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Eric M Genden - One of the best experts on this subject based on the ideXlab platform.
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vessel depleted neck techniques for achieving Microvascular Reconstruction
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2008Co-Authors: Adam S Jacobson, Jean Anderson Eloy, Eunice Park, Benjamin Roman, Eric M GendenAbstract:Background. In the neck, the recipient vessels most frequently used for microsurgical Reconstruction are compromised by prior surgery and radiation. Methods. We conducted a retrospective chart review of all patients who underwent Microvascular Reconstruction between July 2001 and June 2005. Donor vessels, vein grafts, and flap survival were examined. Results. Fourteen of 197 patients (7%) were identified with a vessel-depleted neck. All patients had undergone a prior neck dissection and radiation (100%) or chemoradiation (42%). Free flap revascularization was achieved using the transverse cervical artery with a vein graft and a cephalic vein (4 patients), thoracoacromial artery and cephalic vein (3 patients), internal mammary artery and vein (3 patients), and inferior thyroid artery and cephalic vein (1 case). In 3 patients, the reverse flow thoracodorsal artery and cephalic vein were used to vascularize the scapular flap. Conclusion. The cephalic vein, transverse cervical, internal mammary, and thoracoacromial vessels represent reliable alternatives in the vessel-depleted neck. © 2007 Wiley Periodicals, Inc. Head Neck, 2008
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Vessel‐depleted neck: Techniques for achieving Microvascular Reconstruction
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2008Co-Authors: Adam S Jacobson, Jean Anderson Eloy, Eunice Park, Benjamin Roman, Eric M GendenAbstract:Background. In the neck, the recipient vessels most frequently used for microsurgical Reconstruction are compromised by prior surgery and radiation. Methods. We conducted a retrospective chart review of all patients who underwent Microvascular Reconstruction between July 2001 and June 2005. Donor vessels, vein grafts, and flap survival were examined. Results. Fourteen of 197 patients (7%) were identified with a vessel-depleted neck. All patients had undergone a prior neck dissection and radiation (100%) or chemoradiation (42%). Free flap revascularization was achieved using the transverse cervical artery with a vein graft and a cephalic vein (4 patients), thoracoacromial artery and cephalic vein (3 patients), internal mammary artery and vein (3 patients), and inferior thyroid artery and cephalic vein (1 case). In 3 patients, the reverse flow thoracodorsal artery and cephalic vein were used to vascularize the scapular flap. Conclusion. The cephalic vein, transverse cervical, internal mammary, and thoracoacromial vessels represent reliable alternatives in the vessel-depleted neck. © 2007 Wiley Periodicals, Inc. Head Neck, 2008
Keith E Blackwell - One of the best experts on this subject based on the ideXlab platform.
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Reirradiation After Surgery and Microvascular Reconstruction
Otolaryngology–Head and Neck Surgery, 2020Co-Authors: Elliot Abemayor, Joel A Sercarz, Vishad Nabili, Guy Jf Juillard, Keith E BlackwellAbstract:Problem To evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and Microvascular Reconstruction. Methods Retrospective Study. Twelve patients underwent salvage surgery with Microvascular Reconstruction for recurrent or new primary head and neck cancer in a previously irradiated field. Median prior RT dose was 63.0 Gy (range 30.0–72.8). Patients then underwent postoperative reirradiation, receiving a median total cumulative radiation dose of 115.0 Gy. Results Three patients (25%) experienced acute complications (<3 months) during reirradiation that resolved with conservative care. Four patients (33%) developed grade 3 or 4 late reirradiation complications (>3 months). There were no incidences of free flap failure. No patients suffered brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. There were no treatment-related mortalities. Six patients (50%) are alive without evidence of recurrent disease a median of 40 months after reirradiation (range 4–64 months). Conclusion Free flap Reconstruction followed by reirradiation is not associated with an increased risk of perioperative, acute, or late complications. Microvascular free flaps allow for maximal resection and reliable Reconstruction of previously irradiated cancers before high dose reirradiation, and may reduce the incidence of severe late complications and treatment related mortality. Significance Reirradiation for recurrent head and neck squamous cell carcinoma remains controversial. However, increasing evidence has demonstrated improved survival and locoregional control with reirradiation at the cost of potentially severe or sometimes fatal radiation toxicity. We hypothesize that using well-vascularized tissue and bone at the time of salvage surgery can reduce the incidence of reirradiation complications. This would allow patients at high risk for recurrence to more safely receive a second course of radiation therapy. To our knowledge this is the first report of the effects of Microvascular Reconstruction on complications and outcomes of patients undergoing salvage surgery and external beam reirradiation.
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Reirradiation After Surgery and Microvascular Reconstruction
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Elliot Abemayor, Joel A Sercarz, Vishad Nabili, Guy Jf Juillard, Keith E BlackwellAbstract:ProblemTo evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and Microvascular Reconstruction.MethodsRetrospective Study. Twelve patients underwent salvage surgery with Microvascular Reconstruction for recurrent or new primary head and neck cancer in a previously irradiated field. Median prior RT dose was 63.0 Gy (range 30.0–72.8). Patients then underwent postoperative reirradiation, receiving a median total cumulative radiation dose of 115.0 Gy.ResultsThree patients (25%) experienced acute complications ( 3 months). There were no incidences of free flap failure. No patients suffered brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. There were no treatment-related mortalities. Six patients (50%) are alive without evidence of re...
