Microvascular Tissue Transfer Research Articles

Serratus branch as recipient vessel for microvascular tissue transfer in breast reconstruction.

Sir: Although the internal mammary vessels remain the recipient vessels of choice in free flap breast reconstruction, the thoracodorsal vessels are still chosen for a variety of reasons. The use of the internal mammary artery as a recipient vessel is justified despite concern for future coronary revascularization.1 The thoracodorsal vessels continue to be used because of surgeon preference and cases of suboptimal internal mammary vessels upon dissection. The potential disadvantages of the thoracodorsal artery and vein as recipient vessels include difficultly in achieving medial fullness in the final breast mound and the inability to use the latissimus flap for future breast reconstruction. We present a case in which the serratus branch is used as recipient vessels for microvascular tissue transfer, with the advantage of preserving the thoracodorsal vessels for future flap reconstruction. The patient is a 44-year-old woman with history of left breast cancer status post mastectomy, who presented for delayed autologous free flap reconstruction. After excision of the previous mastectomy scar, the prepectoral pocket was created. It was noted that the previous mastectomy scar went quite lateral, and therefore, the decision was made to dissect the thoracodorsal vessels. During the dissection, the serratus branch of the thoracodorsal vessels was noted to be quite large and suitable for microvascular anastomosis (Fig. 1). We chose to use the serratus branch as recipient vessels to spare the thoracodorsal vessels. This would allow for future use of her latissimus muscle for breast or general reconstruction. Fig. 1. Dissection of the thoracodorsal vessels. The serratus branch of the thoracodorsal vessels was found large and suitable for microvascular anastomosis. Few studies have described the use of the serratus branch as recipient vessels for microvascular transfer. Arnez et al2 describe a case of a patient who underwent a free transverse rectus abdominis myocutaneous flap reconstruction with the serratus anterior branch as a recipient vessel, thus conserving the remainder of the thoracodorsal vessels in case they were needed in a secondary salvage surgery. In a study describing their experience with 50 free TRAM flap reconstructions, Arnez et al3 describe 1 of 2 reconstructions using the serratus branch, citing the superior back flow of the serratus branch in comparison with the flow of the proximal pedicle. Another group describes their use of the serratus branch as recipient vessels in 4 patients undergoing partial breast reconstruction with mini-superficial inferior epigastric artery and mini-deep inferior epigastric artery perforator flaps to achieve the proper anatomic placement of miniflaps.4 Most cases describe the use of the serratus branch and other distal branches of the thoracodorsal artery as a means to successfully salvage a deep inferior epigastric artery perforator flap through retrograde flow anastomosis.5 In conclusion, the serratus branch of the thoracodorsal vessels provides a viable recipient site for microvascular tissue transfer with the advantages of sparing the thoracodorsal vessels for future latissimus flap reconstruction.

Anemia is not a predictor of free flap failure: A review of NSQIP data

Thrombosis is a common cause of flap failure in microvascular tissue transfer, which questions the effects of anemia on this outcome. This article seeks to contribute a large, multi-institutional data analysis to this debate. Free tissue transfer patients were identified in the National Surgical Quality Improvement database through a specified Current Procedural Terminology algorithm. Bivariate analysis compared anemic and nonanemic groups with respect to flap failure and other outcomes. Multivariable logistic regression was used to determine risk factors for flap failure. Of the 864 patients who met inclusion criteria, 244 were anemic and 620 were not. Bivariate analysis showed no significant difference between groups with respect to flap failure (3.28% vs. 4.03%, P = 0.0603). Multivariate regression analysis supported this (OR 95% CI = 0.371-1.912). These findings, based on the largest sample in the literature, show anemia is neither a predictor of free tissue transfer failure nor is it protective.

