Flap Surgery Research Articles

Effect of Laser Combined with Periodontal Flap Surgery on Severe Periodontitis

Objective: To explore the clinical effect of laser combined periodontal flap surgery in patients with severe periodontitis. Methods: Eighty patients with severe periodontitis from March 2023 to March 2024 were selected as study samples and randomly divided into two groups. The control group (a total of 40 patients) received only traditional periodontal flap surgery as a treatment option. In contrast, the observation group (which also included 40 patients) combined Er: YAG laser technology with periodontal flap surgery during treatment. The periodontal health of the two groups was compared before treatment and 3 months after treatment. Compare pain and sleep patterns; The treatment efficiency of the two groups was compared. Results: After treatment, the indexes of PD, PLI, GI, SBI, VAS score and PSQI score of 2 groups were lower than before treatment, and the decrease rate of observation group was higher than control group (P < 0.05). The effective rate of observation group was significantly higher than that of control group (P < 0.05). Conclusion: Laser combined periodontal flap surgery has significant clinical effect on patients with severe periodontitis, which can improve the periodontal condition and sleep status, and reduce the postoperative pain of patients.

Efficacy evaluation of a high-precision simulator of posterior pharyngeal flap pharyngoplasty

BackgroundIn order to improve medical students' preclinical skills and enable them to quickly comprehend the procedure of posterior pharyngeal flap surgery, our teaching team developed a surgical simulator specifically for pharyngeal flap surgery. MethodsThirteen undergraduate students and eight first-year residents trained from March to May 2023, participated in simulated surgical training. Initially, multimedia was used to explain and demonstrate relevant anatomy, surgical principles, and procedural steps to them. This was followed by independent simulated surgeries by the students, culminating in the completion of a questionnaire. Independent samples t-test was used for statistical analysis. Results: Before the simulated surgery, the residents had a greater understanding of the surgical design compared to the undergraduate students. After the simulated surgery, the residents showed not only significantly higher levels of understanding of the surgical design, but also increased familiarity with the surgical process, and enhanced confidence in independent surgery compared to the undergraduate students. Both groups showed a notable increase in familiarity with the surgical process and confidence in independent surgery after the simulated surgery. ConclusionThe surgical simulator demonstrates high clinical fidelity and provides tactile feedback that closely resembles reality. It significantly enhances the understanding and mastery of surgical techniques for young doctors, ultimately improving their surgical skills.

Patient-reported outcome measures and health economics in regenerative periodontal therapy: A systematic review and meta-analysis.

Understanding patient responses to periodontal regeneration is crucial. This systematic review and meta-analysis addressed two key questions: (a) the impact of periodontal regeneration on patient-reported outcome measures (PROMs) for intrabony and furcation involvement and (b) the cost-effectiveness of periodontal regeneration for treating periodontal defects. Twenty-four studies were included, with 20 randomized clinical trials (RCTs) reporting patient-reported outcomes and five (three RCTs and two economic model-based studies) reporting cost-effectiveness outcomes. Results favored regeneration therapy over conventional flap surgery for intrabony defects, showing improvements in qualitative (i.e., amount of regenerated attachment apparatus) and quantitative parameters (i.e., probing and radiographic parameters). In terms of PROMs, regenerative treatments involving barrier membranes resulted in longer chair times and higher rates of complications (such as membrane exposure or edema) compared to flap with biologic agents or access flap alone. Despite this, oral health-related quality of life improved after both regenerative and extraction procedures. Economically, regeneration remained favorable compared to extraction and replacement or open flap debridement alone for periodontal defects. Single-flap variants in open flap debridement yielded similar outcomes to regenerative treatment, offering a potentially cost-effective option. Nevertheless, further discussion on the benefits of less-invasive flap designs is needed due to the lack of histological evaluation.

