Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (4): 86-90.doi: 10.6040/j.issn.1673-3770.0.2021.375

Previous Articles    

Factors affecting flap neurosis and other postoperative flap-related complications after free-flap reconstruction of head and neck tumors

ZHANG Lijun, XU Ran, LUO Jifang, LIU Guoqi, HE Qian, LI Wei, JIANG Zhenhua   

  1. Department of Otorhinolaryngology, Mianyang Central Hospital / Mianyang Hospital Affiliated to School of Medicine of University of Electronic Science and Technology of China, Mianyang 621000, Sichuan, China
  • Published:2022-07-11

PDF (PC)

384

Abstract: Objective This study aimed to explore the factors affecting flap neurosis and other postoperative flap-related complications. Methods Patients who underwent free-flap reconstruction of head and neck tumors were examined. Factors such as of age, sex, operation duration, smoking, alcohol consumption, hypertension, diabetes, preoperative radiotherapy, vascular anastomosis skill on flap neurosis, and flap-related complications were analyzed. Results We observed that age, sex, operation duration, smoking, alcohol consumption, preoperative radiotherapy, and vascular anastomosis skill were not risk factors for flap neurosis and flap-related complications after free flap reconstruction in patients with head and neck tumors; Diabetes was observed to be a risk factor for flap failure after free-flap reconstruction in patients with head and neck tumors(P=0.006), whereas hypertension(P=0.040)and diabetes(P=0.024)were independent risk factors for flap-related complications. Conclusion Individualized reconstruction methods should be used in patients with head and neck tumors who are suffering from diabetes and are candidates for free-flap reconstruction.

Key words: Head and neck tumor, Free flap, Reconstruction, Risk factors, Surgery

CLC Number: 

