Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

Tony C.T. Huang, Pedro Ciudad, Oscar J. Manrique, Mouchammed Agko, Shih Heng Chen, Phoebe Yueh Bih Tang, M. Diya Sabbagh, Hung Chi Chen

Research output: Contribution to journalArticle

Abstract

Introduction: Microsurgical reconstruction of complex head and neck defects often requires reliable tissue in multiple spatial configurations to achieve good functional and aesthetic outcomes. In addition to robust perforators, flap inset and wound closure require great caution to minimize complications especially in the presence of trismus with limited space for inset. This report describes the technique and results of our staged approach to flap inset which increases the chance of total flap survival in complex head and neck reconstructions. Methods: From February 2010 to August 2016, a total of 53 patients were identified via a retrospective chart review. Patients who were suspected to have a high risk of vascular compromise and subsequently underwent complex head and neck reconstruction with staged inset of anterolateral thigh (ALT) flaps were included. The flap was inset only partially at the recipient site initially with fewer sutures. At a second stage, after neovascularization from surrounding tissue was established, the flap was partially elevated, divided and mobilized on its own pedicle for definitive inset. Results: Fifty-one patients had complete survival of flaps and had uneventful postoperative course. Six cases required immediate re-exploration to release wound tension or reposition the pedicle. Of these, 4 flaps were salvaged, 2 failed due to small perforators despite anastomosis revision. The flap survival rate was 96.2% and the average time between 2 stages was 24 days (range, 21–28). Conclusion: Staged flap inset can improve free flap survival in complex head and neck reconstructions.

Original languageEnglish (US)
Pages (from-to)844-851
Number of pages8
JournalMicrosurgery
Volume38
Issue number8
DOIs
StatePublished - Nov 1 2018
Externally publishedYes

Fingerprint

Free Tissue Flaps
Neck
Head
Survival
Trismus
Perforator Flap
Wounds and Injuries
Thigh
Esthetics
Sutures
Blood Vessels
Survival Rate

ASJC Scopus subject areas

  • Surgery

Cite this

Huang, T. C. T., Ciudad, P., Manrique, O. J., Agko, M., Chen, S. H., Tang, P. Y. B., ... Chen, H. C. (2018). Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival. Microsurgery, 38(8), 844-851. https://doi.org/10.1002/micr.30370

Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival. / Huang, Tony C.T.; Ciudad, Pedro; Manrique, Oscar J.; Agko, Mouchammed; Chen, Shih Heng; Tang, Phoebe Yueh Bih; Sabbagh, M. Diya; Chen, Hung Chi.

In: Microsurgery, Vol. 38, No. 8, 01.11.2018, p. 844-851.

Research output: Contribution to journalArticle

Huang, TCT, Ciudad, P, Manrique, OJ, Agko, M, Chen, SH, Tang, PYB, Sabbagh, MD & Chen, HC 2018, 'Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival', Microsurgery, vol. 38, no. 8, pp. 844-851. https://doi.org/10.1002/micr.30370
Huang, Tony C.T. ; Ciudad, Pedro ; Manrique, Oscar J. ; Agko, Mouchammed ; Chen, Shih Heng ; Tang, Phoebe Yueh Bih ; Sabbagh, M. Diya ; Chen, Hung Chi. / Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival. In: Microsurgery. 2018 ; Vol. 38, No. 8. pp. 844-851.
@article{242918acf3524c4e8837d4c75cabdc18,
title = "Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival",
abstract = "Introduction: Microsurgical reconstruction of complex head and neck defects often requires reliable tissue in multiple spatial configurations to achieve good functional and aesthetic outcomes. In addition to robust perforators, flap inset and wound closure require great caution to minimize complications especially in the presence of trismus with limited space for inset. This report describes the technique and results of our staged approach to flap inset which increases the chance of total flap survival in complex head and neck reconstructions. Methods: From February 2010 to August 2016, a total of 53 patients were identified via a retrospective chart review. Patients who were suspected to have a high risk of vascular compromise and subsequently underwent complex head and neck reconstruction with staged inset of anterolateral thigh (ALT) flaps were included. The flap was inset only partially at the recipient site initially with fewer sutures. At a second stage, after neovascularization from surrounding tissue was established, the flap was partially elevated, divided and mobilized on its own pedicle for definitive inset. Results: Fifty-one patients had complete survival of flaps and had uneventful postoperative course. Six cases required immediate re-exploration to release wound tension or reposition the pedicle. Of these, 4 flaps were salvaged, 2 failed due to small perforators despite anastomosis revision. The flap survival rate was 96.2{\%} and the average time between 2 stages was 24 days (range, 21–28). Conclusion: Staged flap inset can improve free flap survival in complex head and neck reconstructions.",
author = "Huang, {Tony C.T.} and Pedro Ciudad and Manrique, {Oscar J.} and Mouchammed Agko and Chen, {Shih Heng} and Tang, {Phoebe Yueh Bih} and Sabbagh, {M. Diya} and Chen, {Hung Chi}",
year = "2018",
month = "11",
day = "1",
doi = "10.1002/micr.30370",
language = "English (US)",
volume = "38",
pages = "844--851",
journal = "Microsurgery",
issn = "0738-1085",
publisher = "Wiley-Liss Inc.",
number = "8",