Comparison of Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Periodontal Flap Surgery in the Mandible

Abstract Introduction: The efficacy of infiltration versus inferior alveolar nerve block (IANB) injection techniques during periodontal flap surgery in the mandible is crucial for optimising patient care. This comparative study aims to evaluate the pain management, ease of administration and clinical outcomes associated with both anaesthetic methods. Infiltration anaesthesia involves localised administration, targeting specific sites, whereas IANB provides a broader anaesthetic effect by numbing the entire mandibular nerve. Understanding the advantages and limitations of each technique will enhance procedural efficiency and patient comfort. This research contributes valuable insights into best practices for periodontal surgeries. Materials and Methods: Twenty-five subjects who required periodontal flap surgery were included in the study to treat chronic periodontitis in the mandibular jaw. The surgery was performed under local infiltration of an anaesthetic agent on one side of the jaw and by an IANB on the other side. Pain perception was evaluated using the Visual Analogue Scale (VAS) score at various intervals during periodontal flap surgery. The effect of anaesthesia between the two techniques was compared and evaluated by analysis of variance using IBM Corp. IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows [Version 25]. Armonk, New York, USA. IBM Corp; 2017. Results: Analysis determined the onset, duration and termination of anaesthesia induced by infiltration and the IANB technique. The onset and duration of anaesthesia by both techniques were comparable. The pain perception evaluated using the VAS score while using both anaesthesia techniques was also comparable. Conclusion: Infiltration anaesthesia can be used as an alternative to overcome the disadvantages and complications of IANB for periodontal surgery in the mandibular jaw.

Development and evaluation of a surgical 3D simulation model on submental flap surgery training.

The purpose of the present study was to design and assess a 3D simulation model for submental flap surgery in training oral and maxillofacial surgery (OMFS) residents. This quasi-experimental study involved a total of 20 OMFS residents attending and was conducted from September 2023 to December 2023. A 3D submental flap surgical phantom was designed using Mimics V.21 software and printed using fused deposition modeling technology. Participants were first tested on their knowledge of submental flap surgery before being randomly assigned to experimental or control groups. The experimental group received a lecture and demonstration using the developed phantom, while the control group had traditional lecture education only. Afterward, the same test was administered to all participants post-training. Pre- and post-test scores were calculated and compared between the two groups. p-Value<0.05 was considered statistically significant. The average pre-intervention test scores in the control and experimental group, were 2.5±1.43 and 3±0.816, respectively (p=0.35). Post-intervention, the experimental group exhibited significantly higher exam scores compared to the group who had only received academic lecture training (6.9±0.87 vs. 4.9±0.99) (p<0.001). Irrespective of the applied teaching method, both groups showed a significant increase in exam scores after receiving submental flap training (p<0.001 for both groups, paired-sample t-test). The use of the developed submental flap phantom model significantly improved OMFS residents' test scores and knowledge of the surgical technique, suggesting its potential integration into the conventional resident training curriculum.

Effects of suspension pharyngeal flap on speech in Filipino individuals with velopharyngeal insufficiency.

This study investigated the effects of suspension pharyngeal flap surgery for velopharyngeal insufficiency (VPI) due to cleft palate. Ten Filipino individuals (mean age = 20.63 years, range = 8.4 to 34.9 years) with a cleft palate who underwent suspension pharyngeal flap surgery for VPI were included in this study. Perceptual and instrumental speech assessments were conducted at two different time points: before surgery (data point 1) and after surgery (data point 2, range = 4 to 26 weeks post-operatively). Speech intelligibility in different contexts and satisfaction with speech were assessed by the participants themselves using a self-report questionnaire. Additionally, the risk for obstructive sleep apnea was assessed using the The Berlin Questionnaire. Velopharyngeal gap size significantly decreased after the surgery. Additionally, significant improvements in speech understandability and acceptability were observed following the suspension pharyngeal flap procedure. Besides, a significant reduction in hypernasality, nasal emission, and the occurrence of passive articulation errors was seen. No difference in the occurrence of active articulation errors was observed when comparing data pre- and post-surgery. The ten individuals reported to be significantly more intelligible in different contexts after surgery. Improved speech was observed in individuals who received the suspension pharyngeal flap procedure. This procedure also positively influences an individual's intelligibility in different contexts in daily life. In individuals with persisting active articulation errors, post-surgery speech therapy will still be necessary.