OP211: Microvascular tissue transfer in the management of advanced osteoradionecrosis

The purpose of this study is to evaluate the outcomes of the use of microvascular free flaps (MVFF’s) in the management of advanced stage III osteoradionecrosis (ORN) that fails conservative management. This is a retrospective review of all patients treated for ORN with radical resection and microvascular reconstruction at the University of Maryland department of oral & maxillofacial surgery between July of 2010 and October of 2012. Outcomes measured included the resolution rate (resolution of pain, infection, and exposed bone) as well as perioperative complications. There were 12 patients (10 men and two women) (eight caucasians, three blacks, and one hispanic). The mean age at time of treatment was 62 years. Mean follow up was 15 months. All had Marx stage III ORN. Six patients had radiation therapy alone, and 6 had combined chemoradiation. The presenting features included pain (10 patients), orocutaneous fistulas (4), exposed bone (11), and pathologic fracture (8). Eight patients had hyperbaric oxygen (HBO) as part of their conservative treatment. The mean latency period between completion of adjuvant therapy and development of symptoms was 6.7 years (10–312 months). Seven patients were reconstructed with a fibula flap, four with a scapula flap, and one with a deep circumflex iliac artery flap. The resolution rate was a 100% with resolution of pain, drainage, and exposed bone. The perioperative complication rate was 50%. One flap developed vascular compromise, and was successfully salvaged. Four patients had postoperative infections which required a washout and drainage, one had a hematoma evacuation. Three patients have chronic dysphagia and are partially PEG tube dependent. Resection and microvascular reconstruction is a highly predictable mode of treatment for advanced ORN. The increased postoperative complication rate is consistent with the literature, and is expected given the poor quality fibrotic tissue in radiated patients.

PP059: Comparative study of locoregional flaps and free flaps in reconstruction after resection of oral cavity cancer: A cost analysis

Purpose Free flaps have proved to be superior in both functionality and aesthetics in front of classical treatment with locoregional flaps in the treatment of patients with large tumors in the oral cavity. The aim of the present study is to assess if free-flap reconstruction is an economically profitable option. Material and methods The present study was based on a retrospective cohort of 60 patients. Of the 60 patients, 30 underwent surgical reconstruction with microvascular tissue transfer and in 30 only local or regional flaps were used. The 6 months of which the overall management costs according to the hospital perspective were calculated were divided into three periods: operative period, the postoperative phase, follow-up during first 6 months. The following outcome variables were analyzed: operative time; blood loss; admission length, including intensive care unit; complications; secondary interventions; readmissions; and feeding status. Cumulative costs were calculated. Statistical analysis was applied. Results Total estimated costs within the first 6 month were comparable in both. The lower costs of hospital admission in the postoperative phase outweighed the higher costs of the surgical procedure in free flap group when compared with local flaps patients. Conclusions In experienced centers, the reconstruction using free flaps in patients treated for tumors of the oral cavity is safe, improves patient quality of life and is economically sustainable. Forty patients who underwent immediate free radial forearm flap reconstruction for oral or oropharyngeal soft tissue defects were matched with patients who underwent pectoralis major myocutaneous flap reconstruction for similar defects. The 2 years of which the overall management costs according to the hospital perspective were calculated were divided into four periods: operative period, the postoperative phase, follow-up during first year and follow-up during second year after discharge. Results The total costs within the first 2 years were comparable at approximately 50,000 Euros. The lower costs of hospital admission (24 days versus 28 days; P = 0.005) in the postoperative phase outweighed the higher costs of the surgical procedure (692 min versus 462 min; P Conclusions Oral and oropharyngeal reconstruction with radial forearm flap is not more costly than pectoralis major flap reconstruction. Given the better functional outcome and the present cost analysis, reconstruction of oral and oropharyngeal defects is preferably performed using free tissue transfer.