}

TY - JOUR

T1 - Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

AU - Huang, Tony C.T.

AU - Ciudad, Pedro

AU - Manrique, Oscar J.

AU - Agko, Mouchammed

AU - Chen, Shih Heng

AU - Tang, Phoebe Yueh Bih

AU - Sabbagh, M. Diya

AU - Chen, Hung Chi

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Introduction: Microsurgical reconstruction of complex head and neck defects often requires reliable tissue in multiple spatial configurations to achieve good functional and aesthetic outcomes. In addition to robust perforators, flap inset and wound closure require great caution to minimize complications especially in the presence of trismus with limited space for inset. This report describes the technique and results of our staged approach to flap inset which increases the chance of total flap survival in complex head and neck reconstructions. Methods: From February 2010 to August 2016, a total of 53 patients were identified via a retrospective chart review. Patients who were suspected to have a high risk of vascular compromise and subsequently underwent complex head and neck reconstruction with staged inset of anterolateral thigh (ALT) flaps were included. The flap was inset only partially at the recipient site initially with fewer sutures. At a second stage, after neovascularization from surrounding tissue was established, the flap was partially elevated, divided and mobilized on its own pedicle for definitive inset. Results: Fifty-one patients had complete survival of flaps and had uneventful postoperative course. Six cases required immediate re-exploration to release wound tension or reposition the pedicle. Of these, 4 flaps were salvaged, 2 failed due to small perforators despite anastomosis revision. The flap survival rate was 96.2% and the average time between 2 stages was 24 days (range, 21–28). Conclusion: Staged flap inset can improve free flap survival in complex head and neck reconstructions.

AB - Introduction: Microsurgical reconstruction of complex head and neck defects often requires reliable tissue in multiple spatial configurations to achieve good functional and aesthetic outcomes. In addition to robust perforators, flap inset and wound closure require great caution to minimize complications especially in the presence of trismus with limited space for inset. This report describes the technique and results of our staged approach to flap inset which increases the chance of total flap survival in complex head and neck reconstructions. Methods: From February 2010 to August 2016, a total of 53 patients were identified via a retrospective chart review. Patients who were suspected to have a high risk of vascular compromise and subsequently underwent complex head and neck reconstruction with staged inset of anterolateral thigh (ALT) flaps were included. The flap was inset only partially at the recipient site initially with fewer sutures. At a second stage, after neovascularization from surrounding tissue was established, the flap was partially elevated, divided and mobilized on its own pedicle for definitive inset. Results: Fifty-one patients had complete survival of flaps and had uneventful postoperative course. Six cases required immediate re-exploration to release wound tension or reposition the pedicle. Of these, 4 flaps were salvaged, 2 failed due to small perforators despite anastomosis revision. The flap survival rate was 96.2% and the average time between 2 stages was 24 days (range, 21–28). Conclusion: Staged flap inset can improve free flap survival in complex head and neck reconstructions.

UR - http://www.scopus.com/inward/record.url?scp=85057479289&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057479289&partnerID=8YFLogxK

U2 - 10.1002/micr.30370

DO - 10.1002/micr.30370

M3 - Article

C2 - 30488493

AN - SCOPUS:85057479289

VL - 38

SP - 844

EP - 851

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 8

ER -