A New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps.

Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps. A retrospective medical record study involving all patients who underwent bilateral or bipedicled robotic DIEP (rDIEP) or standard DIEP (sDIEP) flap harvest between July 2021 and September 2022. Outcomes included abdominal wall morbidity, total operative time, length of stay (LOS), and complications. Forty-seven patients were included (48 sDIEP flaps, 46 rDIEP flaps) with no significant difference in patient characteristics. Fascial incision length in the rDIEP group was shorter (4.1 vs. 11.7 cm, p < 0.001). Mesh reinforcement of the abdominal wall was used in 13/24 sDIEP and none in rDIEP patients (p < 0.001). Operative time was longer in the rDIEP cohort (739 vs. 630 minutes, p = 0.013), although subanalysis showed no difference in the second half of the cohort. The average robotic dissection time was 135 minutes, which decreased significantly with the surgeon's experience. There were no intraoperative complications from using the robot. LOS was shorter with rDIEP but not statistically significant (3.9 vs. 4.3 days, p = 0.157). This study represents the most extensive cohort analysis of bilateral rDIEP flap harvest, offering a comprehensive comparison to traditional sDIEP. The initial results underscore the viability of robotic techniques for flap harvesting, highlighting potential advantages including reduced fascial incision length and decreased abdominal disruption. Furthermore, using robotics may obviate the necessity for fascial reinforcement with mesh.

Randomized controlled trial on the efficacy of a custom-made, fully guided implant system for flapless crestal sinus floor elevation: Accuracy and patient-reported outcomes.

To compare fully guided flapless implant surgery using a light-cured surgical guide (FG group) with partially guided open flap surgery (PG group) in the posterior maxilla when performing simultaneous sinus floor elevation in terms of the accuracy, time requirements, and patient/clinician-reported outcomes (PROMs and CROMs). In this study, 56 tissue-level implants were placed with crestal sinus floor elevation in 56 patients at single-tooth sites, with 28 implants allocated to the PG group and 28 to the FG group. The deviations of the placed implants from the virtually planned positions were measured at the implant platform and apex and for the angular deviation. The presurgical preparation time and the duration of surgery were measured. PROMs and CROMs were made by administering questionnaires at multiple time points. Horizontal deviations at the platform and apex and the angular deviation were significantly smaller in the FG group than the PG group (p < .05). Presurgical preparation and surgery times were significantly shorter in the FG group (p < .001). Patient satisfaction and willingness to receive repeat treatment were significantly better in the FG group than in the PG group (p < .005 and .025, respectively). Clinicians were more satisfied in the FG group than the PG group (p < .05). When placing an implant with sinus floor elevation, the flapless approach using a fully guided surgical system can be more accurate, faster, and increase the satisfaction of both the clinician and patient compared to the partially guided surgery.

Case Report: Radical Vulvectomy V-Y Flap Surgical Procedure in a Woman with Vulva Cancer

