Home  About us  Contact
 

And Neck Defects (and + neck_defect)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of And Neck Defects

  • head and neck defect
    		•

    Selected Abstracts

    Analysis of free flap viability based on recipient vein selection

    HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2009
    David O. Francis MD
    Abstract Background. Venous anastomotic failure is the primary reason for microvascular free tissue transfer failure. Donor and recipient veins can be oriented in the same longitudinal axis (end-to-end anastomosis), or the donor vein can be anastomosed to the internal jugular vein in an end-to-side configuration. No consensus on the optimal anastomosis configuration exists. We sought to evaluate whether type of venous anastomosis impacts flap survival rate. Methods. Data were collected on all patients undergoing microvascular free flap reconstruction of head and neck defects at the University of Washington between August 1993 and April 2007. Flaps with a single venous anastomosis were analyzed. Flaps were stratified into those with end-to-end and end-to-side anastomoses. Survival rates were compared between groups using bivariate and multivariate techniques. Results. Inclusion criteria were met by 786 free flaps; 87% performed in an end-to-end and 13% in an end-to-side configuration. Flap re-exploration and failure rate were 4.3% and 1.1%, respectively. In multivariate analysis, there was no difference in odds of flap re-exploration (OR .70, 95% CI .23,2.18) or flap failure whether or not an end-to-end or end-to-side anastomosis was performed (OR 2.09, 95% CI .38,11.5). Conclusions. In this large cohort of patients, we found no difference in the odds of flap re-exploration or failure based on venous anastomotic configuration. Reconstructive surgeons should have both anastomotic techniques in their repertoire to optimize the success of every flap. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]

    Simplifying head and neck microvascular reconstruction

    HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2004
    Eben Rosenthal MD
    Abstract Background. Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results. © 2004 Wiley Periodicals, Inc. Head Neck26: 930,936, 2004 [source]

    Microvascular surgery in the previously operated and irradiated neck,

    MICROSURGERY, Issue 1 2009
    Matthew M. Hanasono M.D.
    Microvascular reconstruction of head and neck defects can be extremely challenging in patients with a history of prior neck dissection and/or irradiation. We reviewed of 261 head and neck free flaps performed between 2004 and 2007 at a tertiary cancer center. One hundred twenty-four (52%) free flaps were performed in patients with a history of prior neck dissection and/or irradiation. The ipsilateral external carotid artery or one of its branches was not available in 43 (19%) cases: 13 with no history of prior neck dissection or irradiation, and 30 with a history of prior neck dissection and/or irradiation (P = 0.03). The ipsilateral internal/external jugular veins (IJ/EJ) were not available in 37 (16%) cases: 11 with no history of prior neck dissection or irradiation, and 26 with a history of prior neck dissection and/or irradiation (P = 0.002). Strategies for dealing with lack of a recipient vessels included anastomosis to contralateral neck vessels, transverse cervical vessels, internal mammary vessels, the cephalic vein, and the pedicle of another free flap. We propose an algorithm for locating recipient vessels adequate for microvascular anastomosis should the ipsilateral external carotid arterial and/or the internal/external jugular venous systems not be available, such as in the setting of prior neck dissection or irradiation. © 2008 Wiley-Liss, Inc. Microsurgery, 2009. [source]

    Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

    MICROSURGERY, Issue 7 2007
    Sukru Yazar M.D.
    The development of microsurgical techniques has facilitated proper management of extensive head and neck defects and deformities. Bone or soft tissue can be selected to permit reconstruction with functional and aesthetic results. However, for free tissue transfer to be successful, proper selection of receipient vessels is as essential as the many other factors that affect the final result. In this article selection strategies for recipient vessels for osteocutaneous free flaps, soft tissue free flaps, previously dissected and irradiated areas, recurrent and subsequent secondary reconstructions, simultaneous double free flap transfers in reconstruction of extensive composite head and neck defects, and the selection of recipient veins are reviewed in order to provide an algorithm for the selection of recipient vessels for head and neck reconstruction. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source]

    The Platysma Myocutaneous Flap: Underused Alternative for Head and Neck Reconstruction,

    THE LARYNGOSCOPE, Issue 7 2002
    Wayne M. Koch MD
    Abstract Objectives The use, advantages, and disadvantages of the platysma flap were assessed. Study Design Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001. Methods Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the ,2 test. Results Thirty-four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions. Conclusions The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects. [source]