and oropharyngeal cancer patients undergoing salvage surgery following concomitant chemoradiation
ABSTRACT The purpose of this study was to determine whether chemotherapy delivered concurrently with external beam radiation therapy for loco-regionally advanced head and neck cancer affects the rate or severity of postoperative complications in patients who underwent salvage surgery for recurrent or persistent disease with simultaneous microvascular free flap reconstruction. The primary study group consisted of patients with head and neck malignancies that had undergone surgical salvage with microvascular free flap reconstruction for persistent or recurrent disease following definitive radiation or concomitant chemoradiation treatment. A group of demographically matched patients who underwent microvascular free flap reconstruction for non-malignant and malignant conditions who never received radiation were randomly selected to serve as a control group. The study cohort was divided according to radiation treatment. The overall success rate of flap reconstruction was 92%, with an overall complication rate of 23%. Concurrently administered chemotherapy did not appear to affect the type of or the complication rate. The results of this investigation indicate that microvascular free flap reconstruction of head and neck defects is highly predictable, results in relatively few major complications, and suggests that neither radiation alone nor concomitant chemoradiation has a statistically significant effect on overall flap survival or complication rate.
SourceAvailable from: Christopher M E Avery[Show abstract] [Hide abstract]
ABSTRACT: In general, the pedicled pectoralis major (PPM) flap has become a secondary choice for reconstruction in the developed world while remaining popular within the developing world. The pectoralis major flap is utilised in varying proportions as either the preferred reconstruction or for salvage reconstruction following free flap failure, further disease or complications. Refinements in surgical technique and an experienced surgeon may yield high total flap success rates with modest levels of wound complications. The pectoralis major flap is particularly useful with serious or multiple comorbidities, advanced disease, and previous surgery and/or chemoradiotherapy. It has primarily been used for reconstruction of extended radical neck dissection, posterolateral mandible, large glossectomy and oropharyngeal defects, and occasionally together with a free flap. A second free flap has increasingly been used after initial failure, particularly in the larger centres, but the PPM flap probably remains the most commonly used salvage option. The needs of the local population vary, survival outcomes are improving and patient choice may become an increasing factor in flap selection.Oral Surgery 02/2014; DOI:10.1111/ors.12080
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ABSTRACT: 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.Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 01/2015; DOI:10.1007/s00405-014-3489-1 · 1.61 Impact Factor
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ABSTRACT: Transoral resection of recurrences, second primaries and benign abnormalities after previous radiotherapy or concomitant chemoradiotherapy for head and neck cancer is not without risks. Chondroradionecrosis, cervical osteomyelitis and postoperative bleedings can occur several weeks postoperatively and can be life-threatening. Patients should be selected very carefully for transoral excision and they should be informed about the risk of complications. Only limited lesions should be selected and bare bone and cartilage has to be avoided. Appropriate antibiotic prophylaxis and tracheostomy in high-risk cases is recommended. This article is protected by copyright. All rights reserved.Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 08/2014; DOI:10.1111/coa.12265 · 2.27 Impact Factor