Introduction: Vulva cancer is one of the relatively rare malignancies, accounting for only 4% of all malignancies in gynecologic organs. Vulva cancer is often asymptomatic. Surgery is the basic management in patients with earliest-stage vulvar cancer and frequently requires a combined radical vulvectomy followed by inguinal LN dissection through a separate incision. Therefore, the author hopes this case can add insight into the knowledge related to early detection and comprehensive management of vulva cancer. Case Presentation: A woman, 67 years old, referred from Gambiran General Hospital Kediri with a vaginal biopsy result of vulva cancer, came to the Saiful Anwar General Hospital oncology clinic. The patient complained of pain in the pubic area accompanied by tissue growth around the pubic area since August 2023. History of weight loss (+) 10 kg in the past year. History of menopause since 18 years ago. The examination results obtained vital signs: BP 132/79 mmHg, pulse 128x/min, RR 20x/min, temperature 36.5C, height 155 cm, weight 40kg, and BMI 16.64 kg / m2 (underweight). Physical examination of external genitalia revealed a 12x8 cm mass on the right vulva, odour (+). The results of the vulvar biopsy examination on 25/08/2023 were found to be squamous cell carcinoma, well differentiated. The patient is planned for elective-wide excision. The management performed was radical vulvectomy with V-Y flap reconstruction surgery. Conclusion: In this case, it can be concluded vulva cancer is a relatively rare malignancy. The subtype often found is SCC (90-95%). This patient planned for radical vulvectomy using the V-Y flap reconstruction technique with SAB.

Effectiveness of 3D printing technology-assisted neuroendoscopic surgery for hypertensive intracerebral hemorrhage in primary hospitals

BackgroundWe aimed to investigate the clinical effectiveness of integrating 3D-printing technology with neuroendoscopy for treating hypertensive intracerebral hemorrhage (HICH). MethodsBetween November 2020 and November 2023, a total of 105 HICH cases were selected and categorized into the conventional surgery group and the neuroendoscopic surgery. General data, Glasgow Coma Scale (GCS), National institutes of health neurological impairment score (NIHSS), preoperative hematoma volume, intracerebral parenchymal and intraventricular hematoma (IVH) clearance rates, Modified Graeb Scale (mGS), postoperative rebleeding rate, intracranial infection, and Modified Rankin Scale (mRS) were collected to assess the therapeutic effectiveness. ResultsThere were no significant statistical differences in gender, age, preoperative GCS scores, NIHSS or hematoma volume between the neuroendoscopic surgery and conventional surgery group. The postoperative results indicated that the clearance rate of intracerebral parenchymal and IVH in neuroendoscopic surgery group was notably higher than the conventional surgery group. The neuroendoscopic surgery group achieved superior outcomes in terms of bone flap area, operation time, extubation time, and average hospital stay compared to the conventional surgery group (P < 0.05). Following a 3-month follow-up, there was no significant difference in the mRS and NIHSS between the two groups. However, when the patients with IVH (mGS≥10) indicated better postoperative outcomes in the neuroendoscopic surgery group (P < 0.05). ConclusionThe integration of neuroendoscopic minimally invasive surgery with 3D-printing technology for treating HICH demonstrated high efficacy for removing intracerebral and IVH. This approach incurred less trauma compared to traditional craniectomy surgery, affording shortened surgical and hospitalization durations. Consequently, it appears to be a highly efficacious method for treating HICH, particularly in cases involving IVH.

Esthetic reconstruction of traumatic defects by plastic surgery

The primary goal is preservation of the affected extremity, which can be associated with limitations in tasks relevant for daily life and adistorted body image caused by the original trauma. Therefore, asecondary goal is to reduce the trauma sequelae. For an esthetic outcome the choice of flap surgery is crucial. Factors such as tissue thickness, skin color, and hair covering need to be considered. The flap should blend seamlessly with the tissue surrounding the defect. The localization and closure of the defect are also important. The flaps undergo vascular, lymphatic and trophic postoperative changes caused by the so-called autonomization. Measures, such as compression therapy reshape the microcirculation and result in volume reduction of the transplant. It is important to preoperatively educate patients about this process. After completion of the conditioning surgical thinning procedures are available for persistent unattractive results, e.g., open surgical and liposuction techniques. Microsurgical defect coverage of traumatic skin and soft tissue defects is acompromise between limb preservation and functionality. In cases of missing local soft tissue, secure closure of the defect should be prioritized but initial esthetic considerations should also influence the choice of tissue transplant. Patients should be informed early about the development of the flap surgery and undergo postoperative compression therapy for conditioning. Secondary operative corrections are also possible.

