Nolan B Seim1, Matthew Old2, Daniel Petrisor3, William Thomas3, Akash Naik2, Alia J Mowery3, Stephen Kang2, Ryan Li3, Mark K Wax4. 1. The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA. Electronic address: nolanseim@gmail.com. 2. The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA. 3. Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239, USA. 4. Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239, USA. Electronic address: waxm@ohsu.edu.
Abstract
OBJECTIVE: Interposition vein grafting in free flap reconstruction is often viewed as a risky procedure, but is necessary in cases of inadequate pedicle length. MATERIALS AND METHODS: Two tertiary care centers retrospectively.reviewed 3008 head and neck free flap reconstructions from 2008 to 2017 91 patients were identified requiring interposition vein grafting during reconstruction. Pre and perioperative characteristics were recorded Univariate and multivariate analyses were conducted with a p value <0.05 indicating statistical significance. RESULTS: Of the 91 patients 75% had undergone reconstruction for cancer, 66% of these cases were in the setting of recurrence or complication, 33% had a previous free flap, and 52% had prior radiation therapy. Surgical site was primarily craniofacial (36%) or oral cavity (26%). The majority of vein grafts were saphenous (64%), average graft length 18 cm (SD 11 cm). Half were used for both artery and vein anastomosis. Flap survival was 85% overall and only prior free flap was predictive of failure on multivariate analysis. No other peri-operative or graft variable assessed in this study were predictive of flap failure. CONCLUSION: In a multi-institutional study of head and neck free flap reconstructions using interposition vein grafts, we identified an overall 85% success rate with no significant difference between soft tissue and osteocutaneous flaps despite the complicated nature of these cases.
OBJECTIVE: Interposition vein grafting in free flap reconstruction is often viewed as a risky procedure, but is necessary in cases of inadequate pedicle length. MATERIALS AND METHODS: Two tertiary care centers retrospectively.reviewed 3008 head and neck free flap reconstructions from 2008 to 2017 91 patients were identified requiring interposition vein grafting during reconstruction. Pre and perioperative characteristics were recorded Univariate and multivariate analyses were conducted with a p value <0.05 indicating statistical significance. RESULTS: Of the 91 patients 75% had undergone reconstruction for cancer, 66% of these cases were in the setting of recurrence or complication, 33% had a previous free flap, and 52% had prior radiation therapy. Surgical site was primarily craniofacial (36%) or oral cavity (26%). The majority of vein grafts were saphenous (64%), average graft length 18 cm (SD 11 cm). Half were used for both artery and vein anastomosis. Flap survival was 85% overall and only prior free flap was predictive of failure on multivariate analysis. No other peri-operative or graft variable assessed in this study were predictive of flap failure. CONCLUSION: In a multi-institutional study of head and neck free flap reconstructions using interposition vein grafts, we identified an overall 85% success rate with no significant difference between soft tissue and osteocutaneous flaps despite the complicated nature of these cases.
Authors: Hannah C Langdell; Ronnie L Shammas; Andrew Atia; Edward I Chang; Evan Matros; Brett T Phillips Journal: Plast Reconstr Surg Date: 2022-03-01 Impact factor: 4.730
Authors: Paolo Iacoviello; Susanna Bacigaluppi; Simone Callegari; Carlo Rossello; Andrea Antonini; Marco Gramegna; Mariano Da Rold; Giuseppe Signorini; Giuseppe Verrina Journal: Front Surg Date: 2022-06-30
Authors: Andreas M Fichter; Thomas Mücke; Lucas M Ritschl; Marie-Kristin Hofmann; Constantin T Wolff; Leonard H Schmidt; Klaus-Dietrich Wolff Journal: Sci Rep Date: 2021-04-22 Impact factor: 4.379