OP034: Orbital exenteration defects with maxillectomy: Options and outcome

Purpose The present study attempts to review the options and outcomes of orbital exenteration defect reconstruction with free flaps. We also present the risk categorization and patient selection criteria used at our institute. Material and methods A study of 23 consecutive patients who underwent maxillectomy/ Craniofacial resection with orbital exenteration and free flap reconstruction. The study period was between 2004 and 2011. Results There were 17 male and 6 females in the study. The flaps used were free rectus abdominis myocutaneous flap ( n = 10), anterolateral thigh flap ( n = 4); free fibula flap ( n = 3), deep circumflex iliac flap with internal oblique muscle ( n = 5). Free tensor fascia lata with iliac crest and internal oblique muscle was used in five patients to get a composite eye socket reconstruction with ocular prosthesis. One patient had a simultaneous double free flap reconstruction with a combination of free fibula flap and free radial forearm flap. This patient died in the immediate postoperative period due to systemic complications. Excluding this patient, the flap success rate w as 95.5% (21/22). Eight patients are alive and disease free after a mean follow up of 30.5 months (range: 6–76 months). We present an algorithm for the choice of reconstructive approach. In high risk, old patients with co-morbidities, regional flaps like Temporalis with spectacle prosthesis/Obturator; In intermediate risk patients we suggest, soft tissue flaps with bulk (rectus abdominis) and spectacle prosthesis and in young low risk individuals, a composite socket reconstruction with the free tensor fascia lata with iliac crest and internal oblique muscle is an ideal option. Conclusions Free microvascular tissue transfer has improved the results of reconstruction of orbital exenteration defects. Free rectus abdominis flap remains the commonest choice. Free fibula flap is useful in cases with associated bony defects of maxillectomy. When a composite socket reconstruction is to be achieved, the innovative free tensor fascia lata with iliac crest and internal oblique muscle is an excellent option but needs two simultaneous pair of vessel anastamosis.

Monitoring in microvascular tissue transfer by measurement of oxygen partial pressure: Four years experience with 125 microsurgical transplants

In a prospective study, the characteristics and benefit of an invasive measurement of oxygen partial pressure (pO2) with the aid of a polarographic sensor were investigated in 125 microsurgical reconstructions of the head and neck area over a period of 45 months. Measurements were performed over 96 h in eight different types of microsurgically revascularized flaps for extra- and intraoral reconstructions and were evaluated separately for each flap type.Of 125 reconstructions the system indicated malperfusion in 18 cases. Salvage surgery was performed in 17 cases due to venous thrombosis (6 cases), arterial thrombosis (3 cases), a combination of arterial and venous thrombosis (2 cases), rheological problems (3 cases), venous insufficiency by hematoma (2 cases) and kinking of vessels (1 case). In 10 cases salvage surgery was successful, 7 flaps were lost despite salvage surgery. In all these cases, the polarographic probe indicated the necessity of salvage surgery correctly. After 96 h no malperfusion was seen. Postoperatively, a common and characteristic development of the oxygen partial pressure in different types of flaps was seen. Initially, a clear increase of pO2 could be measured. During 96 h, a slow decrease of pO2 was observed.In conclusion polarographic measurement of pO2 can be an excellent apparative supplement for the postoperative clinical control of microsurgically revascularized transplants. In buried flaps, this technique represents the only reliable method for transplant monitoring.

The use of ovarian vessels for microvascular tissue transfer in lower extremity limb salvage

Limb salvage procedures in previously operated, radiated, and vessel-depleted fields rely heavily on the use of microvascular tissue transfer. This report illustrates the feasibility of the use of ovarian vessels for the revascularization of a free flap. We have achieved success with the use of rectus abdominis muscle free flap for coverage of exposed vascular reconstruction in the 75-year-old soft tissue sarcoma patient with twice chemoradiated femoral and hypogastric defect, preventing external hemipelvectomy.

