Neck Reconstruction Research Articles

Hypothermia During Microsurgical Head and Neck Reconstruction and Incidence of Venous Thromboembolism

Venous thromboembolism (VTE) is a severe complication after microsurgical free tissue transfer (FTT) to the head and neck. Hypothermia during surgery is a modifiable risk factor, and avoiding it may reduce the postoperative VTE rate. To assess the association between hypothermia (temperature <36 °C) and postoperative VTE and free flap pedicle thrombosis rates after head and neck reconstruction with FTT. This retrospective cohort study in a tertiary academic referral center used prospective and retrospective database and medical record data collected for patients who underwent head and neck reconstruction with FTT between January 1, 2012, and August 31, 2023. Temperature over time was classified as normothermia (temperature ≥36 °C), hypothermia (<36 °C) for more than 30 minutes and less than 120 minutes, and hypothermia for 120 minutes or more. Venous thromboembolism. The study outcomes were VTE events and thrombosis of the free flap pedicle that required revision surgery. Univariable and multivariable regressions were used to test the association between the outcomes and clinical factors. A total of 1078 patients (mean [SD] age, 61.3 [12.6] years; 724 males [67.2%]; mean [SD] Caprini score, 6.4 [2.1]) were included. The VTE and pedicle thrombosis rates were 3.2% (35 patients) and 2.2% (24 patients), respectively. In a multivariable model controlled for Caprini score and chemoprophylaxis, VTE was associated with hypothermia of more than 30 minutes and less than 120 minutes (odds ratio [OR], 3.82; 95% CI, 0.99-14.07) and hypothermia of 120 minutes or longer (OR, 3.55; 95% CI, 1.05-11.95). Free flap pedicle thrombosis was not associated with hypothermia (OR, 0.61; 95% CI, 0.26-1.43). These findings suggest that preventing hypothermia during microsurgical FTT to the head and neck may decrease the postoperative rate of VTE. Future studies should explore the optimal intraoperative body temperature range that may prevent the development of VTE without compromising patient safety.

Donor site morbidity of upper extremity flaps in head and neck reconstruction

ObjectiveThis retrospective cohort study aims to compare donor site morbidity of three commonly used upper extremity flaps used in head and neck reconstructive surgery: scapular tip free flap (STFF), radial forearm free flap (RFFF), and pectoralis major pedicled flap (PMPF). MethodsThe billing database of an urban, academic, tertiary otolaryngology practice was queried to identify patients who underwent STFF, RFFF, and PMPF from 2020 to 2023. The primary outcome was identification of donor site pain and need for physical therapy (PT) referral after undergoing reconstruction. ResultsSeventy-three patients (44 M:29F) underwent surgery that utilized upper extremity free or pedicled flaps. Patients undergoing free tissue transfer (FTT) were 5.455 times more likely to require PT referral compared to patients undergoing pedicled tissue transfer (PTT). Patients undergoing FTT were 3.417 times more likely to report donor site pain compared to patients undergoing PTT. There were no differences in post-operative PT referrals or post-operative donor site pain when comparing STFF or RFFF groups. Importantly, RFFF were primarily all fasciocutaneous flaps (33/35). ConclusionsThese findings have important implications when counselling patients regarding reconstructive options for complex head and neck surgery defects.

Adult Bladder Exstrophy Managed by Complete Primary Repair: A Case Report

Bladder Exstrophic diseases, referred to collectively as Bladder Exstrophy-Epispadiasis complex, are a spectrum of embryological anomalies with a rare prevalence of approximately 3.3 per 1,00,000 live births with a male gender predominance. An 18-year-old man presented to Urology Outpatient Department (OPD) with subumbilical abdominal wall defect, absent anterior bladder wall with epispadiasis and was diagnosed as a case of adult classic bladder exstrophy with Epispadiasis complex. There was no history of any fever, haematuria, dysuria or abdominal pain. His ultrasound abdomen and intravenous pyelography reported normal kidney function. He had a low Body Mass Index (BMI) (17.5 kg/m2 ) with serum creatinine of 0.6 mg/dL. The patient underwent a complete primary repair, including bladder template closure and bladder neck reconstruction using Young-Dees-Leadbetter technique. Epispadias was repaired with the Modified Cantwell-Ransley approach. Abdominal wall defect closure was done with the help of rectus abdominis muscle flap which was later grafted using Split Thickness Skin Graft (STSG). Postoperatively, a small vesicocutaneous fistula developed which healed spontaneously over two weeks period. On follow-up patient was on clean intermittent catheterisation with some incontinence episodes during night-time. Bladder exstrophy in adult patients is rare, as the condition is usually identified in the neonatal period and can be surgically corrected early on. Due to the complexity of the surgery, these cases require thorough multidisciplinary evaluation and careful planning for successful correction.

