Cases Of Free Flaps Research Articles

Comparing venous thrombosis rates in hand-sewn anastomosis to anastomotic coupler devices

<br><b>Background:</b> Anastomotic coupling device (ACD) has reached wide popularity, especially in venous anastomosis of free-tissue transfers. There are scant reviews in the literature about the reliability of these devices in venous anastomosis. We retrospectively analyzed our free flap cases to compare the thrombosis rates between ACDs and handsewn anastomosis and other possible risk factors that may contribute to venous thrombosis. <b>Materials and Methods:</b> Data of all microvascular free-tissue transfers performed between January 2015 and August 2019 were retrospectively reviewed. Patient characteristics were recorded. Reconstruction characteristics such as venous anastomosis type (hand-sewn vs. anastomotic coupler device), reconstruction site, and number of surgical interventions were also recorded. <b>Results:</b> A total of 385 consecutive-free microvascular reconstructions were identified. Total venous thrombosis rate was 4.7%. There was no statistically significant difference between hand-sewn anastomosis and anastomosis with coupler device (5.2% vs. 3.2%, <i>P</i> = 0.58). Only reconstruction site was found to be significantly associated with higher venous thrombosis (<i>P</i> = 0.03). <b>Discussion:</b> Our results involving different reconstruction sites and including multiple flap types demonstrated comparable revision rates between ACDs and hand-sewn anastomosis. This finding is consistent with the current literature.<br>

Venous Flow Coupler in Head and Neck Free Flap Reconstruction.

To describe the utility of venous flow couplers in monitoring free tissue flaps in the immediate postoperative setting. Retrospective case series. Otolaryngology department at a single tertiary care institution. A retrospective case series of free flap reconstructions in which venous flow couplers were employed to supplement flap monitoring. All free flap cases performed over the past 4 years were reviewed. Inclusion criteria were venous flow coupler and arterial flow Doppler monitored for 5 days postoperatively. From July 2014 through May 2018, the venous flow coupler was used with the arterial flow Doppler and clinical monitoring in 228 cases. Eleven cases did not meet criteria for inclusion; thus, 217 cases were analyzed. Twenty cases (9.2%) returned to the operating room with concern for flap compromise, and 16 were salvaged. The combination of venous flow coupler and arterial flow Doppler identified 19 of these flaps. Venous flow couplers identified 5 compromised flaps before there was an arterial signal change, and all were salvaged. Additionally, there was a 24.1% false-positive rate when 2 venous flow couplers were used in parallel. For the venous flow coupler, the positive predictive value was 64.3% and the negative predictive value, 98.9%. The false-positive rate in the series was 5.1%. The sensitivity was 90% and the specificity, 94.9%. The venous flow coupler is able to detect venous thrombosis in the absence of arterial thrombosis and may contribute to improved flap salvage rates.

Head and Neck Microsurgeon Practice Patterns and Perceptions Regarding Venous Thromboembolism Prophylaxis.

Patients undergoing head and neck (H&N) microvascular reconstruction comprise a population at high risk for venous thromboembolism (VTE). Free flap and VTE thromboprophylaxis may coincide but tend to vary from surgeon to surgeon. This study identifies VTE prophylaxis patterns and perceptions among H&N microsurgeons in the United States. An online survey on VTE prophylaxis practice patterns and perceptions was emailed to 172 H&N microsurgeons in the United States using an anonymous link. There were 74 respondents (43% response rate). These surgeons completed residencies in otolaryngology (59%), plastic surgery (31%), and oral maxillofacial surgery (7%). Most underwent fellowship training (95%) and have practiced at an academic center (97%) for at least 6 years (58%), performing an average of 42 ± 31 H&N free flap cases per year (range = 1-190). Most adhered to general VTE prophylaxis guidelines (69%) while 11% did not and 20% were unsure. Nearly all surgeons (99%) would provide prophylactic anticoagulation, mostly in the form of subcutaneous heparin (51%) or enoxaparin (44%); 64% additionally used aspirin, while 4% used aspirin alone. The majority of surgeons (68%) reported having postoperative VTE complications, with six surgeons (8%) reporting patient deaths due to pulmonary embolism. A third of the surgeons have encountered VTE prophylaxis-related adverse bleeding events, but most still believe that chemoprophylaxis is important for VTE prevention (92%). While 35% of surgeons were satisfied with their current practice, most would find it helpful to have official prophylactic anticoagulation guidelines specific to H&N free flap cases. The majority of microsurgeons experienced postoperative VTE complications after H&N free flap reconstruction despite the routine use of prophylactic anticoagulation. Though bleeding events are a concern, most surgeons believe chemoprophylaxis is important for VTE prevention and would welcome official guidelines specific to this high-risk population.