Micro-RNA profiling as biomarkers in flap ischemia-reperfusion injury

Ischemia-reperfusion injury (IRI) is usually the key and often plays an irreversible role to induce flap compromise in microvascular tissue transfers. This article aims to profile the expression of micro-RNAs (miRs) in free flap surgeries following IRI. The miRs expression profiling was initially surveyed in rat epigastric flap vessels using Agilent 350-Microarrayed miRs after IRI, and then quantified by real-time reverse transcription polymerase chain reaction in flap vessels and tissues (n = 5) at three intervals: before induction of ischemia (normoxia without IRI, sham), 2 and 72 hours after reperfusion following 2 hours of ischemia. Furthermore, for seven patients with free anterolateral thigh flap reconstruction, the miRs expression patterns in these flaps before induction of ischemia (normoxia), at 2 and 72 hours after reperfusion following an ischemic interval were investigated. Four miRs (miR-96, miR-193-3p, miR-210, and miR-21) of 350 tested rat miRs were found to be positively significant. In rat flap vessels, the upregulation of these miRs at 72-hour reperfusion was statistically significant. These patterns were not noted in rat flap tissues, except for miR-96. However, there seemed to be no significant difference in human flap vessels between normoxia and 2-hour reperfusion following ischemia. In human flap tissue, significant upregulation of miR-193-3p, miR-210, and miR-21 was detected at 72-hour perfusion. Our findings show some changes of four upregulated miRs in our model of IRI. We suggest that further investigation is needed to determine the role of miRs in IRI of microsurgical reconstruction.

Revising Large Scars

Large scars in the head and neck are often the cause of significant emotional distress to patients, and often present unique challenges to the plastic and reconstructive surgeon undertaking their revision. The primary goal of scar revision is to eliminate compromise of function that may have resulted from scar contracture; a secondary goal is to improve the appearance of the scar. Special techniques for the revision of large scars include serial partial excision, rapid intraoperative or prolonged tissue expansion, split- and full-thickness skin grafting, regional flaps, and free microvascular tissue transfer. Recent research has investigated the use of artificial skin and autologous fat grafting for large scar revision.

Microvascular approach to scalp replantation and reconstruction: A thirty‐six year experience

Soft tissue defects of the scalp may result from multiple etiologies and can be challenging to reconstruct. We discuss our experience with scalp replantation and secondary microvascular reconstruction over 36 years, including techniques pioneered at our institution with twin-twin scalp allotransplant and innervated partial superior latissimus dorsi (LD) for scalp/frontalis loss. A retrospective review of all patients presenting with scalp loss requiring microvascular reconstruction at a single center was performed from January 1971 to January 2007. Medical records were reviewed for age, gender, defect size/location, etiology, type of reconstruction, recipient vessels used, vein grafts, and complications. Thirty-three patients were identified; mean age was 33 years (range, 7-79). Mean scalp defect size was 442 cm(2) (range, 120-900 cm(2)). Thirty-six microvascular reconstructions were performed; of these, 10 scalp replants and 26 microvascular tissue transfers. Of these 26, 17 were LD based (partial superior LD with and without reinnervation, LD combined with serratus, LD combined with parascapular, LD combined with split rib, LD only) and 2 free scalp allotransplant among others. The superficial temporal artery and vein was used as recipient vessels in 70% of cases. Overall, microvascular success rate was 92%; complications occurred in 14 cases, nine major (tumor recurrence [n = 2], partial flap loss [n = 2], replant loss [n = 3, size <300 cm(2) ], hematoma [n = 2]) and five minor (donor site seroma /hematoma [n = 3], flap congestion [n = 1], superficial wound infection [n = 1]). Every attempt should be made at scalp replantation when the patient is stable and the parts salvageable. Larger avulsion defects had higher success rates after replantation than smaller defects (<300 cm(2) ), with the superficial temporal artery and vein most commonly used for recipient vessels (P = 0.0083). Microvascular tissue transfer remains a mainstay of treatment for scalp defects, with LD-based flaps, demonstrating excellent versatility for a range of defects.