A single-center retrospective comparison of muscle versus cutaneous free flaps for posterior elbow defect reconstruction

IntroductionComparative data regarding free flap outcomes for elbow defect reconstruction is still lacking. This study aims to compare complication rates of free muscle (MFs) versus cutaneous flaps (CFs) for posterior elbow reconstruction. MethodsIn a single-center retrospective analysis, patients with free MFs and CFs for posterior elbow reconstruction from 2000 until 2021 were analyzed. Retrospective chart review included patient demographics, operative details, and postoperative complications. Compared outcomes of interest were microvascular complications, partial or total flap necroses, wound dehiscence, hematoma or flap infection, and donor-site complications. ResultsSixty-six free flaps (CFs: n=42; MFs: n=24) were included, with a trend over time towards using CFs (64%). MFs were used for larger defects (CF: 175 ± 82 vs MF: 212 ± 146 cm2; p=0.13). Outcome analysis revealed an equal distribution of microvascular complications (10% vs 13%; p=0.7), partial flap necrosis (7% vs 8%; p>0.9), wound dehiscence (7% vs 4%; p>0.9), evacuation of hematoma (10% vs 4%; p = 0.7), and infection (0% vs 4%; p = 0.4). Total flap necrosis requiring additional flap surgery was necessary in one CF (2%) and in no MF (0%) (p>0.9). ConclusionSurgical outcomes, flap necrosis rates, and microsurgical complications did not differ between CFs and MFs. Both flap types are safe and effective options. The free anterolateral thigh and latissimus dorsi flaps represent indispensable workhorses for the reconstruction of extensive elbow defects.

Handheld Ultrasound Detection of Supratrochlear Artery in Forehead Flap Surgery: A Feasibility Study.

Handheld Ultrasound Detection of Supratrochlear Artery in Forehead Flap Surgery: A Feasibility Study.

Mandibular overdenture retained by four one-piece titanium-zirconium mini implants: A 2-year follow-up on prosthodontic outcomes

ObjectiveThis 2-year prospective study reports the incidence of prosthetic complications and maintenance events after treatment with mandibular overdenture retained by four mini implants opposed to a maxillary denture. MethodsImplant intervention included flapless or flapped surgery combined with immediate or delayed loading, as part of a randomized clinical trial. Four one-piece titanium-zirconium mini-implants (Straumann Mini Implant System) were inserted, and the retentive PEEK elements (Optiloc) were incorporated into the overdenture using chairside procedures. Prosthodontic complications and maintenance events were recorded over a 2-year follow-up, and the final outcome was defined according to standardized criteria. Data analysis included descriptive statistics, incidence and incidence density rates, and Kaplan-Meier survival. Results73 out of 74 patients (64.9 % female), mean age of 64 (SD=8.2) years, completed the study follow-up (one withdrew after 9 months). Implant survival was 100 %. A total of 163 prosthodontic events occurred in 53 patients (72.6 %), and 20 patients had no clinical complaints or maintenance needs. The most common procedures were adjustment/repair of the overdenture base (47.0 %), replacement of retentive inserts (19.8 %), and laboratory relining (12.9 %). A high prosthodontic success rate was achieved (93.2 %), and all patients presented serviceable overdentures and continuous use after the resolution of prosthodontic complications. The incidences of matrix replacement and laboratory relines were low in the first year, while denture base adjustments were common within the first year, especially in the first 6 months. ConclusionThe mini implant system showed high prosthodontic success rates. Minor adjustments/repairs during the initial follow-up were common. Relines and matrix replacements tend to occur after one year of overdenture use, and matrix replacements may occur as a consequence of the need for relining.

Outcomes of Pedicled Groin Flaps for Upper Extremity Injuries.