Early And Recent Development Of Reconstructive Microsurgery Subspeciality In Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia (1983-2020)

Plastic surgery in Indonesia was pioneered and developed by Moenadjat Wiratmadja, MD., in 1958. This specialty experienced many developments and improvements over time with more specific subspecialties to facilitate the advancement of the science of plastic surgery, including the reconstructive microsurgery subspecialty. The reconstructive microsurgery service in the plastic surgery division dr. Ciptomangunkusumo National Hospital (RSCM), Jakarta, Indonesia was first initiated by Sidik Setiamiharja, MD., self-taught from the textbooks. In late 1985, following the success of conducting the first basic microsurgery course in Jakarta, the plastic surgery team in RSCM which consisted of Sidik Setiamihardja, MD, Chaula L. Sukasah, MD and Gentur Sudjatmiko, M.D. pioneered many of the first microsurgery cases, including the first major limb replantation, first penile replantation and the first free flap. Overtime, the reconstructive microsurgery subspecialty has been growing significantly. In 2019, the number of free flap cases at RSCM reached the highest number in Indonesia with 90 free flap cases with 94% success rate.

The chicken or the egg? Relationship between venous congestion and hematoma in free flaps

Postoperative hematoma and venous congestion after free tissue transfer may occur independently or concurrently. We aimed to explore the association between these two events. All free flap reconstructions for head and neck (HN) and breast from a single institution between 2004 and 2014 were retrospectively reviewed for reoperation for venous congestion and/or hematoma. There were 2985 free flap cases for HN reconstruction and 2345 cases for breast reconstruction. In HN, 100 patients developed a hematoma (3.4%) and 84 patients developed venous congestion (2.8%). The prevalence of hematoma was 17.8% and 2.9% in the presence and absence of congestion, respectively (p<0.001). Among the 15 patients who had both hematoma and venous congestion were separate events that occurred from 1 to 9 days apart in 8 patients. Hematoma caused the compression of the pedicle vein in 4 patients, while venous congestion possibly caused hematoma in 3 patients. In breast, 56 patients developed a hematoma (2.4%) and 64 patients developed venous congestion (2.7%). The prevalence of hematoma was 12.5% and 2.1% in the presence and absence of congestion, respectively (p<0.001). In the 8 patients who developed both, hematoma and congestion were separate events in 4 patients. Venous congestion caused hematoma in 3 patients, and hematoma caused venous congestion in 1 patient. Although postoperative hematoma and venous congestion often present concurrently, most events are not causally associated. When related, however, venous congestion leading to hematoma is more common in breast reconstruction, while hematoma preceding venous congestion is more common in HN reconstruction.

Analysis of outcome and complications in a ten year experience of 469 cases of free flap reconstruction in head and neck cancer

We audited prospectively 469 cases of head and neck free flap cases over a ten year period in a single unit. Over the ten years several adaptations have been made to the clinical path of head and neck cancer cases.

Microsurgery Fellows' Impression of Clinical and Educational Offerings during Fellowship Year.