Patient reported health related quality of life outcomes after viable cryopreserved umbilical tissue placement directly over spared neurovascular bundles after robotic assisted radical prostatectomy.

Incontinence and sexual dysfunction remain common side effects from robotic-assisted radical prostatectomy (RARP) despite nerve sparing (NS) and bladder neck reconstruction techniques. Placing growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA-approved for surgery. The objective is to determine if vCUT use in NS-RARP accelerates return of continence and sexual function. A retrospective cohort of 176 patients undergoing NS-RARPs with and without vCUT from 2015 to 2020 was identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence at 3, 6, and 12months, postoperatively was evaluated using MUSIC patient-reported outcomes (PRO), a validated questionnaire assessing urinary and sexual quality of life at baseline and post-treatment. A distinct cohort of 65 patients undergoing NS-RARP with and without vCUT was assessed for erections firm enough for intercourse at 12 and 24months post-operatively using MUSIC-PRO. The association between vCUT use and social continence at 3months was assessed via multivariable logistic regression. A descriptive analysis among patients with quality erections prior to surgery assessed the association between vCUT use and erection quality. Continence was achieved by 3months post-op in 86% (99/115) of vCUT patients versus 74% (45/61) in non-vCUT patients (p = 0.044). In a multivariable analysis, although not reaching conventional statistical significance, vCUT patients were more likely to achieve continence than non-vCUT patients (OR = 2.21, p = 0.073). At 24months post-op, 32% of vCUT patients reported good sexual function versus 33% in non-vCUT patients (p = 0.9). vCUT use during NS-RARP is associated with quicker return to social urinary continence. However, no differences were seen in return of potency. Further studies with longer follow-up and larger sample sizes may further evaluate effectiveness of vCUT in accelerating return of postoperative continence and potency.

Relationship among cancer treatment, quality of life, and oral function in head and neck cancer survivors: A cross-sectional study

PurposeTreatment for head and neck cancer (HNC), such as surgery and chemoradiotherapy, can reduce oral function and affect quality of life (QoL). However, whether HNC treatment affects QoL via the decline of oral function remains unclear. This study aimed to investigate the relationship among cancer treatment, QoL, and actual oral function in HNC survivors.MethodsA total of 100 HNC survivors who had completed definitive treatment for HNC at least 6 months prior to enrollment were enrolled in this cross-sectional study. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 summary score. Oral diadochokinesis (ODK), tongue pressure, moisture level on the mucosal surface, and mouth opening were measured. Information on age, sex, tumor site, tumor stage, history of HNC treatment, height, body weight, and lifestyle were collected from medical records. Structural equation modeling (SEM) was conducted to analyze the indirect/direct associations among HNC treatment, QoL, and oral function.ResultsIn total, 100 HNC survivors (58 males and 42 females; age range, 30–81 years, median, 67 years) were analyzed. Overall, 63 patients (63.0%) were diagnosed as oral cancer, 66 (66.0%) developed advanced cancer (stage 3/4), and 58 (58.0%) underwent reconstruction surgery in 100 HNC survivors. The SEM results supported the hypothesized structural model (root mean square error of approximation = 0.044, comparative fit index = 0.990, Tucker-Lewis index = 0.986). Surgery with neck dissection and reconstruction for advanced cancer had indirect effects on lower QoL via ODK and mouth opening.ConclusionHNC treatment is indirectly associated with QoL via oral function in HNC survivors.

