The use of microvascular free flaps in head and neck reconstruction performed by the otorhinolaryngologists: a series of 65 flaps

Yıl 2016, Cilt: 26 Sayı: 6, 317 - 324, 22.12.2016

Bora Başaran Selin Ünsaler İsmet Aslan

Öz

Objectives: This study aims to assess the success rate of surgery and postoperative morbidity in patients who underwent major head and neck surgery with reconstruction by microvascular free flaps performed by otolaryngologists. Patients and Methods: We retrospectively analyzed the medical records of 63 patients 31 males, 32 females; mean age 47.9±12.5 years; range 20-71 years operated in our clinic between September 2012 - August 2016. The indications of reconstruction by free flap, success rates, need for revision and re-exploration, reasons of flap failure, morbidity and mortality were evaluated. Results: Thirty-seven 56.9% of the 65 microvascular free flaps were radial forearm; 23 flaps 35.4% were fibula and five flaps 7.7% were rectus abdominis. Three of the total 65 flaps ended up in failure; accordingly the success rate was 95.4%. Except for these three failure cases, an urgent re-exploration was performed on 13 patients in the first postoperative 48 hours n=16, %24.6 . No permanent major sequel was observed in any of the patients. Conclusion: From the otolaryngologists’ point of view, we observed that performing microvascular surgery and the successful surgical results not only gives the flexibility in reconstruction but also provides safer resection during ablative surgery.

Anahtar Kelimeler

Free flap, head and neck surgery, microvascular, reconstruction

Baş boyun bölgesi rekonstrüksiyonunda kulak burun boğaz uzmanlarınca mikrovasküler serbest doku fleplerinin kullanımı: 65 fleplik seri

Öz

Amaç: Bu çalışmada majör baş-boyun cerrahisi sonrası, kulak burun boğaz uzmanlarınca mikrovasküler serbest doku flebi ile rekonstrüksiyon yapılan hastalarda flep başarı oranları ve hasta morbiditesi araştırıldı. Hastalar ve Yöntemler: Eylül 2012 - Ağustos 2016 tarihleri arasında kliniğimizde ameliyat edilen toplam 63 hastanın 32 kadın, 31 erkek; ort. yaş 47.9±12.5 yıl; dağılım 20-71 yıl tıbbi kayıtları retrospektif olarak incelendi. Serbest doku flebi seçimindeki endikasyonlar, başarı oranları, revizyon ve reeksplorasyon gereksinimleri; flep kaybı, morbidite ve mortalite nedenleri değerlendirildi. Bulgular: Altmış beş mikrovasküler serbest doku flebinin 37’si %56.9 radyal ön kol, 23’ü %35.4 fibula ve beşi %7.7 rektus abdominis flebi idi. Toplam 65 flebin üçü kaybedildi, buna göre genel flep başarı oranı %95.4 idi. Kaybedilen üç flep dışında, 13 hastada ameliyat sonrası 48 saat içinde ameliyathanede reeksplorasyon yapıldı n=16, %24.6 . Hiçbir hastada donör sahada kalıcı majör sekel gelişmedi. Sonuç: Kulak burun boğaz uzmanı açısından bakıldığında, mikrovasküler tekniğe hakim olunması ve elde edilen başarılı cerrahi sonuçlar, rekonstrüksiyonda esneklik ve dolayısıyla da ablatif cerrahi sırasında da güvenli rezeksiyon rahatlığı sağladığı gözlemlendi.

Anahtar Kelimeler

Serbest doku, baş-boyun cerrahisi, mikrovasküler, rekonstrüksiyon

Kaynakça

• Baxi SS, Pinheiro LC, Patil SM, Pfister DG, Oeffinger KC, Elkin EB. Causes of death in long-term survivors of head and neck cancer. Cancer 2014;120:1507-13.
• Sankaranarayanan R, Masuyer E, Swaminathan R, Ferlay J, Whelan S. Head and neck cancer: a global perspective on epidemiology and prognosis. Anticancer Res 1998;18:4779-86.
• Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus- associated cancers? Cancer 2007;110:1429-35.
• Lydiatt WM, Moran J, Burke WJ. A review of depression in the head and neck cancer patient. Clin Adv Hematol Onco 2009;7:397-403.
• Seidenberg B, Rosenak SS, Hurwitt ES, Som ML. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959;149:162-71.
• Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975;55:533-44.
• Pennington DG, Pelly AD. The rectus abdominis myocutaneous free flap. Br J Plast Surg 1980;33:277-82.
• Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, et al. Forearm free skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg 1997;50:162-5.
• Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989;84:71-9.
• Panje WR, Bardach J, Krause CJ. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg 1976;58:415-8.
• Spiegel JH, Polat JK. Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 2007;117:485-90.
• Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 2001;47:385-9.
• Gil Z, Abergel A, Leider-Trejo L, Khafif A, Margalit N, Amir A, et al. A comprehensive algorithm for anterior skull base reconstruction after oncological resections. Skull Base 2007;17:25-37.
• Pribaz JJ, Fine NA. Prefabricated and prelaminated flaps for head and neck reconstruction. Clin Plast Surg 2001;28:261-72.
• Schwabegger AH. Flap re-exploration. In: Wei FC, Mardini S, editors. Flaps and Reconstructive Surgery. 1st ed. Philadelphia: Saunders-Elsevier Publishers; 2009. p. 125-36.
• Salgado CJ, Smith A, Kim S, Higgins J, Behnam A, Herrera HR, et al. Effects of late loss of arterial inflow on free flap survival. J Reconstr Microsurg 2002;18:579-84.
• Esclamado RM, Carroll WR. The pathogenesis of vascular thrombosis and its impact in microvascular surgery. Head Neck 1999;21:355-62.
• Kubo T, Yano K, Hosokawa K. Management of flaps with compromised venous outflow in head and neck microsurgical reconstruction. Microsurgery 2002;22:391-5.
• Davies DM. A world survey of anticoagulation practice in clinical microvascular surgery. Br J Plast Surg 1982;35:96-9.
• Khouri RK. Avoiding free flap failure. Clin Plast Surg 1992;19:773-81.
• Collaborative overview of randomised trials of antiplatelet therapy--II: Maintenance of vascular graft or arterial patency by antiplatelet therapy. Antiplatelet Trialists' Collaboration. BMJ 1994;308:159-68.
• Johnson PC, Barker JH. Thrombosis and antithrombotic therapy in microvascular surgery. Clin Plast Surg 1992;19:799-807.
• Pugh CM, Dennis RH, Massac EA. Evaluation of intraoperative anticoagulants in microvascular free- flap surgery. J Natl Med Assoc 1996;88:655-7.
• Ritter EF, Cronan JC, Rudner AM, Serafin D, Klitzman B. Improved microsurgical anastomotic patency with low molecular weight heparin. J Reconstr Microsurg 1998;14:331-6.