Acquisition of microsurgical skill and clinical knowledge is the primary goal of a microsurgery fellowship. There has yet to be any comprehensive reporting in the literature of how American microsurgery fellows viewed their curricula and training at the conclusion of their fellowship year. An anonymous, electronic survey was developed and distributed to all 2016 to 2017 microsurgery fellows (n = 37) at the U.S.-based microsurgery fellowship programs (n = 23). Qualitative questions were assessed using either a Likert-type scale of 1 (not at all) to 5 (very), multiple choice, or free response. Twenty-six of 37 fellows (70%) responded to the survey. Respondents reported a mean of 14.4 lectures offered, with a range of 0 to 100. Dry laboratory simulation training was formally incorporated into 32% of microsurgery fellowships and live animal simulation training was formally incorporated into 12%. The median number of free deep inferior epigastric perforator flap cases performed was 112.5, ranging from 60 to 230. A majority felt that an organized microsurgical educational curriculum would be "beneficial," with 42% reporting that an organized microsurgery curriculum would be "very beneficial." Twenty-six of the respondents (100%) said that they would choose to do a microsurgery fellowship again if given the choice. Respondent data show that microsurgery fellows are satisfied with training, clinical experience is variable but adequate, educational experiences and opportunities vary from program to program, simulation skills training are perceived to be underutilized, and a program-organized microsurgery curriculum is believed to be advantageous to optimize development of technical and clinical skills.

Application of deep femoral artery third perforating artery flap for reconstruction of soft tissue defect in lower limles

Objective To investigate the feasibility and clinical effects of deep femoral artery third perforating artery perforator flap for reconstruction of soft tissue defect in lower limbs. Methods From September, 2008 to October, 2016, 8 cases of soft tissue defect in lower limbs which were repaired by deep femoral artery third perforating artery perforator flap, including 4 cases of traffic accident trauma, 2 cases of chronic ulcer, 1 case of a fall injury, 1 case of the scar after fracture operation. The area of wounds was 8.0 cm×7.0 cm-19.0 cm×8.0 cm. Seven patients were accompanied by different degrees of infections. The deep femoral artery third perforating artery perforator flap was designed to repair, including 5 cases of pedicled flaps and 3 cases of free flaps. The flap’s appearance, color, texture, infection recurrence and the recovery of lower limb function were recorded at 1, 3, 6, 9 and 12 months followed-up. Results One flap suffered partial necrosis due to cross-zone backflow disorder, the ipsilateral medial sural artery pedicled perforator flap was used to repair. The rest of the flaps survived successfully. Skin graft was used to close the donor site in 1 case, and other donor sites were closed directly. All patients had no postoperative hematoma or secondary infection. The followed-up periods ranged from 2 to 28 months (mean, 8.1 months). All flaps had satisfied appearance and texture. There were no complications such as paresthesia and numbness in the donor sites. And no motion limitations in hip and knee joint of the operated leg. Conclusion Deep femoral artery third perforating artery perforator flap can be used for both free flaps and pedicled flaps, which is a feasible method to repair soft tissue defect in lower limbs. Key words: Perforator flap; Deep femoral artery; Third perforating artery; Lower limb; Soft tissue defect

Repair of skin and soft tissue defects in extremities with the superior lateral genicular artery perforator flap