  • R739.91
[1] Bray Freddie, Ferlay Jacques, Soerjomataram Isabelle, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA(A Cancer Journal for Clinicians), 2018, 68(6): 394-424. doi:10.3322/caac.21492.
[2] 陈曦, 乔明哲. 免疫检查点抑制剂在复发或转移性头颈鳞癌的治疗进展[J]. 山东大学耳鼻喉眼学报, 2019,33(3): 42-48. doi: 10.6040/j.issn.1673-3770.1.2019.001. CHEN Xi, QIAO Mingzhe. Progress of immune checkpoint inhibitors in the treatment of recurrent or metastatic head and neck squamous cell carcinoma[J]. J Otolaryngol Ophthalmol Shandong Univ, 2019,33(3): 42-48. doi: 10.6040/j.issn.1673-3770.1.2019.001.
[3] 刘绍严, 鄢丹桂. 头颈肿瘤术后缺损修复的现状与展望[J]. 中国耳鼻咽喉颅底外科杂志, 2020,26(3): 231-234. doi: 10.11798/j.issn.1007-1520.202003001. LIU Shaoyan, YAN Dangui. Current situation and prospect of defect repair after head and neck tumor resection[J]. Chin J Otorhinolaryngol - Skull Base Surg, 2020,26(3): 231-234. doi: 10.11798/j.issn.1007-1520.202003001.
[4] Üstün GG, Aksu AE, Uzun H, et al. The systematic review and meta-analysis of free flap safety in the elderly patients[J]. Microsurgery, 2017, 37(5): 442-450. doi:10.1002/micr.30156.
[5] Spindler N, Pieroh P, Spiegl U, et al. Free flap reconstruction of the extremities in patients who are ≥65 years old: a single-center retrospective 1-to-1 matched analysis[J]. Clin Interv Aging, 2021, 16: 497-503. doi:10.2147/cia.s300558.
[6] D'Andréa G, Scheller B, Gal J, et al. How to select candidates for microvascular head and neck reconstruction in the elderly? Predictive factors of postoperative outcomes[J]. Surg Oncol, 2020, 34: 168-173. doi:10.1016/j.suronc.2020.04.016.
[7] Thomas B, Gazyakan E, Falkner F, et al. Free tissue transfer with the free rectus abdominis flap in high-risk patients above 65 years: a retrospective cohort study[J]. J Plast Reconstr Aesthet Surg, 2019, 72(4): 555-564. doi:10.1016/j.bjps.2019.01.005.
[8] Wang C, Fu G, Ji F, et al. Perioperative risk factors for radial forearm-free flap complications[J]. J Craniofac Surg, 2020, 31(2): 381-384. doi:10.1097/scs.0000000000006035.
[9] Ishimaru M, Ono S, Suzuki S, et al. Risk factors for free flap failure in 2, 846 patients with head and neck cancer: a national database study in Japan[J]. J Oral Maxillofac Surg, 2016, 74(6): 1265-1270. doi:10.1016/j.joms.2016.01.009.
[10] Hwang K, Lee JP, Yoo SY, et al. Relationships of comorbidities and old age with postoperative complications of head and neck free flaps: a review[J]. J Plast Reconstr Aesthet Surg, 2016, 69(12): 1627-1635. doi:10.1016/j.bjps.2016.08.018.
[11] Chow LQM. Head and neck cancer[J]. N Engl J Med, 2020, 382(1): 60-72. doi:10.1056/NEJMra1715715.
[12] Wang CY, Dudzinski J, Nguyen D, et al. Association of smoking and other factors with the outcome of mohs reconstruction using flaps or grafts[J]. JAMA Facial Plast Surg, 2019, 21(5): 407-413. doi:10.1001/jamafacial.2019.0243.
[13] 彭小伟, 喻建军, 李赞, 等. 游离皮瓣修复头颈缺损皮瓣坏死原因分析[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(2): 118-122. doi: 10.3760/cma.j.issn.1673-0860.2015.02.006. PNEG Xiaowei, YU Jianjun, LI Zan, et al. Analysis of the causes of flap necrosis after head and neck reconstruction[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2015, 50(2): 118-122. doi: 10.3760/cma.j.issn.1673-0860.2015.02.006.
[14] Ehrl D, Heidekrueger PI, Haas EM, et al. Does cigarette smoking harm microsurgical free flap reconstruction?[J]. J Reconstr Microsurg, 2018, 34(7): 492-498. doi:10.1055/s-0038-1639377.
[15] Edwards K, Donato D, Tatro E, et al. Operative time and flap failure in unilateral and bilateral free flap breast reconstruction[J]. J Reconstr Microsurg, 2018, 34(6): 428-435. doi:10.1055/s-0038-1627445.
[16] Wang KY, Lin YS, Chen LW, et al. Risk of free flap failure in head and neck reconstruction[J]. Ann Plast Surg, 2020, 84(1S): S3-S6. doi:10.1097/sap.0000000000002180.
[17] Thankappan K. Microvascular free tissue transfer after prior radiotherapy in head and neck reconstruction-A review[J]. Surg Oncol, 2010, 19(4): 227-234. doi:10.1016/j.suronc.2009.06.001.
[18] Rostetter C, Kuster IM, Schenkel JS, et al. The effects of preoperative radiotherapy on head and neck free flap anastomosis success[J]. J Oral Maxillofac Surg, 2016, 74(12): 2521-2525. doi:10.1016/j.joms.2016.05.020.
[19] Mijiti A, Kuerbantayi N, Zhang ZQ, et al. Influence of preoperative radiotherapy on head and neck free-flap reconstruction: Systematic review and meta-analysis[J]. Head Neck, 2020, 42(8): 2165-2180. doi:10.1002/hed.26136.
[20] Akazawa T, Sekido M, Adachi K, et al. End-to-side venous anastomosis to a ligated vein stump for free flap transfer in head and neck reconstruction[J]. Ann Plast Surg, 2019, 83(2): 180-182. doi:10.1097/sap.0000000000001905.
