Apurva Nayan Samant Final Year Resident, Department of Plastic Surgery, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 400008, Maharashtra, India
Sagar Gundewar Department of Plastic Surgery, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 400008, Maharashtra, India
Yogesh Jaiswal Department of Plastic Surgery, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 400008, Maharashtra, India
Rajat Kapoor Department of Plastic Surgery, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 400008, Maharashtra, India
Address for correspondence: Apurva Nayan Samant, Final Year Resident, Department of Plastic Surgery, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 400008, Maharashtra, India E-mail: dr.samant1313@gmail.com
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Samant AN, Gundewar S, Jaiswal Y, et al. Surgical outcome of free flap surgery in a tertiary referral center in Maharashtra. New Indian J Surg. 2023;14(3):133–8.
Timeline
Received : September 27, 2023
Accepted : August 08, 2023
Published : September 25, 2023
Abstract
Introduction: Reconstruction with a free flap is routinely done at site especially head and neck and oral because of better surgical and functional outcomes, improved esthetics results, and overall higher success rates. Aim & Objective: To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions and study various demographic and pre-operative factors associated with it. Methods: This was a retrospective study of 45 patients undergoing reconstructions with free flaps from January 2020 to December 2022. Different types of free flap were performed like Anterolateral thigh, Free fibula osteocutaneous flap (FFOCF), free functioning muscle transfer (FFMT), Free radial artery forearm flap (FRAF), The medial sural artery perforator (MSAP), latissimus dorsi (LD), myocutaneous flap, superficial circumflex iliac artery perforator (SCIP). Results: The patients included total 45 participants, with 35 men and 10 women, with a mean age of 45.56 years. Oral malignancy was the most common cause. Squamous cell carcinoma represented the majority of the diagnosed tumors (31.1%) followed by ameloblastoma. The most common recipient vessels were the internal jugular vein (91.4%), the facial artery (77.4%) followed by superior thyroid artery. The overall flap success rate was 93.33%. Venous thrombosis was the most common cause for re-exploration. The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site on 1 month follow up. Conclusion: Microsurgical free flap seems to be a valuable and successful method in head and neck surgery. The reconstruction can be done by skilled surgeons with post-op monitoring.
References
1. Alberto Grammatica1*, Cesare Piazza2, Raul Pellini3, Nausica Montalto, Davide Lancini, Alperen Vural1, Francesco Barbara Free aps for advanced oral cancer in the “Older Old” and “Oldest Old”: A Retrospective Multi-Institutional Study Front. Oncol,. Head and Neck Cancer 03 July 2019; Volume 9.
2. Jiwang Liang a, Tao Yu b, Xu Wang c, Yuejiao Zhao a, Fengqin Fang a, Wei Zeng Free tissue aps in head and neck reconstruction Clinical application and analysis of 93 patients of a single institution Brazilian Journal of Otorhinolaryngology Volume 84, Issue 4, July–August 2018, Pages 416-425 Craft AB. Title with initial cap in Roman: Subtitle also with initial cap in Roman. Plast Reconstr Surg. 1997100:111-115.
3. Chen KH, Kuo SCH, Chien PC, Hsieh HY, Hsieh CH. Comparison of the surgical outcomes of free ap reconstruction for primary and recurrent head and neck cancers: a case-controlled propensity score-matched study of 1,791 free ap reconstructions. Sci Rep. 2021 Jan 27;11(1):2350. doi: 10.1038/s41598-021-82034-5. PMID: 33504947; PMCID: PMC7840944.
4. Brian Somoano MD, Jeremy Kampp MD, Hayes B. Gladstone MD Accelerated takedown of the paramedian forehead ap at 1 week: Indications, technique, and improving patient quality of life Journal of the American Academy of Dermatology Volume 65, Issue 1, July 2011, Pages 97-105.
5. Yu P, Chang DW, Miller MJ, Reece G, Robb GL. Analysis of 49 cases of ap compromise in 1310 free aps for head and neck reconstruction. Head Neck. 2009 Jan; 31(1):45-51. doi: 10.1002/ hed.20927. PMID: 18972428.
6. Yadav PS, Shankhdhar VK, Dushyant J, Seetharaman SS, Rajendra G. Two in one: Double free ap from a single free bula osteocutaneous unit. Indian J Plast Surg. 2012 Sep;45(3):459-65. doi: 10.4103/0970-0358.105942. PMID: 23450653; PMCID: PMC3580343.
7. Moellhoff, N.; Taha, S.; Wachtel, N.; Hirschmann, M.; Hellweg, M.; Giunta, R.E.; Ehrl, D. Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study. Diagnostics 2022, 12, 2877.
8. Nina Irawati, James Every, Rebecca Dawson, et al. Effect of operative time on complications associated with free ap reconstruction of the head and neck. Authorea. March 20, 2022.
9. Ishimaru M, Ono S, Suzuki S, Matsui H, Fushimi K, Yasunaga H. Risk factors for free ap failure in 2,846 patients with head and neck cancer: a national database study in Japan. J Oral Maxillofac Surg. 2016;74(06):1265–127.
10. Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free ap reexploration: indications, treatment, and outcomes in 1193 free aps. PlastReconstr Surg. 2007 Jun; 119(7):2092-2100. doi: 10.1097/01.prs.0000260598.24376.e1. PMID: 17519706.
11. Yadav P. Head and neck reconstruction. Indian J Plast Surg. 2013 May;46(2):275-82. doi: 10.4103 /0970-0358.118604. PMID: 24501464; PMCID: PMC3901909.
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Samant AN, Gundewar S, Jaiswal Y, et al. Surgical outcome of free flap surgery in a tertiary referral center in Maharashtra. New Indian J Surg. 2023;14(3):133–8.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.