To investigate the feasibility and effectiveness of the superior lateral genicular artery perforator flap for repairing of soft tissue defects in extremities. Between September 2010 and October 2017, 11 cases of skin and soft tissue in extremities were repaired with the superior lateral genicular artery perforator flap. There were 10 males and 1 female, with an average age of 37.6 years (range, 6-72 years). The causes of injury were traffic accident in 6 cases, machine injury in 1 case, falling down injury in 1 case, falling from height in 1 case, crushing injury in 1 case, and electric injury in 1 case. The defects located at the forearm in 1 case, knee in 5 cases, popliteal fossa in 2 cases, shank in 1 case, and foot and ankle in 2 cases. The area of the wound ranged from 8.0 cm×4.5 cm to 27.0 cm×8.0 cm. The interval from injury to admission was 6 days on average (range, 3-12 days). The area of perforator flap ranged from 9.0 cm×5.5 cm to 28.0 cm×9.0 cm. There were 8 cases of pedicle flap and 3 cases of free flap. All the donor sites were closed directly. Eight flaps survived without any complications and the donor sites healed by first intention. Two flaps had arterial crisis and 1 flap had venous crisis after operation, and the wounds healed after symptomatic treatment. There was no hematoma and secondary infections in all patients after operation. Ten patients were followed up 2-48 months (mean, 13.1 months). All flaps had satisfied appearance and texture. There was no motion limitations in the hip and knee joints of the operated legs. The superior lateral genicular artery perforator flap not only can be used to repair the soft tissue defect around the knee joint as pedicle flap, but also can be used to repair the forearm and foot skin and soft tissue defects as free flap, which is a feasible way to repair soft tissue defects in extremities.

Subjective morbidity following radial free flap reconstruction in head and neck tumour patients.

Evaluation of post-operative donor site disability remains unaddressed in radial forearm free flap cases. This study aimed to assess donor site dysfunction following radial forearm free flap harvest using validated general, disease-specific and site-specific disability questionnaires. In this retrospective case series of 24 patients at a tertiary academic medical centre, patients were assessed using the Short Form 36 Health Survey, Short Musculoskeletal Function Assessment questionnaire, and Disabilities of the Arm, Shoulder and Hand questionnaire. One-sample z-tests were performed, comparing means of the cohort to controls. Compared to population controls, the cohort had higher mean scores for the Disabilities of the Arm, Shoulder and Hand questionnaire (18.22 vs 10.1, p &lt; 0.01), and Short Musculoskeletal Function Assessment questionnaire bothersome index (21.44 vs 13.77, p = 0.04), and a lower mean score for the Short Form 36 Health Survey physical component (38.88 vs 50, p &lt; 0.01), indicating a greater disability for the cohort compared to controls. Radial forearm free flap harvest causes significant long-term donor site disability in head and neck tumour patients. The Disabilities of the Arm, Shoulder and Hand questionnaire is a concise tool for measuring this dysfunction.

A free gracilis muscle flap for foot resurfacing, the first microsurgical case in a Sub-Saharan African country, Togo

In Togo, reconstructive management has been based on local and regional flaps. In some severe cases and in cases of failure, only a cross leg flap (if possible) or an amputation would save the patient. It has become vital to move forward in the reconstructive ladder in our setting. We report our first case of free gracilis muscle flap for the reconstruction of a foot defect in a 21-year-old male patient who was presented with a foot laceration due to a road traffic accident. The plastic surgeon had training in microsurgery. For other members of the operative team, this was the first microsurgery procedure. The gracilis muscle was harvested from the contralateral thigh and inset in the defect by microsurgical vascular anastomosis. The flap’s monitoring was done clinically. The post-operative course was uneventful. The muscle flap was resurfaced on day 5 using a split thickness skin graft. The patient was discharged on day 12. Total healing was seen on day 21. The patient was very satisfied with the procedure. The success of this first case represents an optimal motivation to build up a microsurgery team and the debut of microsurgery procedures for patients with difficult defects in Togo.

Intraoperative Use of Vasopressors Does Not Increase the Risk of Free Flap Compromise and Failure in Cancer Patients.

