Head and neck free flap survival when requiring interposition vein grafting: A multi-instiutional review

Nolan B. Seim, Matthew Old, Daniel Petrisor, William Thomas, Akash Naik, Alia J. Mowery, Stephen Kang, Ryan Li, Mark K. Wax

Research output: Contribution to journalArticle

Abstract

Objective: Interposition vein grafting in free flap reconstruction is often viewed as a risky procedure, but is necessary in cases of inadequate pedicle length. Materials and methods: Two tertiary care centers retrospectively.reviewed 3008 head and neck free flap reconstructions from 2008 to 2017 91 patients were identified requiring interposition vein grafting during reconstruction. Pre and perioperative characteristics were recorded Univariate and multivariate analyses were conducted with a p value <0.05 indicating statistical significance. Results: Of the 91 patients 75% had undergone reconstruction for cancer, 66% of these cases were in the setting of recurrence or complication, 33% had a previous free flap, and 52% had prior radiation therapy. Surgical site was primarily craniofacial (36%) or oral cavity (26%). The majority of vein grafts were saphenous (64%), average graft length 18 cm (SD 11 cm). Half were used for both artery and vein anastomosis. Flap survival was 85% overall and only prior free flap was predictive of failure on multivariate analysis. No other peri-operative or graft variable assessed in this study were predictive of flap failure. Conclusion: In a multi-institutional study of head and neck free flap reconstructions using interposition vein grafts, we identified an overall 85% success rate with no significant difference between soft tissue and osteocutaneous flaps despite the complicated nature of these cases.

Original languageEnglish (US)
Article number104482
JournalOral Oncology
Volume101
DOIs
StatePublished - Feb 2020

Fingerprint

Free Tissue Flaps
Veins
Neck
Head
Transplants
Multivariate Analysis
Tertiary Care Centers
Mouth
Radiotherapy
Arteries
Recurrence
Survival
Neoplasms

Keywords

  • Free flap
  • Head and neck reconstruction
  • Interposition
  • Survival
  • Vein graft

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Head and neck free flap survival when requiring interposition vein grafting : A multi-instiutional review. / Seim, Nolan B.; Old, Matthew; Petrisor, Daniel; Thomas, William; Naik, Akash; Mowery, Alia J.; Kang, Stephen; Li, Ryan; Wax, Mark K.

In: Oral Oncology, Vol. 101, 104482, 02.2020.

Research output: Contribution to journalArticle

Seim, Nolan B. ; Old, Matthew ; Petrisor, Daniel ; Thomas, William ; Naik, Akash ; Mowery, Alia J. ; Kang, Stephen ; Li, Ryan ; Wax, Mark K. / Head and neck free flap survival when requiring interposition vein grafting : A multi-instiutional review. In: Oral Oncology. 2020 ; Vol. 101.
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T2 - A multi-instiutional review

AU - Seim, Nolan B.

AU - Old, Matthew

AU - Petrisor, Daniel

AU - Thomas, William

AU - Naik, Akash

AU - Mowery, Alia J.

AU - Kang, Stephen

AU - Li, Ryan

AU - Wax, Mark K.

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N2 - Objective: Interposition vein grafting in free flap reconstruction is often viewed as a risky procedure, but is necessary in cases of inadequate pedicle length. Materials and methods: Two tertiary care centers retrospectively.reviewed 3008 head and neck free flap reconstructions from 2008 to 2017 91 patients were identified requiring interposition vein grafting during reconstruction. Pre and perioperative characteristics were recorded Univariate and multivariate analyses were conducted with a p value <0.05 indicating statistical significance. Results: Of the 91 patients 75% had undergone reconstruction for cancer, 66% of these cases were in the setting of recurrence or complication, 33% had a previous free flap, and 52% had prior radiation therapy. Surgical site was primarily craniofacial (36%) or oral cavity (26%). The majority of vein grafts were saphenous (64%), average graft length 18 cm (SD 11 cm). Half were used for both artery and vein anastomosis. Flap survival was 85% overall and only prior free flap was predictive of failure on multivariate analysis. No other peri-operative or graft variable assessed in this study were predictive of flap failure. Conclusion: In a multi-institutional study of head and neck free flap reconstructions using interposition vein grafts, we identified an overall 85% success rate with no significant difference between soft tissue and osteocutaneous flaps despite the complicated nature of these cases.

AB - Objective: Interposition vein grafting in free flap reconstruction is often viewed as a risky procedure, but is necessary in cases of inadequate pedicle length. Materials and methods: Two tertiary care centers retrospectively.reviewed 3008 head and neck free flap reconstructions from 2008 to 2017 91 patients were identified requiring interposition vein grafting during reconstruction. Pre and perioperative characteristics were recorded Univariate and multivariate analyses were conducted with a p value <0.05 indicating statistical significance. Results: Of the 91 patients 75% had undergone reconstruction for cancer, 66% of these cases were in the setting of recurrence or complication, 33% had a previous free flap, and 52% had prior radiation therapy. Surgical site was primarily craniofacial (36%) or oral cavity (26%). The majority of vein grafts were saphenous (64%), average graft length 18 cm (SD 11 cm). Half were used for both artery and vein anastomosis. Flap survival was 85% overall and only prior free flap was predictive of failure on multivariate analysis. No other peri-operative or graft variable assessed in this study were predictive of flap failure. Conclusion: In a multi-institutional study of head and neck free flap reconstructions using interposition vein grafts, we identified an overall 85% success rate with no significant difference between soft tissue and osteocutaneous flaps despite the complicated nature of these cases.

KW - Free flap

KW - Head and neck reconstruction

KW - Interposition

KW - Survival

KW - Vein graft

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