Free flap reconstruction of the head and neck: Analysis of 241 cases
Objective: We undertook this study of free flap reconstruction of the head and neck to stratify patients and procedures, to determine how donor site preference changed over time, to assess medical and surgical outcomes, and to identify variables associated with complications. Methods: We analyzed co...
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Veröffentlicht in: | Otolaryngology-head and neck surgery 2001-07, Vol.125 (1), p.10-17 |
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creator | Haughey, Bruce H. Wilson, Ewain Kluwe, Lucia Piccirillo, Jay Fredrickson, John Sessions, Donald Spector, Gershon |
description | Objective: We undertook this study of free flap reconstruction of the head and neck to stratify patients and procedures, to determine how donor site preference changed over time, to assess medical and surgical outcomes, and to identify variables associated with complications. Methods: We analyzed computerized medical records from 236 patients who underwent a total of 241 reconstructions at a tertiary academic medical center in St. Louis between 1989 and 1998. We created a more detailed retrospective database of 141 of those patients by using 48 perioperative variables and 7 adverse outcome measures. Multivariate statistical models were used to analyze associations between variables and outcomes. Results: The fibula became the preferred donor site for mandibular reconstruction, and the radial forearm became the preferred donor site for pharyngoesophageal reconstruction. For the 241 procedures, the mortality rate was 2.1%, the median length of stay was 11 days, and the flap survival rate was 95%. Administration of more than 7 L of crystalloid during surgery and age over 55 were associated with major medical complications. Blood transfusion, prognostic comorbidity, and number of surgeons correlated with length of stay. Cigarette smoking and receipt of more than 7 L of crystalloid during surgery were associated with overall flap complications, and weight loss of more than 10% before surgery, more than one operating surgeon, and cigarette smoking were associated with major flap complications. Conclusions: Risk to patients and transferred tissue is low in free flap head and neck reconstruction. Age, smoking history, and weight loss should be considered during patient selection. Fluid balance should be considered during and after surgery. Division of labor for patient care should be carefully delineated among surgeons in a teaching setting. (Otolaryngol Head Neck Surg 2001;125:10-7.) |
doi_str_mv | 10.1067/mhn.2001.116788 |
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Methods: We analyzed computerized medical records from 236 patients who underwent a total of 241 reconstructions at a tertiary academic medical center in St. Louis between 1989 and 1998. We created a more detailed retrospective database of 141 of those patients by using 48 perioperative variables and 7 adverse outcome measures. Multivariate statistical models were used to analyze associations between variables and outcomes. Results: The fibula became the preferred donor site for mandibular reconstruction, and the radial forearm became the preferred donor site for pharyngoesophageal reconstruction. For the 241 procedures, the mortality rate was 2.1%, the median length of stay was 11 days, and the flap survival rate was 95%. Administration of more than 7 L of crystalloid during surgery and age over 55 were associated with major medical complications. Blood transfusion, prognostic comorbidity, and number of surgeons correlated with length of stay. Cigarette smoking and receipt of more than 7 L of crystalloid during surgery were associated with overall flap complications, and weight loss of more than 10% before surgery, more than one operating surgeon, and cigarette smoking were associated with major flap complications. Conclusions: Risk to patients and transferred tissue is low in free flap head and neck reconstruction. Age, smoking history, and weight loss should be considered during patient selection. Fluid balance should be considered during and after surgery. Division of labor for patient care should be carefully delineated among surgeons in a teaching setting. (Otolaryngol Head Neck Surg 2001;125:10-7.)</description><identifier>ISSN: 0194-5998</identifier><identifier>EISSN: 1097-6817</identifier><identifier>DOI: 10.1067/mhn.2001.116788</identifier><identifier>PMID: 11458207</identifier><language>eng</language><publisher>Los Angeles, CA: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Esthetics ; Female ; Follow-Up Studies ; Head - physiopathology ; Head - surgery ; Head and Neck Neoplasms - pathology ; Head and Neck Neoplasms - surgery ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neck - physiopathology ; Neck - surgery ; Postoperative Complications ; Reconstructive Surgical Procedures - methods ; Retrospective Studies ; Surgical Flaps ; Tissue Donors ; Treatment Outcome</subject><ispartof>Otolaryngology-head and neck surgery, 2001-07, Vol.125 (1), p.10-17</ispartof><rights>2001 American Academy of Otolarynology - Head and Neck Surgery foundation, Inc.