Single-port transvesical simple prostatectomy for the surgical treatment of benign prostatic hyperplasia: functional and continence outcomes.

Robot-Assisted Simple Prostatectomy (RASP) is recommended for the treatment of large prostate glands. The introduction of the Single-Port (SP) platform in 2018 has enabled transvesical approach to SP-RASP with promising outcomes. Our aim was to describe the functional and urinary continence outcomes of SP-RASP. Clinical and surgical data from all consecutive patients who underwent transvesical SP-RASP between February 2020 and March 2024 were collected in a prospectively maintained institutional dataset and retrospectively analyzed. All procedures were performed using the da Vinci SP platform without any conversions to open surgery. Postoperative outcomes were gathered and analyzed, with a particular focus on the incidence of urinary incontinence (UI) and the time to continence recovery. Overall, 89 patients underwent SP-RASP, with a median prostate size of 110 grams (90-171.5) and a median PSA level of 5.5 mg/dl (2.77-10.93). All patients were on at least one prostate medication prior to surgery. Preoperative evaluations showed a median International Prostate Symptoms Score (IPSS) of 23 (20-27), Quality of Life (QoL) of 4 (3-5), and Post-voiding Residual (PVR) of 153 ml (60-400). The median operative time was 180 min (164-200), with a median estimated blood loss of 100 ml (30-180). Postoperatively, no patients required continuous bladder irrigation. The median postoperative opioid intake was 6.5 morphine equivalents (0-10), with over 78% not requiring narcotics after discharge. Overall, 77.5% were same day discharged. No Clavien-Dindo > 2 complications were recorded. The median follow-up time was 18 (7-35) months. At the last postoperative urological evaluation, the median IPSS was 5 (3-7), QoL was 1 (0-2), and PVR was 10 ml (0-25). Only 4 patients (4.5%) experienced UI postoperatively, and all were continent within 3 months. The UI incidence rate and functional outcomes of SP-RASP are very encouraging, likely due to precise adenoma and urethra dissection and bladder neck reconstruction. This approach also allows for same-day discharge.

The superficial circumflex iliac artery perforator flap in head and neck reconstruction: a retrospective review

Introduction: The superficial circumflex iliac artery perforator flap is a well-established alternative to traditional fasciocutaneous flaps for reconstructive purposes. It is gaining popularity due to short raise time, flap size, ability to provide concurrent raise and donor site concealment. Here we report our initial experience using the superficial circumflex iliac artery perforator flap to reconstruct a variety of defects in the head and neck region. Methods: Eleven patients underwent superficial circumflex iliac artery perforator flap reconstruction for head and neck defects by a single surgeon. Operative details, complications and intermediate outcomes were collected. We reviewed and summarised current published reports on the use of the superficial circumflex iliac artery perforator flap in the head and neck for comparison. Results: At our institution, 11 patients received 12 superficial circumflex iliac artery perforator flaps to reconstruct defects in the head and neck. There were 10 males and one female with a mean age of 60 years, and oncologic resection or complications thereof was the indication for all patients. Defects included five total laryngectomies, four cutaneous defects and two oral cavity reconstructions. The mean flap raise time was 58 minutes and the mean flap size was 92 cm2. Four patients returned to theatre, two for microvascular compromise (one arterial, one venous) and two for salvage operations performed for salivary leak after reconstruction of laryngectomy. Conclusion: Our initial experience with the superficial circumflex iliac artery perforator flap has demonstrated it as a viable and robust free flap for complex head and neck reconstruction.

Use of 3D Exoscope for Free Flaps Microanastomosis in Head and Neck Reconstruction.