[21] 徐中飞, 谭学新, 秦兴军, 等. 影响头颈部游离皮瓣移植成活的因素分析[J]. 中国口腔颌面外科杂志, 2010,8(3): 265-268. XU Zhongfei, TAN Xuexin, QIN Xingjun, et al. Analysis of factors associated with success rate of 124 free flaps in head and neck reconstruction[J]. China J Oral Maxillofac Surg, 2010, 8(3): 265-268.
[22] Mücke T, Ritschl LM, Roth M, et al. Predictors of free flap loss in the head and neck region: a four-year retrospective study with 451 microvascular transplants at a single centre[J]. J Craniomaxillofac Surg, 2016, 44(9): 1292-1298. doi:10.1016/j.jcms.2016.04.029.
[23] Chen XF, Chen YM, Gokavarapu S, et al. Free flap reconstruction for patients aged 85 years and over with head and neck cancer: clinical considerations for comprehensive care[J]. Br J Oral Maxillofac Surg, 2017, 55(8): 793-797. doi:10.1016/j.bjoms.2017.07.003.
[24] Yu J, Hong JP, Suh HP, et al. Prognostic nutritional index is a predictor of free flap failure in extremity reconstruction[J]. Nutrients, 2020, 12(2): 562. doi:10.3390/nu12020562.
[25] Brady JS, Govindan A, Crippen MM, et al. Impact of diabetes on free flap surgery of the head and neck: a NSQIP analysis[J]. Microsurgery, 2018, 38(5): 504-511. doi:10.1002/micr.30276.
[26] 高俊芳, 刘萍. 医护一体化营养管理模式在全喉切除术后的应用[J]. 山东大学耳鼻喉眼学报, 2019,33(3): 143-146. doi: 10.6040/j.issn.1673-3770.1.2018.047. GAO Junfang, LIU Ping. Application of the integration of doctors' and nurses' nutrition management model after total laryngectomy[J]. J Otolaryngol Ophthalmol Shandong Univ, 2019,33(3): 143-146. doi: 10.6040/j.issn.1673-3770.1.2018.047.
[1] WANG Huan, HU LiOverview,YU HongmengGuidance. Research progress of olfactory dysfunction in chronic rhinosinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 43-49.
[2] CAO XuanOverview,XIAO Xuping, LI YunqiuGuidance. Advances in the application of hyaluronic acid in chronic sinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 104-109.
[3] QIN Ming, SUN Zhanwei, WANG Weiwei, LI Shichao, WU Tianyi, WANG Guangke. Efficacy of alkaline isotonic saline in laryngopharyngeal reflux symptom-positive or finding score-positive patients with chronic rhinosinusitis following endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 147-153.
[4] CHEN Shiqin, WEI Pingcun, HU Yunlong, HU Jinwang. Effects of three different nasal uses of glucocorticoid on mucosal outcome after endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 195-201.
[5] ZHAO Xiaobing,ZHANG Dawei, CHEN Renjie. A case of middle-ear anaplastic large T- cell lymphoma and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 7-14.
[6] FENG Yiyuan, YANG Jing, YANG Hongbin. Clinical analysis of 220 cases of deep neck space infection [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 51-57.
[7] DANG Panhong, ZHANG Rui, HU Chunyan, WANG Jie, FAN Mengyun. Clinical analysis of facial nerve decompression via an external transmastoid-subtemporal labyrinth approach in eight children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 37-42.
[8] LIU Shanshan, HAN Shujing, WANG Xiaoxu, LI Yanhong, NI Xin, ZHANG Jie. Hearing loss in children after bacterial meningitis: a systematic review and meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 48-54.
[9] CHEN Kun, LU Hui, HUANG Qi, LI Lei, MENG Guozhen, YANG Jun, HOU Dongming. Clinical diagnosis and treatment of congenital nasal sinus mass in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 81-85.
[10] ZENG Bin, LÜ Dan, REN Jia, HU Juanjuan, YU Lingyu, LU Huan, YANG Hui. Application of laryngeal microsurgery in severe neonatal upper airway obstruction [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 95-99.
[11] LI Ying. Importance of standardized methods in corneal refractive surgery and the prevention of complications [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 1-6.
[12] WANG LixiangOverview,LI Ying, DENG YingpingGuidance. The application of corneal stromal lenticules extracted from small incision lenticule extraction surgery for hyperopia correction [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 7-12.
[13] QIN He, WAN Baogang, WANG Hongli, ZHAO Benqi. Computed tomography-based preoperative diagnosis of fungal ball sinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 32-35.
[14] BA Guangyi, MAO Song, SUN Xiwen, TANG Ru, LI Zhipeng, LIN Hai, ZHANG Weitian. Application of Voxel-man ENT surgery simulation system in the training of nasal operation technique [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 56-61.
[15] CHEN Guoping, FU Minyi, YE Fei, XU Jianhui. Comparative study of holmium and CO2 laser surgeries for early glottic carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 8-11.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd