Simplifying head and neck microvascular reconstruction

Eben Rosenthal, William Carroll, Mathew Dobbs, J. Scott Magnuson, Mark Wax, Glenn Peters

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background. Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), mid-face (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggests improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results.

Original languageEnglish (US)
Pages (from-to)930-936
Number of pages7
JournalHead and Neck
Volume26
Issue number11
DOIs
StatePublished - Nov 2004

Fingerprint

Neck
Head
Oropharynx
Enteral Nutrition
Operative Time
Diet
Forearm
Mouth
Length of Stay
Tissue Donors
Suture Techniques
Hypopharynx
Skin
Fibula
Free Tissue Flaps
Tertiary Healthcare
Deglutition
Blood Vessels
Veins
Transplants

Keywords

  • Cost-efficient
  • Free flap
  • Head and neck reconstruction
  • Microvascular
  • Oral cavity
  • Swallowing

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Rosenthal, E., Carroll, W., Dobbs, M., Magnuson, J. S., Wax, M., & Peters, G. (2004). Simplifying head and neck microvascular reconstruction. Head and Neck, 26(11), 930-936. https://doi.org/10.1002/hed.20076

Simplifying head and neck microvascular reconstruction. / Rosenthal, Eben; Carroll, William; Dobbs, Mathew; Magnuson, J. Scott; Wax, Mark; Peters, Glenn.

In: Head and Neck, Vol. 26, No. 11, 11.2004, p. 930-936.

Research output: Contribution to journalArticle

Rosenthal, E, Carroll, W, Dobbs, M, Magnuson, JS, Wax, M & Peters, G 2004, 'Simplifying head and neck microvascular reconstruction', Head and Neck, vol. 26, no. 11, pp. 930-936. https://doi.org/10.1002/hed.20076
Rosenthal E, Carroll W, Dobbs M, Magnuson JS, Wax M, Peters G. Simplifying head and neck microvascular reconstruction. Head and Neck. 2004 Nov;26(11):930-936. https://doi.org/10.1002/hed.20076
Rosenthal, Eben ; Carroll, William ; Dobbs, Mathew ; Magnuson, J. Scott ; Wax, Mark ; Peters, Glenn. / Simplifying head and neck microvascular reconstruction. In: Head and Neck. 2004 ; Vol. 26, No. 11. pp. 930-936.
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