The use of the 3D exoscope in cervicofacial reconstruction has demonstrated its effectiveness, yet few studies have compared its utility to that of the microscope. To compare the reliability of microanastomoses performed with both tools, along with postoperative outcomes and user experience. This was a retrospective single-center study that included all cases of microanastomosed forearm or fibula free flap reconstructions performed between June 2019 and June 2022. For each procedure, microsurgical characteristics were collected and compared. The primary outcome measure was the reliability of anastomoses (lack of intraoperative events and absence of early surgical revisions). Secondary outcome measures pertained to postoperative evolution. Forty patients underwent microanastomosed flap reconstruction (20 forearm flaps, 20 fibula flaps) using either a microscope (n = 10 in each group) or a 3D exoscope (n = 10 in each group). Patient characteristics were comparable between the two groups. No significant difference was observed between the use of the microscope and the 3D exoscope in terms of anastomosis reliability; OR = 2.07 [0.09-130.88], p = 1. No differences were noted between the two groups in postoperative outcomes except for a shorter hospitalization period for patients undergoing forearm flap reconstruction with the exoscope compared to the microscope (p = 0.03). The use of the 3D exoscope appears to be an interesting alternative to the microscope in cervicofacial reconstruction due to similar microsurgical results, good ergonomics and significant pedagogical appeal.

Innovative use of radial artery retrograde forearm flap for oral and maxillofacial reconstruction

IntroductionThe purpose of this study is to present a novel method of reconstructing oral and maxillofacial defects using the Radial Artery Retrograde Proximal Forearm Flap (RARPFF) and to evaluate the efficacy and safety of the forearm flap for direct closure of the donor site and its effect on hand function in the donor area. MethodsA prospective study of 30 patients who underwent oral and maxillofacial reconstruction with RARPFF between June 2021 and April 2024 was conducted to evaluate the safety and efficacy of the flap and its influence on hand function in the donor area. ResultsFlap survival was 93.3 %. The donor site defect in 28 out of 30 patients healed primarily. All donor sites were directly closed without complications such as splitting, tendon exposure, or numbness in the thumb or thenar region. Statistically significant differences were observed in grip strength (MD = 4.56, p < 0.001) and elbow extension (MD = 2.78, p < 0.001) at 3 months, as well as in grip strength (MD = 2.20, p < 0.001) and elbow extension (MD = 1.67, p < 0.001) at 1 year, compared to the contralateral hand. Wrist flexion, extension, radial deviation, ulnar deviation, elbow flexion, pronation, and supination did not exhibit statistically significant differences from the contralateral hand at both 3 months and 1 year. The Michigan Hand Questionnaire (MHQ) revealed a statistically significant difference in aesthetics compared to the contralateral hand (p < 0.001), along with satisfactory overall hand function, activities of daily living (ADL), work performance, pain levels, and patient satisfaction with hand function. ConclusionsThe reverse radial artery proximal forearm flap is a dependable and secure technique for head and neck reconstruction. This method can effectively reduce donor site complications while preserving hand function.

Closure of the Osteocutaneous Fibula Flap Donor Site with a Tonearm (Propeller) Flap: Anatomic Considerations and Surgical Indications

BackgroundSkin graft is frequently used for donor site closure after osteocutaneous fibula free flap (OCFFF) harvest when primary closure is not possible. Partial skin graft loss requiring wound care is a common complication. The purposes of this prospective study were to investigate the perforator anatomy for local propeller/tonearm flap closure and compare outcomes to skin graft closure. MethodsAll patients undergoing OCFFF for head and neck reconstruction from February 2022 to October 2023 were considered for the tonearm flap. Intraoperative perforator anatomy was prospectively recorded. Surgical techniques and criteria for tonearm flap reconstruction were described. A minimum 6-month follow-up was required. Outcome measures included the rate of flap success and wound complications. Results40 consecutive patients were included. The tonearm flap was not possible in 16 patients (40%) due to unfavorable perforator anatomy and 2 patients underwent primary closure. All successful tonearm flaps were eccentrically designed on a proximal lower leg perforator, located 13.5±1.99cm from the fibular head. Most proximal perforators were musculocutaneous through the soleus muscle (n=20, 90.9%), while the rest were septocutaneous (n=2, 9.1%) originating from the peroneal artery. Three patients experienced distal partial flap loss; one required an additional skin graft. Only half of the skin graft cohort (n=99, 50.8%) achieved complete skin graft take. The average skin graft loss was 34.3% and wound care was required for an average 51.6±52.8 days. ConclusionsThe study findings demonstrate that local tonearm flaps, when anatomically feasible, can be successfully performed with superior outcomes compared to skin graft closures.