Free flap reconstruction has become the more common treatment over pedicled groin flaps for reconstruction of upper extremity injuries in recent years. Groin flaps are still used for a variety of reasons, though limited literature is available to guide surgeons and patients regarding outcomes. This study aimed to investigate the epidemiology and outcomes of pedicled groin flaps for upper extremity pathology. The study was a single-institution retrospective case series at a level one trauma center including patients who underwent pedicled groin flaps for upper extremity soft tissue coverage between 1992 and 2022. The data collected included patient and injury characteristics, surgical management, and complication data. Ordinal logistic regression, univariate analysis, and bivariate analysis were performed to assess the relationship between the total number of groin flap surgeries and complications with patient and injury characteristics. The analysis included 88 pedicled groin flaps performed for upper extremity injuries, with a median follow-up of 1.14 years after injury. Patients had a median age of 35 (interquartile range [IQR]: 22-49) years and underwent a median of 4 (IQR: 3-5.25) surgeries with stiffness (90.6%), partial flap loss (38%), and infection (32%) as the most common complications. High-energy injuries increased the risk of requiring more surgeries based on ordinal logistic regression. Univariate and bivariate analysis revealed no significant difference in wound complications based on patient or injury characteristics. Patients undergoing pedicled groin flaps for upper extremity injuries can expect to undergo an average of 4 surgeries, and high-energy injuries predict the need for more surgeries.

How to increase the success rate in microsurgical free and pedicled flap reconstructions with intraoperative multistep ICG imaging: A case series with 400 consecutive cases

BackgroundOver the last decade, microsurgical soft tissue transfer became the gold standard for a wide variety of reconstructions throughout the body. Continued improvement of instruments and surgical techniques allowed reaching a very high success rate, like the employment of intra-operative indocyanine green angiography (ICG-A). This study aims to assess and validate the role of a standard intraoperative ICG-A in free flap and pedicled flap surgery to improve the overall outcomes. Patients and MethodsFrom April 2018 and April 2023, four hundreds consecutive patients who underwent reconstruction using free flap and pedicled flap were enrolled. The ICG-A was always performed in free flap after elevation of the flap, after microsurgical anastomosis, immediately after the flap inset and after wound closure; in pedicled flap the sequential procedure was performed after elevation of the flap, after flap inset and after wound closure. ResultsAll four hundred patients who underwent flap reconstruction using intraoperative ICG angiography had an extremely low incidence of necrosis (0.75% partial necrosis among free flaps and pedicled flaps) and reoperation for perfusion-related complications (0.75% due to acute ischemia and 0.50% due to flap congestion). Minor complications like hematoma, seroma, wound dehiscence, and wound infections were managed with a second operation. No flaps were lost and all the patients were successfully treated. ConclusionsThe present report shows how the employment of systematic multiple-steps ICG angiography for intra-operative assessment of both free and pedicled flap’s perfusion can significantly reduce the complications rate, including flap loss and re-exploration surgeries, in a time- and cost-effective manner.

Safety of performing multiple free flap surgeries by a single surgeon in a single day

With the growing popularity of the use of free flaps, surgeons may frequently encounter situations necessitating the performance of multiple free flap surgeries in a single day. Given its prolonged duration and technical complexity, concerns remain regarding their safety. This study investigated whether a single surgeon conducting multiple free flap surgeries in a day heightens the risk of complications. Patients who underwent free flap-based reconstruction from March 2002 to May 2023 were reviewed and categorized into 3 groups: one flap per day (Group 1), multiple flaps per day on the same patient (Group 2), and multiple flaps per day on different patients (Group 3). Outcomes, particularly perfusion-related complications (PRCs), were compared. In total, 1910 cases were analyzed: 1570 in Group 1, 126 in Group 2, and 214 in Group 3. Over time, the proportion of cases in Group 3 increased. Group 3 had fewer breast reconstruction cases but more lower extremity reconstructions, with a higher prevalence of chronic wounds. Although the rates of PRCs varied among groups, multivariable analysis exhibited no association of performing multiple flaps in a day with their occurrence, regardless of breast or nonbreast reconstruction. The rate of arterial insufficiency was significantly higher in group 3 compared with group 1 after adjusting for other variables. Performing multiple free flaps in a single day may not significantly increase the risks of overall PRCs. However, there appears to be a higher incidence of arterial insufficiency, emphasizing the need for careful planning and precise execution of procedures.