To examine the effects of vasopressors on free flap outcomes. Most micro-surgeons avoid the use of vasopressors during free flap surgery due to concerns of vasoconstriction, which could potentially lead to vascular thrombosis and flap failure. Previous studies lack the statistical power to draw meaningful conclusions. All free flaps between 2004 and 2014 from a single institution were reviewed retrospectively. Vasopressors were given intraoperatively as an intravenous bolus when blood pressure dropped >20% from baseline. The timing of intraoperative vasopressor administration was divided into 3 phases: from anesthesia induction to 30 minutes before the start of flap ischemia (P1); end of P1 to 30 minutes after revascularization (P2); end of P2 to end of surgery (P3). Agents included phenylephrine, ephedrine and calcium chloride. A total of 5671 free flap cases in 4888 patients undergoing head and neck, breast, trunk, or extremity reconstruction were identified. Vasopressors were used intraoperatively in 85% of cases. The overall incidence of pedicle compromise was 3.6%, with a flap loss rate of 1.7%. A propensity score matching analysis showed that intraoperative use of any agents at any time of surgery was not associated with increased overall pedicle compromise [51/1584 (3.2%) vs 37/792 (4.7%); P = 0.074] or flap failure rates [26/1584 (1.6%) vs 19/792 (2.4%); P = 0.209]. Rather, there was less risk of venous congestion [33/1584 (2.1%) vs 31/792 (3.9%); P = 0.010]. Intraoperative use of phenylephrine, ephedrine, or calcium chloride as an intravenous bolus does not increase flap compromise and failure rates in cancer patients.

Long-term Trends in Head and Neck Surgery Outcomes.

The aim of the present study is to address the paucity of data on long-term trends in postoperative complication rates in head and neck surgery. Specifically, this study assesses trends in morbidity and mortality following head and neck surgery over a 20-year period from 1995 to 2015 and identifies risk factors for the development of complications. Retrospective cross-sectional analysis of Veterans Affairs Surgical Quality Improvement Program database from 1995 to 2015. Veterans Affairs medical centers across the United States. Using the Veterans Affairs Surgical Quality Improvement Program database, we selected 44,161 patients undergoing head and neck procedures from 1995 to 2015. Trends in 30-day morbidity and mortality were assessed, and univariate and multivariate analyses of risk factors for complications were performed. From 1995-2000 to 2011-2015, overall complication rates decreased >45% (from 10.9% to 5.9%), and 30-day postsurgical mortality decreased nearly 70% (from 1.3% to 0.4%). Postoperative hospital stays also significantly declined. Major procedures, such as free flap cases and total laryngectomies, had less change in complication rate as compared with less invasive procedures. Substantial improvement in postoperative morbidity and mortality has taken place in head and neck surgery over the past decades. Static complication rates in some procedures may reflect that the improvement of surgical techniques allow for the treatment of sicker patients. The trends seen in this study speak to the importance of probing further why high rates of complications are still seen in certain procedures and ensuring that effective treatment is balanced with limiting morbidity and mortality.

Outcomes of microvascular flap reconstruction of the head and neck in patients receiving systemic immunosuppressive therapy for organ transplantation

For organ transplant recipients, cancer secondary to immunosuppressive therapy threatens long-term survival. The associated multiple comorbidities make major free flap reconstruction following cancer surgery a complicated event. This study evaluates the outcomes of free flap reconstruction in this population. A retrospective chart review of all head and neck free flap cases in patients with a history of organ transplantation receiving systemic immunosuppressive therapy between 2005 and 2017 at a single-institution was conducted. Of 57 organ transplant patients, 25 patients (28 flaps) were included. Flaps used included the anterolateral thigh (n = 17), radial forearm (n = 4), latissimus dorsi (n = 3), fibula (n = 2), lateral arm (n = 1), and thoracodorsal artery perforator (n = 1) flaps. The most common organ transplant was kidney, then lung, liver, and heart. Mean inpatient stay was 8.2 days (range, 4-28). Complications occurred in 15 patients, with no total or partial flap losses. Major head and neck free flap reconstructive surgery can be performed safely in organ transplant patients receiving immunosuppressive therapy. Meticulous multidisciplinary care is required to achieve consistently successful outcomes.

Trends in Physician Payments for Breast Reconstruction.