Management of the mangled extremity

The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a mangled limb is a technical possibility, the question is often raised whether the end result will also be functional and what treatment would lead to the best patient outcome. The road to salvage is often prolonged with significant morbidity, reoperations, financial costs, and even mortality in some instances. Numerous factors have been implicated in the outcome of these injuries, and a number of scoring systems have been designed in an attempt to help guide the treating surgeon in the acute phase. However, much controversy remains on the ability of these grading systems to predict successful salvage of the mangled extremity. In this review, we discuss the mechanisms of injury, various available scoring systems, initial management, outcome and specific differences between lower and upper extremity trauma injuries.

Outcomes of Total or Near-Total Lip Reconstruction With Microvascular Tissue Transfer

The reconstruction of total lower lip defects is very challenging, whether from trauma or after oncologic treatment. The challenge faced by surgeons is to re-create not only an esthetically pleasing lower lip but also, more importantly, a lip that is functional. The authors reviewed their experience at the Division of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville in reconstructing these challenging defects over a 3 year period. The timeline extended from 2007 through 2010. All surgeries were performed by the senior author. The medical records were reviewed to retrieve demographics, including age, gender, reasons for the acquired defect, lip reconstructed, reconstructive method, flap survival, and outcomes. Twelve patients with 13 free tissue transfers for total or near total lip defects reconstructed with free tissue transfer were identified. The patients' mean age was 57 years, and the overwhelming majority of patients were men (10 vs 2). The defects were due to resection of malignancies affecting the lip in 10 patients and to avulsive gunshot injuries in 2 patients. Of the 13 flaps used to reconstruct the defects, 11 were radial forearm flaps using the palmaris longus tendon and 1 was an anterolateral thigh flap using the fascia to resuspend the lip. There was a 100% survival rate of the flaps. Postoperatively, all patients were able to take oral diet and none of the patients complained of drooling, an inability to eat in a public setting, or microstomia. Of the patients who underwent reconstruction, 8 received pre- or postoperative radiation therapy and the remaining 4 patients did not. In this case series, the radial forearm free flap was the most commonly used flap for lip reconstruction. The use of free tissue transfer for lip reconstruction is a very predictable method for reconstructing these challenging defects and maintaining a patient's ability to take in an oral diet. Although there was a clear color mismatch in most patients, none viewed this as a major drawback of the reconstruction.

Rotina de treinamento laboratorial em microcirurgia do Instituto Nacional do Câncer

A microcirurgia é uma técnica na qual se realiza cirurgia sob magnificação óptica em vasos de diâmetro < 3 mm. Jacobson e Suarez, em 1960, foram os primeiros a utilizar o termo microcirurgia para descrever anastomoses experimentais de vasos com calibre entre 1 mm e 2 mm, sendo a origem da moderna prática microvascular creditada a eles. Desde então, foram desenvolvidos e publicados diversos tipos de transferência microvascular de tecidos para reparo de grandes defeitos corporais e ocorreu intensa modernização do poder óptico e do design dos instrumentos. Apesar dessa evolução, a prática laboratorial é indispensável e permite ao cirurgião alcançar a habilidade necessária à realização da técnica de microanastomoses. Nesse contexto, este artigo apresenta a rotina de treinamento em microcirurgia realizada no Laboratório de Microcirurgia Experimental do Instituto Nacional do Câncer (Rio de Janeiro, RJ, Brasil).

Repair of iatrogenic oronasal fistula after periapical surgery

Oronasal fistula (ONF) is frequently reported as a complication of cleft palate repair. It is not very common after minor oral surgical procedures. A case of ONF as a sequela of enucleation of an infected palatal radicular cyst with apicoectomy of 21, 22, and 23, was referred to the department. A whole spectrum of surgical procedures starting from small local flaps to microvascular tissue transfer, have been employed for the closure of ONF. This article describes a step-by-step procedure using two local flaps that provide epithelial covering to both the superior and inferior surfaces of the defect. The patient was followed up for more than six months.