Donor site morbidity after scapula free flap surgery of head and neck reconstruction: A systematic review and meta-analysis.

The scapula free flap is becoming increasingly more utilized in head and neck reconstruction due to its natural geometry and soft tissue versatility. This study reviews the incidence rate, risk factors, and treatments of complications of scapula donor site morbidity. A review was performed for articles published between October 1990 and November 2022 in Medline (OVID), PubMed, Web of Science, and CENTRAL. After screening, 24 articles meeting the criteria were included. Overall, 660 head and neck surgeries with the scapula donor bone across 24 studies were included. Twenty studies of 612 scapula free flaps reported a pooled postoperative complication rate of 10.7%, with no major complications. Seven studies of 199 scapula reconstructions showed a mean Disability of Arm, Shoulder and Hand (DASH) score of 14.39/100. With its low rate of morbidity, the scapula flap presents itself as a good alternative for patients at risk for poor healing.

IMMEDIATE SINGLE IMPLANT PLACEMENT WITH FLAPLESS SURGERY MAY BETTER PRESERVE BUCCAL BONE THAN FLAP SURGERY, BUT CLINICAL SIGNIFICANCE IS UNCLEAR

Immediate implant placement with flap or flapless surgery: a systematic review and meta-analysis. Pitman J, Christiaens V, Callens J, Glibert M, Seyssens L, Blanco J, et al. J Clin Periodontol. 2023;50:755-64. The present study was funded by the authors and their institutions. The authors have no actual or potential conflicts of interest. Systematic review and meta-analysis.

Fentanyl versus Dexmedetomidine Infusion in Head and Neck Free Flap Surgery for Comparison of Hemodynamic Parameters and Anaesthetic Requirements: A Randomised Controlled Trial.

This prospective, double-blinded, randomized study aimed to compare the efficacy of dexmedetomidine and fentanyl infusions in maintaining hemodynamics during head and neck free flap surgery, as well as their impact on the relative amount of blood loss. Twenty patients with American Society of Anesthesiologists physical status I and II scheduled for elective head and neck free flap surgery were enrolled. The patients were randomly assigned to receive either dexmedetomidine (1µg/kg over 10min at anesthesia induction, followed by 0.2 to 0.75µg/kg per hour infusion during maintenance) or fentanyl (1 to 2µg/kg per hour infusion during maintenance). Intraoperative hemodynamic parameters, blood loss, blood transfusion requirements, surgeon satisfaction, adverse drug effects, and free flap survival up to 7 days were recorded. The dexmedetomidine group achieved a mean arterial pressure (MAP) value between 60 and 70 mmHg at multiple time points (15min, 3rd, 4th, 5th, and 6th hours), while the fentanyl group did not reach this range at any time point. The intergroup statistical analysis revealed a significant difference only at the 5th hour with (95% CI: -16.17 to -0.62) and P = 0.036. Additionally, the dexmedetomidine group exhibited lower heart rates (< 70/min) at several time points (15min, 2nd, 3rd, 4th, 5th, and 6th hours) compared to the fentanyl group. The intergroup comparison indicated a statistically significant difference only at the 3rd hour with (95% CI: -20.94 to -0.45) and P = 0.042. Dexmedetomidine can be a useful adjuvant of GA for inducing controlled hypotension and decreasing bleeding in free flap surgery of the head and neck region without any detrimental effect on the free flap survival.