Prosthetic breast reconstruction rates have risen in the United States, whereas autologous techniques have stagnated. Meanwhile, single-institution data demonstrate that physician payments for prosthetic reconstruction are rising, while payments for autologous techniques are unchanged. This study aims to assess payment trends and variation for tissue expander and free flap breast reconstruction. The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction. Trends in the incidence of surgery and physician reimbursement were characterized by method and year using regression models. There were 21,259 episodes of breast reconstruction, with a significant rise in tissue expander cases (incidence rate ratio, 1.09; p < 0.001) and an unchanged incidence of free flap cases (incidence rate ratio, 1.02; p = 0.222). Bilateral tissue expander cases reimbursed 1.32 times more than unilateral tissue expanders, whereas bilateral free flaps reimbursed 1.61 times more than unilateral variants. The total growth in adjusted tissue expander mean payments was 6.5 percent (from $2232 to $2378) compared with -1.8 percent (from $3858 to $3788) for free flaps. Linear modeling showed significant increases for tissue expander reimbursements only. Surgeon payments varied more for free flaps (the 25th to 75th percentile interquartile range was $2243 for free flaps versus $987 for tissue expanders). The incidence of tissue expander cases and reimbursements rose over a period where the incidence of free flap cases and reimbursements plateaued. Reasons for stagnation in free flaps are unclear; however, the opportunity cost of performing this procedure may incentivize the alternative technique. Greater payment variation in autologous reconstruction suggests the opportunity for negotiation with payers.

Automatic Early-Onset Free Flap Failure Detection for Implantable Biomedical Devices.

Up to 10% of free flap cases are compromised, and without prompt intervention, amputation and even death can occur. Hourly monitoring improves salvage rates, but the gold standard for monitoring requires experienced personnel to operate and suffers from high false-positive rates as high as 31% that result in costly and unnecessary surgeries. In this paper, we investigate free flap patency monitoring using automatic hardware-only classification systems that eliminate the need for experienced personnel. The expected flow ranges of the antegrade and retrograde veins for breast reconstruction are studied using a syringe pump to create the laminar flow seen in veins. Feature data extracted from the Doppler blood flow signals are analyzed for sensitivity, specificity, and false-positive rates. Hardware is built to perform the classification automatically in real-time and output a decision at the end of the observation period. Experimental results using the hardware-only classifier for a 50ms window size show high sensitivity (96.75%), specificity (90.20%), and low false-positive rate (9.803%). The experimental and theoretical classification results show close agreement. This work indicates that automatic hardware-only classifiers can eliminate the need for experienced personnel to monitor free flap patency. The hardware-only classification is amenable to a monolithic implementation and future studies should study a totally implantable wirelessly-powered blood flow classifier. The high classifier performance in a short window period indicates that duty-cycled powering can be used to extend the safe operational depth of an implant. This is particularly relevant for the difficult buried free flap applications.

Reconstruction of Sole of Foot: A Retrospective Study of 26 Consecutive Cases

Loss of part or whole of foot is a distressing problem. The choice of reconstructive modality changes with advancement of science and hence, their long-term outcome is a matter of debate. Materials and methods: consecutive cases of loss of part or whole of sole of over the preceding five years were studied. Patient profiles, etiology, nature of defects, reconstructive method used and the outcome were studied. Results: A total of 26 limbs were treated for defects in sole of foot. Various modalities like adjacent flaps, pedicled flaps and free flaps were used to reconstruct various types of defects. The long-term outcome revealed weight-bearing and return of sensation in all patients. Return to workplace was at 53 days on average. Two cases of free muscle flap with split-skin grafting had repeated skin breakdown. Discussion: reconstructive options for sole of foot are evolving. However, the principles and demand remain the same. Conclusion: The reconstructive surgeon should be aware of the demands on the reconstructed sole and the various reconstructive modalities available. Treatment needs to be individualized to each patient. A continuous review of the cases and long-term results is necessary to enrich the science.