The Burden of Plastic Surgery in Rural Kenya: The Kapsowar Hospital Experience.

Both governmental and nongovernmental training programs are expanding efforts to train the next generation of plastic surgeons who will work in low- and middle-income countries (LMICs). Sufficient training is dependent on acquiring the appropriate skillset for these contexts. Few studies have characterized the spectrum of practice of plastic surgeons in LMICs and their relative disparity. We performed a retrospective review on all patients who received plastic surgery at a single institution in rural western Kenya from 2021 to 2023. Data such as diagnoses, procedures, and home village/town of residence were collected. Patient home location was geomapped using an open-access distance matrix application programming interface to estimate travel time based on terrain and road quality, assuming patient access to a private vehicle and ideal traveling conditions. Descriptive statistics were performed. A total of 296 patients received surgery. Common procedures included treatment of cleft lip/palate (CLP), burn reconstruction, and reconstruction for benign tumors of the head and neck. The average distance to treatment was 159.2 minutes. Increased travel time was not associated with time to CLP repair (P > 0.05). Increased travel time was associated with delayed treatment for burns (P = 0.005), maxillofacial trauma (P = 0.032), and hand trauma (P = 0.016). Training programs for plastic surgeons in LMICs should ensure competency in CLP, flaps, burn reconstruction, and head and neck reconstruction. Our novel use of an application programming interface indicates that international partnerships have been more successful in decreasing treatment delays for CLP patients, but not other reconstructive procedure patients. Expanded commitment from international partners to address these reconstructive burdens in LMICs is warranted.

Clinical and Cost-Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta-Analysis.

Indocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost-effectiveness across various plastic and reconstructive surgery procedures. A systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta-analysis concerned perfusion-related complications and cost data. Twenty-five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty-one studies were AHRQ Standard 'Good'; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (n = 3310) and head and neck reconstruction (n = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta-analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, p < 0.0001), fat necrosis (OR 0.31, p < 0.001), infection (OR 0.66, p = 0.02), and re-operation (OR 0.40, p < 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, p = 0.57/OR 0.87, p = 0.56, respectively) or increase in dehiscence (OR 1.55, p = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, p = 0.04), although not partial flap loss (OR 0.37, p = 0.13) and reoperation (OR 0.92, p = 0.73). Lower limb (n = 104) and abdominal wall (n = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta-analysis. ICGFA appears to be a useful, cost-effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.

Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction.

This study aims to develop a practical algorithm for utilizing smartphone-based thermal imaging (SBTI) in the perioperative setting and to establish a standardized evaluation method for objectively assessing SBTI images for cutaneous perfusion of pedicled flaps in the face, head, and neck. This prospective conducted study, integrated SBTI into the assessment of 16 patients undergoing reconstructive surgery for face and neck defects. Thermal images were captured at four timepoints: after marking (T1), after flap elevation (T2), upon completion of surgery (T3), and 24h postoperatively (T4). The flap areas were divided into three flap zones and graded based on temperature differences (ΔT), with a grading system where grade 1 indicated perfect perfusion and grades 2 to 5 indicated increasing perfusion impairment. 6 male and 10 female patients aged 64-93 years (mean 78.5 years) undergoing reconstructive pedicled skin flap surgery for facial and neck defects (1 × 1cm to 11 × 8cm) due to diagnoses of malignant cutaneous lesions were investigated. Intraoperative assessments indicated good perfusion across flaps. One postoperative dehiscence occurred in an 83-year-old male with a cervical advancement flap, correlated with a significant temperature difference (ΔT > 4°C) intraoperatively. Statistical analysis revealed a strong positive correlation (p = 0.0003) between clinical assessment grades and ΔT values between specific flap zones at T3. SBTI is an easy-to-apply, low-cost, real-time and reproducible technique for indirect perfusion assessment in pedicled skin flaps of the head and neck region. Further studies are needed implementing this methodology in large and free flaps.

Clinical Applications and Outcomes of the Supraclavicular Osteocutaneous Flap for Head and Neck Reconstruction.