</rights><rights>2001 SAGE Publications</rights><rights>2001 American Association of Otolaryngology‐Head and Neck Surgery Foundation (AAO‐HNSF)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4947-76ebe650455370f083b1a2a2fa42e5d247fd7276f5178eaeb68ff96b32a327633</citedby><cites>FETCH-LOGICAL-c4947-76ebe650455370f083b1a2a2fa42e5d247fd7276f5178eaeb68ff96b32a327633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1067/mhn.2001.116788$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1067/mhn.2001.116788$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,1417,21819,27924,27925,43621,43622,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11458207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haughey, Bruce H.</creatorcontrib><creatorcontrib>Wilson, Ewain</creatorcontrib><creatorcontrib>Kluwe, Lucia</creatorcontrib><creatorcontrib>Piccirillo, Jay</creatorcontrib><creatorcontrib>Fredrickson, John</creatorcontrib><creatorcontrib>Sessions, Donald</creatorcontrib><creatorcontrib>Spector, Gershon</creatorcontrib><title>Free flap reconstruction of the head and neck: Analysis of 241 cases</title><title>Otolaryngology-head and neck surgery</title><addtitle>Otolaryngol Head Neck Surg</addtitle><description>Objective: We undertook this study of free flap reconstruction of the head and neck to stratify patients and procedures, to determine how donor site preference changed over time, to assess medical and surgical outcomes, and to identify variables associated with complications. Methods: We analyzed computerized medical records from 236 patients who underwent a total of 241 reconstructions at a tertiary academic medical center in St. Louis between 1989 and 1998. We created a more detailed retrospective database of 141 of those patients by using 48 perioperative variables and 7 adverse outcome measures. Multivariate statistical models were used to analyze associations between variables and outcomes. Results: The fibula became the preferred donor site for mandibular reconstruction, and the radial forearm became the preferred donor site for pharyngoesophageal reconstruction. For the 241 procedures, the mortality rate was 2.1%, the median length of stay was 11 days, and the flap survival rate was 95%. Administration of more than 7 L of crystalloid during surgery and age over 55 were associated with major medical complications. Blood transfusion, prognostic comorbidity, and number of surgeons correlated with length of stay. Cigarette smoking and receipt of more than 7 L of crystalloid during surgery were associated with overall flap complications, and weight loss of more than 10% before surgery, more than one operating surgeon, and cigarette smoking were associated with major flap complications. Conclusions: Risk to patients and transferred tissue is low in free flap head and neck reconstruction. Age, smoking history, and weight loss should be considered during patient selection. Fluid balance should be considered during and after surgery. Division of labor for patient care should be carefully delineated among surgeons in a teaching setting. (Otolaryngol Head Neck Surg 2001;125:10-7.)</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Esthetics</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Head - physiopathology</subject><subject>Head - surgery</subject><subject>Head and Neck Neoplasms - pathology</subject><subject>Head and Neck Neoplasms - surgery</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neck - physiopathology</subject><subject>Neck - surgery</subject><subject>Postoperative Complications</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Retrospective Studies</subject><subject>Surgical Flaps</subject><subject>Tissue Donors</subject><subject>Treatment Outcome</subject><issn>0194-5998</issn><issn>1097-6817</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFP2zAUhy00RDvgzG3yaSdSbMfxc3aDsg4kRC9wthzneTVLk85OmPrfL1Uq7bTtZOn5-_309D1CrjhbcKbgZrtpF4IxvuBcgdYnZM5ZCZnSHD6QOeOlzIqy1DPyMaU3xphSAGdkxrkstGAwJ_eriEh9Y3c0ouva1MfB9aFraedpv0G6QVtT29a0RffjC71tbbNPIR2-heTU2YTpgpx62yS8PL7n5HX19WX5kD2tvz0ub58yJ0sJGSisUBVMFkUOzDOdV9wKK7yVAotaSPA1CFC-4KDRYqW096WqcmHzcZzn5-Tz1LuL3c8BU2-2ITlsGttiNyQDnAmhmRzBmwl0sUspoje7GLY27g1n5iDOjOLMQZyZxI2JT8fqodpi_Yc_mhoBmIBfocH9__rM-uH5biUg14fk9ZRM9juat26Io8P0j03KCcfR5HvAaJIL2Dqsw3ih3tRd-Gv2N1b2mKQ</recordid><startdate>200107</startdate><enddate>200107</enddate><creator>Haughey, Bruce H.