Complex wound-healing problems in neurosurgical patients: risk factors, grading and treatment strategy

Wound-healing problems in the neurosurgical patient can be particularly bothersome, owing to various specific risk factors involved. These may vary from simple wound dehiscence to complex multi-layer defects with cerebrospinal fluid (CSF) leakage and contamination. The latter is quite rare in practice and requires an individually titrated reconstruction strategy. The objective is to retrospectively analyze neurosurgical patients with complex, recalcitrant wound-healing problems we had treated in our department, attempt to develop a grading system based on the risk factors specific to our specialty and adapt a surgical reconstruction algorithm. During an 11-year period, 49 patients were identified to have had complex, recalcitrant wound-healing problems involving the cranial vault (n = 43) and the skull base (n = 6) that required an adapted surgical wound-management strategy. The etiologies of wound healing problems were aftermaths of surgical treatment of: (1) brain tumors (nine cases), (2) aneurysm clipping (ten cases), (3) trauma (27 patients), and (4) congenital malformations (three patients). Local rotational advancement flaps were performed in 18 patients and free microvascular tissue transfer was performed in 37 cases. Major risk factors leading to recalcitrant wound healing problems in the presented group were: prolonged angiographic interventions (20%), ongoing chemotherapy or radiotherapy (47%), prolonged cortisone application (51%), CSF leak (76%) and, above all, multiple failed attempts at wound closure (94%). Stable long-term wound healing was achieved in all patients using vascularized tissue coverage. A ternary grading system was developed based on various risk factors in the presented cohort. Accordingly, the algorithm for reconstruction in neurosurgical patients was adapted. Primary disease, treatment history, and distorted anatomical structures are major concerns in the management of complex wound-healing problems in neurosurgical patients. The higher the risk factors involved, the more complex is the surgical strategy. Free microvascular tissue transfer offers stable long-term results in recalcitrant cases. However, this may be indicated only in patients with a good prognosis of the underlying disease.

Microvascular Tissue Transfer in Cleft Palate Patients

The closure of wide palatal clefts and recurrent oronasal fistulae may be challenging. After repeated failure of conventional techniques, microvascular tissue transfer may be indicated in the closure of such fistulae. Depending on the location and the size of the palatal fistula, different tissues are required to sufficiently close the palatal gaps. A subdivision of common flaps into mucosa, muscular, bony, skin, and fascia flaps was carried out to analyze their suitability for alveolar, hard, and soft palate reconstruction. Furthermore, the bulk of flaps and the length of the vascular pedicle were analyzed to rate the suitability of different flaps for palatal closure. Based on a new classification of oronasal fistulae, all these factors were taken into consideration to introduce a decision guidance of what microvascular flap fits a particular clinical situation. The radial free forearm flap was found to be sufficient in the closure of all classes of oronasal fistulae.

Outcomes of Total or Near-Total Lip Reconstruction With Microvascular Tissue Transfer

The reconstruction of total lower lip defects is very challenging, whether due to trauma or post-oncologic. The challenge faced by surgeons is to not only recreate an aesthetically pleasing lower lip but more importantly one that is functional. We reviewed our experience at the University of Florida College of Medicine Jacksonville, Division of Oral and Maxillofacial Surgery, in reconstructing these challenging defects over the past five years. Our time-line extended from 2007 to 2010. All surgeries were done by the senior author. The medical records were reviewed to retrieve demographics including: age, gender, reasons for the acquired defect, lip reconstructed, reconstructive method, flap survival, and outcomes. We identified 12 patients with a total of 13 free tissue transfers with total or near total lip defects reconstructed with free tissue transfer. The mean age was 57 years old with the overwhelming majority of the patients being male (10 vs 2). In 10 patients, the defects were due to resection of malignancies affecting the lip, while the remaining 2 patients were due to gunshot avulsive injuries. Of the 13 flaps used to reconstruct the defects, 11 were radial forearm flaps with the use of the palmaris longus tendon while one was the anterolateral thigh flap with the use of the fascia to resuspend the lip. There was a 100% survival rate of the flaps. Postoperatively all of the patients were able to take oral diet and none of the patients complained of drooling, inability to eat in a public setting, or microstomia. Of the patients reconstructed, 8 received either pre- or postoperative radiation therapy while the remaining 4 patients did not. In our case series, the radial forearm free flap was the most commonly used flap for lip reconstruction. The use of free tissue transfer for lip reconstruction is a very predictable method for reconstructing these challenging defects, while maintaining the patient's ability to take in an oral diet. While there was a clear color mismatch in most of the patients, none viewed this as a major drawback of the reconstruction.

Management of Salivary Bypass Tube and Stent Migration in Pharyngoesophageal Microvascular Reconstruction

Objective: Post-chemoradiation salvage surgery with pharyngoesophageal reconstruction may be associated with postop fistula, even with free tissue transfer. Salivary bypass tubes and stents have thus been used to minimize this complication, but migration is a real risk. We present our series of bypass tube and esophageal stent distal migrations and management. Method: A retrospective chart review at a tertiary academic medical center identified those patients undergoing pharyngoesophageal salvage resection, simultaneous complex pharyngoesophageal reconstruction, and salivary bypass tube or esophageal stent placement. Demographics, surgical details and postop management of tube or stent migration distally into the GI tract were investigated. Results: Distal migration of the salivary bypass tube was identified in 2 patients, and migration of the esophageal stent was identified in 1 patient. All cases were in the setting of complex pharyngoesophageal flap reconstruction after salvage surgical resection. Dates of migration discovery ranged from weeks to months postop. All patients were asymptomatic and without fistula formation, but with the tubes/stent radiographically confirmed in the GI tract. Management was via a team approach with our GI colleagues, and all salivary-channeling devices were successfully retrieved endoscopically, without complication. Conclusion: Pharyngoesophageal reconstruction after salvage surgery carries the risk of fistula even in the setting of micro-vascular tissue transfer. To minimize this dreaded complication, salivary bypass tubes/stents may be used, but migration is a well-recognized risk. Our series presents successful management of such via a team approach.

Survival After Free Flap Reconstruction in Patients With Advanced Oral Squamous Cell Carcinoma

The purpose of the present study was to assess the effect of free-flap reconstruction on the survival of patients treated for oral squamous cell carcinoma. The present study was based on a retrospective cohort of 98 patients. Of the 98 patients, 49 underwent surgical reconstruction with microvascular tissue transfer (test group) and in 49 (control group), only local or regional flaps were used. For the free-flap group, the average follow-up period was 34.6 months. For the control group, the average follow-up was 39.8 months. At the end of the follow-up period, 23 (47%) and 33 (67.3%) patients had died of oral squamous cell carcinoma in the microvascular reconstructive and control group, respectively. The difference in the final status between the 2 groups was statistically significant (P = .03). In the free-flap group, the mean and median survival time was 65 and 60 months. In the locoregional flap group, the mean and median survival time was 54 and 24 months, respectively. No difference was seen in the survival time between the free-flap and local flap groups (P = .2). Univariate Kaplan-Meier analysis revealed that positive surgical margins were significantly associated with shortened survival in the free-flap group and that recurrence was significant in both reconstructive groups. On multivariate Cox regression analysis, the status of the resection margin (P = .07) and tumor recurrence (P < .0005) showed a significant relationship with survival. Patients with free-flap reconstruction of surgically created defects after oral cancer resection showed a trend toward better 5-year survival.

Effect of intraoperative use of vasopressors on the outcome of microvascular tissue transfer in head and neck surgery

Objective: To evaluate the effect of intraoperative administration of vasopressors on the outcomes of microvascular tissue transfer.