Reconstruction of the head and neck with free osteoseptocutaneous flap in elderly heavy smokers

Abstract

Objectives: We evaluated complications of free flap reconstruction following oncological head and neck surgery in elderly patients who smoked heavily. Patients and Methods: The study included eight patients 2 females, 6 males; mean age 68.5 years; range 65 to 74 years over 65 years of age, who smoked heavily at least 1 pack/day . All cases but one with mandibular ameloblastoma had intraoral squamous cell carcinoma. Two patients underwent reconstruction with free radial forearm osteoseptocutaneous flap following bilateral maxillary resection, and six patients with free fibular osteoseptocutaneous flap following mandibular resection. Postoperative complications, in particular those associated with the donor and recipient sites were evaluated. Results: No partial or total flap loss was observed. Wound healing problems were seen in three patients 37% , which were at the donor site in two patients, and at the recipient site in one patient. Psychogenic disorders were observed in two patients 25% . No other complications were encountered. Conclusion: Aside from some recipient- and donorsite-related healing problems, heavy smoking and advanced age cannot be regarded as contraindications for free flap reconstruction.

Keywords

• Reconstructive surgical procedures, smoking/ adverse effects, risk factors, surgical flaps, wound healing

Ağır sigara içici yaşlı hastaların baş-boyun rekonstrüksiyonunda serbest osteoseptokutan flep uygulamaları

Abstract

Amaç: Bu çalışmada, ağır sigara içici yaşlı hastalarda onkolojik baş-boyun cerrahisi sonrası gelişebilecek serbest flep komplikasyonları araştırıldı.Hastalar ve Yöntemler: Çalışmaya, 65 yaş üstü, ağır sigara içici en az 1 paket/gün sekiz hasta alındı. Hastalardan biri mandibüler ameloblastom, yedisi ağız içi yerleşimli skuamöz hücreli karsinom nedeniyle ameliyat edildi. İki hastaya iki taraflı maksiller rezeksiyon sonrası serbest radial önkol osteoseptokutan flep, altı hastaya mandibüler rezeksiyon sonrası serbest fibular osteoseptokutan flep uygulandı. Tüm olgular, alıcı ve verici sahadaki komplikasyonlar ile genel tıbbi komplikasyonlar açısından incelendi.Bulgular: Hiçbir hastada kısmi ya da tam flep kaybı görülmedi. Üç hastada %37 yara iyileşmesi komplikasyonu gelişti; bu komplikasyonların ikisi verici sahada, biri alıcı sahada idi. İki hastada %25 psikojenik sorunlar görüldü. Bunun dışında genel tıbbi komplikasyonlara rastlanmadı.Sonuç: Alıcı ve verici sahada oluşabilecek komplikasyonlara rağmen, ağır sigara içimi ve ileri yaş serbest flep uygulamaları açısından kontrendikasyon olarak görülmemelidir

Keywords

• Rekonstrüktif cerrahi işlem, sigara içme/yan etki, risk faktörü, cerrahi flep, yara iyileşmesi

References

1. Howard MA, Cordeiro PG, Disa J, Samson W, Gonen M, Schoelle RN, et al. Free tissue transfer in the elder- ly: incidence of perioperative complications follow- ing microsurgical reconstruction of 197 septuagenar- ians and octogenarians. Plast Reconstr Surg 2005;116: 1659-68.
2. Türkiye nüfus ve kalkınma göstergeleri. 2007. Internet erişimi: http://nkg.tuik.gov.tr/goster.asp?aile=1
3. Harris GD, Finseth F, Buncke HJ, Norris T. Microvascular procedure in patients over fifty years of age. Chir Plastica 1981;6:37-41.
4. Chick LR, Walton RL, Reus W, Colen L, Sasmor M. Free flaps in the elderly. Plast Reconstr Surg 1992;90:87-94.
5. Shestak KC, Jones NF. Microsurgical free-tissue transfer in the elderly patient. Plast Reconstr Surg 1991;88:259-63.
6. Shestak KC, Jones NF, Wu W, Johnson JT, Myers EN. Effect of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects. Head Neck 1992;14:14-8.
7. Schusterman MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H. A single center’s experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994;93:472-8.
8. Furnas H, Canales F, Lineaweaver W, Buncke GM, Alpert BS, Buncke HJ. Microsurgical tissue transfer in patients more than 70 years of age. Ann Plast Surg 1991;26:133-9.

9. Malata CM, Cooter RD, Batchelor AG, Simpson KH, Browning FS, Kay SP. Microvascular free-tissue trans- fers in elderly patients: the Leeds experience. Plast Reconstr Surg 1996;98:1234-41.
10. Davenport HT. Anaesthetics and elderly patients. BMJ 1991;303:870-1.
11. Bonawitz SC, Schnarrs RH, Rosenthal AI, Rogers GK, Newton ED. Free-tissue transfer in elderly patients. Plast Reconstr Surg 1991;87:1074-9.
12. Chang DW, Reece GP, Wang B, Robb GL, Miller MJ, Evans GR, et al. Effect of smoking on complications in patients undergoing free TRAM flap breast recon- struction. Plast Reconstr Surg 2000;105:2374-80.
13. Chang LD, Buncke G, Slezak S, Buncke HJ. Cigarette smoking, plastic surgery, and microsurgery. J Reconstr Microsurg 1996;12:467-74.
14. Reus WF 3rd, Colen LB, Straker DJ. Tobacco smok- ing and complications in elective microsurgery. Plast Reconstr Surg 1992;89:490-4.
15. Aydin A, Emekli U, Erer M, Hafiz G. Fibula free flap for mandible reconstruction. Kulak Burun Bogaz Ihtis Derg 2004;13:62-6.
16. Mosely LH, Finseth F, Goody M. Nicotine and its effect on wound healing. Plast Reconstr Surg 1978;61:570-5.
17. Kaufman T, Eichenlaub EH, Levin M, Hurwitz DJ, Klain M. Tobacco smoking: impairment of experimen- tal flap survival. Ann Plast Surg 1984;13:468-72.
18. Yaffe B, Cushin BJ, Strauch B. Effect of cigarette smoking on experimental microvascular anastomoses. Microsurgery 1984;5:70-2.
19. Rao VK, Morrison WA, O’Brien BM. Effect of nicotine on blood flow and patency of experimental microvas- cular anastomosis. Ann Plast Surg 1983;11:206-9.
20. Forrest CR, Pang CY, Lindsay WK. Pathogenesis of ischemic necrosis in random-pattern skin flaps induced by long-term low-dose nicotine treatment in the rat. Plast Reconstr Surg 1991;87:518-28.
21. van Adrichem LN, Hoegen R, Hovius SE, Kort WJ, van Strik R, Vuzevski VD, et al. The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in the rat. Plast Reconstr Surg 1996;97:86-96.
22. Sachar K, Goel R, Weiss AP. Acute and chronic effects of nicotine on anastomotic patency following isch- emia/reperfusion. J Reconstr Microsurg 1998;14:179-84.
23. Shaw WW. Microvascular free flaps. The first decade. Clin Plast Surg 1983;10:3-20.
24. Kobus K, Stepniewski J. Free flaps versus conventional surgery. Ann Plast Surg 1985;15:14-34.