Venous thromboembolism incidence in head and neck surgery patients: Analysis of the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database

ObjectiveVenous thromboembolism (VTE) may cause significant postoperative morbidity and mortality; research in other surgical fields suggests an elevated VTE risk persists up to 30 days after surgery, beyond hospital discharge. We performed a review of the Veteran’s Affairs Surgical Quality Improvement Project (VASQIP) database to determine the 30-day incidence of VTE following head and neck surgery and assess the proportion of VTE that occur post-discharge. Materials and methodsA retrospective review was performed of all head and neck ablative procedures captured in the VASQIP database between 1991 and 2015. Post-operative VTE incidence was determined and the relationship of pre-operative data and post-operative mortality to VTE incidence was assessed. Results48,986 patients were included in the study; there were 152 VTE events (0.31%) and 39 (25.7%) occurred post-discharge. Lower VTE rates were found in parotidectomies (0.22%) and thyroid/parathyroid cases (0.23%), and higher rates in free flap (1.52%) and laryngectomy cases (0.69%). Age >70, recent weight loss, low serum albumin, and increased surgical time were all associated with increased VTE incidence on multivariate analysis. 90-day mortality in patients without VTE was 2.1% compared to 19.7% in patients who experienced a VTE. ConclusionWhile the documented rate of VTE in a national dataset is relatively low following head and neck surgeries, it is elevated with certain procedure categories and following long operations, and a significant proportion of VTE occur post-discharge. This study provides baseline data to better inform efforts to risk-stratify and customize thromboprophylaxis for patients undergoing head and neck procedures.

Antibiotic prophylaxis in clean‐contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta‐analysis

Optimal antibiotic prophylaxis duration in head and neck clean-contaminated free-flap cases is unknown. A systematic review/meta-analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus databases. Of the 3755 searched articles, 5 articles were included for a total of 861 patients. The recipient surgical site infection risk was significantly higher in patients receiving prophylactic antibiotics for ≤24 hours compared to >24 hours (relative risk [RR] 1.56; 95% confidence interval [CI] 1.13-2.14). In the post hoc multivariate analysis based on available individual-level data on 697 patients from 3 studies, the risk of surgical site infection for ≤24 hours versus >24 hours was not significant after adjusting for antibiotic type (RR 1.09; 95% CI 0.78-1.55). When compared to ampicillin-sulbactam, patients who received clindamycin prophylaxis had an increased likelihood of recipient surgical site infection (RR 2.85; 95% CI 1.95-4.17). Less than or equal to 24 hours of antibiotic prophylaxis in head and neck clean-contaminated free-flap is likely sufficient but a strong conclusion remains elusive. Clindamycin prophylaxis increases the risk of recipient surgical site infection. Further prospective trials are necessary to clarify.

Early Experiences of Head and Neck Reconstruction: Appropriacy and Surgical Outcome

Background and Objectives The reconstruction of surgical defects in head and neck cancer patients requires thorough anatomical knowledge and considerable clinical experiences, hence it is a demanding job for un-experienced reconstructive surgeons. We evaluated the appropriateness and the surgical outcome of a one-year experience of head and neck reconstruction carried out in a tertiary hospital setting. Subjects and Method We performed a retrospective review of the medical records of 73 patients who underwent reconstructive surgery at the Otolaryngology Department and Plastic Surgery from January, 2012 to September, 2016. Results Twenty-eight of 42 patients underwent free-flap reconstruction, including anterolateral thigh, radial forearm, or fibula free-flap by a head and neck surgeon. The rest of the patients underwent pedicled-flap surgery including pectoralis major or latissimus dorsi myocutanous flap. The mean operation time was 209.5 minutes and an average of 1.2 days intensive care unit- and 37.2 days of hospital stay were required in the free-flap cases. The flap failure happened in three patients, two in free-flap and one in pedicled flap. These surgical outcomes were comparable to those of the plastic surgery patient group. Conclusion The technical appropriacy and acceptable outcome of head and neck reconstruction by head and neck surgeons was proven in this investigation. We propose that reconstructive surgery should be performed by head and neck surgeons as they could reduce operation time or complications because of their familiarity with complex surgical anatomy and early decision making competency. Key words: Appropriateness ㆍ Free-flap ㆍ Head and neck cancer