Author(s): 1.Zuhera Khan 2. Munazza Saleem,3.Fahmina Buriro,4. Mazhar nizam,5.Syed Aqil Shah,6. Asim Durrani,7. Ahmad Rahim Bux
Received: 11/01/2022 | Published: 10/07/2022 | Pages: 39-44 |
Background: With the advancement in clinical techniques, free flap surgery for head and neck defects has gained popularity as a refined microvascular surgical technique that comes with numerous challenges. The objective of this study is to define the frequency of venous complications in free flaps employed for head and neck cancer surgeries in a tertiary care hospital to establish guidelines for the early management of failing flaps and to look for a similar pattern of venous complications in free flaps of the head and neck. Methodology: This prospective study was conducted in the plastic surgery department of Patel Hospital Karachi from January 16th, 2017, to July 16th, 2017. It included all patients with head and neck malignancies who had free flap reconstruction and were examined for venous problems within five days of surgery, regardless of gender. Result: Venous issues were found in 6 out of 70 free flaps (8.6%) in head and neck cancer reconstruction, resulting in a 95.4% flap success rate. Even when external factors were not considered, venous thrombosis was the most common cause of venous complications. Conclusion: The study concluded that venous complications are the most common reason for free flap failure, followed by arterial causes, neck hematoma, recipient or donor artery issues, and infections.
Keywords | Free flaps, venous complications in free flaps, salvage flaps, microvascular free tissue transfer
1. J F, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. 2020.
2. Xie L, Shang Z. Burden of oral cancer in Asia from 1990 to 2019: Estimates from the Global Burden of Disease 2019 study. PLoS One. 2022;17(3):e0265950.
3. Cancer Registry and Clinical Data Management (CRCDM) – Shaukat Khanum Memorial Cancer Hos-pital and Research Center (SKMCH&RC) – (www. shaukatkhanum.org.pk). Report based on cancer cases registered at SKMCH&RC from Dec. 1994-Dec. 2021 and in 2021. Released May 2022. [Internet]. 2022.
4. Anwar N, Pervez S, Chundriger Q, Awan S, Moatter T, Ali TS. Oral cancer: Clinicopathological features and associated risk factors in a high risk population presen-ting to a major tertiary care center in Pakistan. PLoS One. 2020;15(8):e0236359.
5. Fatima N, Mohiuddin S, Hosein S, Mervyn M. Socioeconomic implications of a Younger aged Female Predilection in malignant transformation of Oral Su
mucous Fibrosis. J Ayub Med Coll Abbottabad. 2019; 31:16-20.
6. Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck. 2010;32(9):1236-45.
7. Odorico SK, Reuter Muñoz K, J. Nicksic P, Gunderson KA, Wood K, H. Nkana Z, et al. Surgical and demographic predictors of free flap salvage after takeback: A systematic review. Microsurgery. 2022.
8. Khan S, Khan Z, Ali M, Shaikh SA, Rahman MF. Should 1 or 2 venous anastomoses be done in microsurgical flap transfer? Ann Plast Surg. 2020;85(5):522-6.
9. Christianto S, Lau A, Li K, Yang W, Su Y. One versus two venous anastomoses in microsurgical head and neck reconstruction: a cumulative meta-analysis. Int J Oral Maxillofac Surg. 2018;47(5):585-94.
10. Verhelst P-J, Dons F, Van Bever P-J, Schoenaers J, Nanhekhan L, Politis C. Fibula free flap in head and neck reconstruction: identifying risk factors for flap failure and analysis of postoperative complications in a low volume setting. Craniomaxillofac Trauma Reconstr. 2019;12(3):183-92.
11. Geierlehner A, Rodi T, Mosahebi A, Tanos G, Wormald J. Meta-analysis of venous anastomosis techniques in free flap reconstruction. J Plast Reconstr Aesthet Surg. 2020;73(3):409-20.
12. Shen AY, Lonie S, Lim K, Farthing H, Hunter-Smith DJ, Rozen WM. Free flap monitoring, salvage, and
failure timing: a systematic review. J Reconstr Microsurg.2021;37(03):300-8.
13. Tasch C, Pattiss A, Maier S, Lanthaler M, Pierer G. Free flap outcome in irradiated recipient sites: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2022;10(3).
14. Joseph J, Bharathwaj S, Arvind A, Ganapathy Bhagavathy R, Muram Reddy HK. Re-exploration in the early postoperative period has a better salvage rate in free flaps. Eur Plast Surg. 2021;44(2):219-30.
15. Kovatch KJ, Hanks JE, Stevens JR, Stucken CL. Current practices in microvascular reconstruction in otolaryngology– head and neck surgery. Laryngoscope. 2019; 129(1):138-45.
16. Sweeny L, Topf M, Wax MK, Rosenthal EL, Greene BJ, Heffelfinger R, et al. Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction. Laryngoscope. 2020;130(2):347-53.
17. Sweeny L, Curry J, Crawley M, Cave T, Stewart M, Luginbuhl A, et al. Factors impacting successful salvage of the failing free flap. Head Neck. 2020;42(12): 3568- 79.
18. Wei F-C, Deek NFA, Cheng M-H, Lin C-H. The triangle of unfavorable outcomes after microsurgical head and neck reconstruction: planning, design, and execution. Clin Plast Surg. 2016;43(4):615-20.
19. Lin Y, He J-f, Zhang X, Wang H-m. Intraoperative factors associated with free flap failure in the head and neck region: a four-year retrospective study of 216 patients and review of the literature. Int J Oral Maxillofac Surg. 2019;48(4):447-51.
20. Qiao Q-h, Yin S-c, Shi C, Wang S, Xu Q, Xu Z-f, et al. Risk Factors for Free Flap Outcomes: A Retrospective Study of 318 Free Flaps for Head and Neck Defect
Reconstruction. Ear Nose Throat J. 2022: 0145561322 1115143.
21. Boczar D, Colon RR, Anzai L, Daar DA, Chaya BF, Trilles J, et al. Single Versus Double Venous Anastomosis Microvascular Free Flaps for Head and Neck Reconstruction. J Craniofac Surg. 2022;33(3):784-6.
22. Cariati P, Cabello Serrano A, Monsalve Iglesias F, Roman Ramos M, Fernandez Solis J, Martinez Lara I. Unfavorable outcomes in microsurgery: possibilities for improvement. J Plast Surg Hand Surg. 2019; 53(5): 279-87.
23. van Gijn DR, D’Souza J, King W, Bater M. Free flap head and neck reconstruction with an emphasis on postoperative care. Facial Plast Surg. 2018;34(06): 597-604.
24. Sweeny L, Rosenthal EL, Light T, Grayson J, Petrisor D, Troob SH, et al. Outcomes and cost implications of microvascular reconstructions of the head and neck. Head Neck. 2019;41(4):930-9.
25. Kääriäinen M, Halme E, Laranne J. Modern postoperative monitoring of free flaps. Curr Opin Otolaryngol Head Neck Surg. 2018;26(4):248-53. October –
All published material becomes the sole property of the Pakistan Journal of Plastic Surgery, copyrighted by the Pakistan Association of Plastic Surgeons (PAPS). By submitting an article or brief communication, all authors agree to these conditions.
During the submission process, all authors have required to complete a copyright transfer agreement, “Author Consent form” By completing the copyright transfer agreement, you are transferring copyright of figures, tables, videos, and the content of the manuscript to the Pakistan Association of Plastic Surgeons (PAPS).
If you do not wish to or cannot transfer copyright of some or all of your content, please contact the editorial office at pjpspakistan@gmail.com.