Yen-Hao Chiu1, Dun-Hao Chang, Cherng-Kang Perng. 1. From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital; †School of Medicine, National Yang-Ming University; ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital Taiwan, Republic of China.
Abstract
INTRODUCTION: Despite the excellent reliability of free tissue transfer, flap failure is devastating, and in addition to patient morbidity, it may increase hospital stay and associated costs. Previous studies have evaluated factors related to flap salvage, regarding the operative strategy for flap salvage surgery. The present study aimed to share our experience of reexploration and describe operative standards dealing with vascular thrombosis. METHODS: We retrospectively reviewed 150 (of 1258) free flaps for head and neck reconstruction that showed signs of vascular compromise at our institution during a 13-year period between 2002 and 2015. Patient demographics, including sex, age, premorbid health status, personal history, indication for reexploration, flap type, and number of recipient vessels, were analyzed. Days between the end of initial surgery and salvage surgery were also recorded. The incidence of postsalvage complications (hematoma formation, wound dehiscence, and infection requiring surgical intervention) and the overall flap survival were recorded. RESULTS: Of the 150 flaps, 87 flaps had evident arterial or venous thrombosis; 34 of these failed and required a second free flap or pedicle flap reconstruction. The remaining 53 were successfully salvaged. Although vascular thrombosis was found to be a major contributing factor in flap loss, no significant differences in any factor were found between patients with salvageable flaps and those with unsalvageable flaps. CONCLUSIONS: Vascular thrombosis is a major contributing factor in flap loss. The incidence of venous thrombosis is higher, but arterial thrombosis may be more severe. Improvements in the surgical technique and perioperative management are highly reliable. We believe that strict models of flap monitoring; well-trained, dedicated staff; and immediate reexploration will potentially further improve flap survival and optimize the quality of life.
INTRODUCTION: Despite the excellent reliability of free tissue transfer, flap failure is devastating, and in addition to patient morbidity, it may increase hospital stay and associated costs. Previous studies have evaluated factors related to flap salvage, regarding the operative strategy for flap salvage surgery. The present study aimed to share our experience of reexploration and describe operative standards dealing with vascular thrombosis. METHODS: We retrospectively reviewed 150 (of 1258) free flaps for head and neck reconstruction that showed signs of vascular compromise at our institution during a 13-year period between 2002 and 2015. Patient demographics, including sex, age, premorbid health status, personal history, indication for reexploration, flap type, and number of recipient vessels, were analyzed. Days between the end of initial surgery and salvage surgery were also recorded. The incidence of postsalvage complications (hematoma formation, wound dehiscence, and infection requiring surgical intervention) and the overall flap survival were recorded. RESULTS: Of the 150 flaps, 87 flaps had evident arterial or venous thrombosis; 34 of these failed and required a second free flap or pedicle flap reconstruction. The remaining 53 were successfully salvaged. Although vascular thrombosis was found to be a major contributing factor in flap loss, no significant differences in any factor were found between patients with salvageable flaps and those with unsalvageable flaps. CONCLUSIONS:Vascular thrombosis is a major contributing factor in flap loss. The incidence of venous thrombosis is higher, but arterial thrombosis may be more severe. Improvements in the surgical technique and perioperative management are highly reliable. We believe that strict models of flap monitoring; well-trained, dedicated staff; and immediate reexploration will potentially further improve flap survival and optimize the quality of life.
Authors: Amit Walia; Jake J Lee; Ryan S Jackson; Angela C Hardi; Craig A Bollig; Evan M Graboyes; Joseph Zenga; Sidharth V Puram; Patrik Pipkorn Journal: Otolaryngol Head Neck Surg Date: 2021-09-07 Impact factor: 5.591
Authors: Daniel Schiltz; Sebastian Geis; Andreas Kehrer; Jürgen Dolderer; Lukas Prantl; Christian D Taeger Journal: Plast Reconstr Surg Glob Open Date: 2017-10-24
Authors: Alberto Ballestín; Javier G Casado; Elena Abellán; F Javier Vela; Verónica Álvarez; Alejandra Usón; Esther López; Federica Marinaro; Rebeca Blázquez; Francisco Miguel Sánchez-Margallo Journal: PLoS One Date: 2018-12-27 Impact factor: 3.240