</creator><creator>Wilson, Ewain</creator><creator>Kluwe, Lucia</creator><creator>Piccirillo, Jay</creator><creator>Fredrickson, John</creator><creator>Sessions, Donald</creator><creator>Spector, Gershon</creator><general>Elsevier Inc</general><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>200107</creationdate><title>Free flap reconstruction of the head and neck: Analysis of 241 cases</title><author>Haughey, Bruce H. ; Wilson, Ewain ; Kluwe, Lucia ; Piccirillo, Jay ; Fredrickson, John ; Sessions, Donald ; Spector, Gershon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4947-76ebe650455370f083b1a2a2fa42e5d247fd7276f5178eaeb68ff96b32a327633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Esthetics</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Head - physiopathology</topic><topic>Head - surgery</topic><topic>Head and Neck Neoplasms - pathology</topic><topic>Head and Neck Neoplasms - surgery</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neck - physiopathology</topic><topic>Neck - surgery</topic><topic>Postoperative Complications</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Retrospective Studies</topic><topic>Surgical Flaps</topic><topic>Tissue Donors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haughey, Bruce H.</creatorcontrib><creatorcontrib>Wilson, Ewain</creatorcontrib><creatorcontrib>Kluwe, Lucia</creatorcontrib><creatorcontrib>Piccirillo, Jay</creatorcontrib><creatorcontrib>Fredrickson, John</creatorcontrib><creatorcontrib>Sessions, Donald</creatorcontrib><creatorcontrib>Spector, Gershon</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>ComDisDome</collection><jtitle>Otolaryngology-head and neck surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haughey, Bruce H.</au><au>Wilson, Ewain</au><au>Kluwe, Lucia</au><au>Piccirillo, Jay</au><au>Fredrickson, John</au><au>Sessions, Donald</au><au>Spector, Gershon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Free flap reconstruction of the head and neck: Analysis of 241 cases</atitle><jtitle>Otolaryngology-head and neck surgery</jtitle><addtitle>Otolaryngol Head Neck Surg</addtitle><date>2001-07</date><risdate>2001</risdate><volume>125</volume><issue>1</issue><spage>10</spage><epage>17</epage><pages>10-17</pages><issn>0194-5998</issn><eissn>1097-6817</eissn><abstract>Objective: We undertook this study of free flap reconstruction of the head and neck to stratify patients and procedures, to determine how donor site preference changed over time, to assess medical and surgical outcomes, and to identify variables associated with complications. Methods: We analyzed computerized medical records from 236 patients who underwent a total of 241 reconstructions at a tertiary academic medical center in St. Louis between 1989 and 1998. We created a more detailed retrospective database of 141 of those patients by using 48 perioperative variables and 7 adverse outcome measures. Multivariate statistical models were used to analyze associations between variables and outcomes. Results: The fibula became the preferred donor site for mandibular reconstruction, and the radial forearm became the preferred donor site for pharyngoesophageal reconstruction. For the 241 procedures, the mortality rate was 2.1%, the median length of stay was 11 days, and the flap survival rate was 95%. Administration of more than 7 L of crystalloid during surgery and age over 55 were associated with major medical complications. Blood transfusion, prognostic comorbidity, and number of surgeons correlated with length of stay. Cigarette smoking and receipt of more than 7 L of crystalloid during surgery were associated with overall flap complications, and weight loss of more than 10% before surgery, more than one operating surgeon, and cigarette smoking were associated with major flap complications. Conclusions: Risk to patients and transferred tissue is low in free flap head and neck reconstruction. Age, smoking history, and weight loss should be considered during patient selection. Fluid balance should be considered during and after surgery. Division of labor for patient care should be carefully delineated among surgeons in a teaching setting. (Otolaryngol Head Neck Surg 2001;125:10-7.)</abstract><cop>Los Angeles, CA</cop><pub>Elsevier Inc</pub><pmid>11458207</pmid><doi>10.1067/mhn.2001.116788</doi><tpages>8</tpages></addata></record> |
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subjects | Adolescent Adult Aged Aged, 80 and over Analysis of Variance Esthetics Female Follow-Up Studies Head - physiopathology Head - surgery Head and Neck Neoplasms - pathology Head and Neck Neoplasms - surgery Humans Logistic Models Male Middle Aged Multivariate Analysis Neck - physiopathology Neck - surgery Postoperative Complications Reconstructive Surgical Procedures - methods Retrospective Studies Surgical Flaps Tissue Donors Treatment Outcome |
title | Free flap reconstruction of the head and neck: Analysis of 241 cases |
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