This study evaluates the clinical applications of the supraclavicular osteocutaneous (SOC) flap in complex head and neck reconstruction and its impact on shoulder function following clavicle resection. Case series with a planned chart review. Single-institution tertiary care center. We reviewed patients with complex mandibular and maxillary defects who underwent SOC flap reconstruction from 2016 to 2020. We detailed flap harvesting techniques, patient characteristics, diagnoses, defect sites, bone dimensions, skin paddle size, vascular supply, and donor site management. Complications and outcomes were also documented. The study included 7 patients with diverse clinical conditions and diagnoses. Reconstruction techniques varied, leading to different clavicle thicknesses and skin paddle sizes. Two cases had flap necrosis due to infection, and 1 experienced chronic shoulder discomfort following partial-thickness clavicle flap surgery. Full-thickness clavicle harvesting resulted in better outcomes and simplified the procedure. Notably, there were no significant long-term complications affecting shoulder function. The SOC flap is a promising option for complex head and neck reconstruction, adaptable to specific case requirements and providing reliable vascular supply. It offers favorable clinical outcomes both functionally and aesthetically. Full-thickness clavicle harvesting, with joint preservation, effectively maintains shoulder function.

Sex Differences in Donor Site Morbidity after Microvascular Free Tissue Head and Neck Reconstruction.

Sex Differences in Donor Site Morbidity after Microvascular Free Tissue Head and Neck Reconstruction.

Clinical Outcomes of Scapular versus Fibular free flaps in Head and Neck Reconstructions: A Retrospective Study of 120 patients".

The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The present study aimed to evaluate their use in maxillomandibular reconstructions and examine surgical and patient outcomes. Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at two Swedish University Hospitals were evaluated for their intraoperative execution (osseous and soft tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACEQ Head and Neck Cancer Module. Donor-site morbidity was assessed using the DASH and SEFAS questionnaires for scapular- and fibular-reconstructed patients, respectively. A total of 120 patients were recruited: 86 mandibular reconstructions (26 scapulas, 60 fibulas) and 34 maxillary reconstructions (32 scapulas, 2 fibulas). The concave scapula facilitated fewer osteotomies for curved reconstructions, particularly for lateral mandibular defects (p=0.039). Intraoral lining was primarily achieved with muscle accompanying the scapula and skin accompanying the fibula. Using the latissimus dorsi muscle instead of only teres major decreased fistulas, plate/bone exposure and non-unions (p=0.039) in scapular reconstructions. Both flaps demonstrated comparable facial QoL, but the scapula presented superior donor site outcomes (p=0.001). Donor limb outcomes were unaffected by harvesting the latissimus dorsi with the scapula (p=0.64), and by re-suturing the detached muscles to the remaining scapula. (p=0.35). The scapular free flap can be advantageous in osseous head and neck reconstructions, enabling non-osteotomized and chimeric reconstructions without compromising surgical outcomes or quality of life.

Computer-Aided Design and Manufacturing in Free Fibula Reconstruction of the Mandible: Comparison of Long-Term Outcomes with the Conventional Technique.

Pre-operative computer-aided design and manufacturing (CAD/CAM) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique have limited long-term follow-up. We aimed to compare short and long-term outcomes between conventional and CAD/CAM approaches for mandibular reconstruction with free fibula flaps. Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, past medical history, surgical details, complications, and reconstructive outcomes were collected. Patients who had CAD/CAM were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware maintenance was displayed using the Kaplan-Meier method. A total of 215 patients (n=79 conventional, n=136 CAD/CAM) were included. Both cohorts had similar demographics except the CAD/CAM cohort was younger (p=0.043). The mean operative duration was 54 minutes shorter with the use of CAD/CAM (p=0.014). Total and partial flap loss rates were similar. Patients with CAD/CAM had significantly lower rates of early wound dehiscence (p=0.037). Median [interquartile range] follow-up duration was similar (931 [1854] days in conventional vs 728 [841] days in CAD/CAM, p=0.084). After excluding patients with major surgical complications in the first 30-days, CAD/CAM cohort had a lower hardware removal rate (28.8% vs 13.9%, p=0.011). The significance persisted after including only the patients with more than 2 years of follow-up. The use of preoperative CAD/CAM may reduce operative duration, while allowing for longer maintenance of hardware with reduced removal rates due to complications.

Predictors for prolonged and escalated perioperative antibiotic therapy after microvascular head and neck reconstruction: a comprehensive analysis of 446 cases

Literature suggests that intravenous prophylaxis exceeding 48 h offers no additional benefit in preventing surgical site infections (SSI) in patients with microvascular head and neck reconstruction. However, protocols for antibiotic therapy duration post-reconstruction are not standardized. This study identifies factors predicting prolonged intravenous antibiotic use and antibiotic escalation in patients receiving free flap head neck reconstruction. A retrospective analysis of 446 patients receiving free flap reconstruction was conducted, examining predictors for antibiotic therapy > 10 days and postoperative escalation. 111 patients (24.8%) experienced escalation, while 159 patients (35.6%) received prolonged therapy. Multivariate regression analysis revealed predictors for escalation: microvascular bone reconstruction (p = 0.008, OR = 2.0), clinically suspected SSI (p < 0.001, OR = 5.4), culture-positive SSI (p = 0.03, OR = 2.9), extended ICU stay (p = 0.01, OR = 1.1) and hospital-acquired pneumonia (p = 0.01, OR = 5.9). Prolonged therapy was associated with bone reconstruction (p = 0.06, OR = 2.0), preoperative irradiation (p = 0.001, OR = 1.9) and culture-positive SSI (p < 0.001, OR = 3.5). The study concludes that SSIs are a primary factor driving the escalation of perioperative antibiotic use. Clinical suspicion of infection often necessitates escalation, even in the absence of confirmed microbiological evidence. Microvascular bone reconstruction was a significant predictor for both the escalation and extension of antibiotic therapy beyond 10 days. Furthermore, preoperative radiation therapy, hospital-acquired pneumonia, and prolonged ICU stay were associated with an increased likelihood of escalation, resulting in significantly extended antibiotic administration during hospitalization. Antibiotic stewardship programmes must be implemented to reduce postoperative antibiotic administration time.Trial registration The study was registered approved by the local Ethics Committee (Nr: 18-1131-104).

Author Correction: Establishing safe high hydrostatic pressure devitalization thresholds for autologous head and neck cancer vaccination and reconstruction

Author Correction: Establishing safe high hydrostatic pressure devitalization thresholds for autologous head and neck cancer vaccination and reconstruction

Superthin Anterolateral Thigh Flap for Head and Neck Reconstruction.

This study was performed to clarify whether the superthin anterolateral thigh (ALT) flap is an appropriate choice for head and neck reconstructions requiring thinner and more pliable flaps. Data of patients who underwent head and neck reconstruction from January 2020 to December 2022 were retrospectively collected. Nine patients (4.2%) underwent reconstruction with a superthin ALT flap. All the flaps survived with no cases of total or partial necrosis. Six patients treated with superthin ALT flaps and 15 patients treated with conventional ALT flaps who underwent oral cavity reconstruction were compared. The mean body mass index was significantly higher in the superthin flap group than in the conventional ALT flap group (25.2 vs 21.2kg/m2, respectively; P = 0.04). The rate of postoperative complications requiring debridement was 0% and 13% (P = 0.37). The mean postoperative Hirose score was 9.7 and 8.7 (P = 0.17). The mean postoperative Functional Oral Intake Scale score was 6.7 and 5.9 (P = 0.12). Secondary flap refinement surgery after facial skin reconstruction was performed in 0 of 2 patients (0.0%) in the superthin flap group and 4 of 52 patients (7.7%) in the conventional ALT flap group (P = 0.04). Oral cavity reconstruction with superthin ALT flaps did not increase the incidence of postoperative flap necrosis and resulted in comparable postoperative function. In addition, superthin ALT flaps did not require additional flap refinement surgeries after facial skin reconstruction. The superthin ALT flap is a safe and reliable choice for obese patients with thick thigh subcutaneous tissue.