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Microvascular Reconstruction after previous neck dissection
Archives of Otolaryngology-head & Neck Surgery, 2002Co-Authors: Christian Head, Elliot Abemayor, Joel A Sercarz, Thomas C Calcaterra, Jeffrey D Rawnsley, Keith E BlackwellAbstract:Background Microvascular Reconstruction of defects in the head and neck is more challenging in patients who have undergone a previous neck dissection, owing to prior resection of potential cervical recipient blood vessels used for free flap perfusion. Objective To evaluate the reliability and safety of free flap Reconstruction in patients with previous neck dissection. Patients and Methods Sixty free flaps were performed in 59 patients with a medical history of neck dissection for head and neck cancer. This included patients undergoing salvage surgery for recurrent cancer as well as patients undergoing secondary Reconstruction of cancer surgery–related defects. Flap selection included 25 radial forearm flaps, 20 fibula flaps, 7 rectus abdominis flaps, 7 subscapular system flaps, and 1 iliac crest flap. Results Recipient vessels were used in the field of previous neck dissection in approximately half the patients with previous selective neck dissection, while contralateral recipient vessels were always used in patients with a history of modified radical or radical neck dissection. Vein grafts were not necessary in any cases. One arterial anastomosis that was created under excessive tension required urgent reoperation and revision, but there were no cases of free flap failure. Conclusions Free flap Reconstruction of the head and neck is highly successful in patients with a history of neck dissection, despite a relative paucity of potential cervical recipient blood vessels. Heavy reliance on free flaps with long vascular pedicles obviated the need to perform vein grafts in the present series, probably contributing to the absence of free flap failure. Previous neck dissection should not be considered a contraindication to Microvascular Reconstruction of the head and neck.
Adam S Jacobson - One of the best experts on this subject based on the ideXlab platform.
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vessel depleted neck techniques for achieving Microvascular Reconstruction
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2008Co-Authors: Adam S Jacobson, Jean Anderson Eloy, Eunice Park, Benjamin Roman, Eric M GendenAbstract:Background. In the neck, the recipient vessels most frequently used for microsurgical Reconstruction are compromised by prior surgery and radiation. Methods. We conducted a retrospective chart review of all patients who underwent Microvascular Reconstruction between July 2001 and June 2005. Donor vessels, vein grafts, and flap survival were examined. Results. Fourteen of 197 patients (7%) were identified with a vessel-depleted neck. All patients had undergone a prior neck dissection and radiation (100%) or chemoradiation (42%). Free flap revascularization was achieved using the transverse cervical artery with a vein graft and a cephalic vein (4 patients), thoracoacromial artery and cephalic vein (3 patients), internal mammary artery and vein (3 patients), and inferior thyroid artery and cephalic vein (1 case). In 3 patients, the reverse flow thoracodorsal artery and cephalic vein were used to vascularize the scapular flap. Conclusion. The cephalic vein, transverse cervical, internal mammary, and thoracoacromial vessels represent reliable alternatives in the vessel-depleted neck. © 2007 Wiley Periodicals, Inc. Head Neck, 2008
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Vessel‐depleted neck: Techniques for achieving Microvascular Reconstruction
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2008Co-Authors: Adam S Jacobson, Jean Anderson Eloy, Eunice Park, Benjamin Roman, Eric M GendenAbstract:Background. In the neck, the recipient vessels most frequently used for microsurgical Reconstruction are compromised by prior surgery and radiation. Methods. We conducted a retrospective chart review of all patients who underwent Microvascular Reconstruction between July 2001 and June 2005. Donor vessels, vein grafts, and flap survival were examined. Results. Fourteen of 197 patients (7%) were identified with a vessel-depleted neck. All patients had undergone a prior neck dissection and radiation (100%) or chemoradiation (42%). Free flap revascularization was achieved using the transverse cervical artery with a vein graft and a cephalic vein (4 patients), thoracoacromial artery and cephalic vein (3 patients), internal mammary artery and vein (3 patients), and inferior thyroid artery and cephalic vein (1 case). In 3 patients, the reverse flow thoracodorsal artery and cephalic vein were used to vascularize the scapular flap. Conclusion. The cephalic vein, transverse cervical, internal mammary, and thoracoacromial vessels represent reliable alternatives in the vessel-depleted neck. © 2007 Wiley Periodicals, Inc. Head Neck, 2008
Eben L Rosenthal - One of the best experts on this subject based on the ideXlab platform.
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use of internal mammary vessels in head and neck Microvascular Reconstruction
Archives of Otolaryngology-head & Neck Surgery, 2012Co-Authors: Daniel S Schneider, Lauren E Mcclain, Philip K Robb, Eben L RosenthalAbstract:Objective To describe the use of the internal mammary vessels (IMVs) in Microvascular head and neck Reconstruction in a small case series with select donor sites. Design Retrospective medical record review study. Setting Oregon Health and Science University and University of Alabama. Patients Patients for whom IMVs were used for head and neck Reconstruction from January 1, 1998, through December 31, 2010. Main Outcome Measures Intraoperative or postoperative complications, flap survival, and morbidity due to the flap. Results Of 2721 free tissue transfers, 55 (2%) (in 48 patients) used IMVs. Use of IMVs was associated with ablative surgery with sternal resection (25 of 55 [45%]), a vessel depleted neck (23 of 55 [42%]), and fistula repair with gross contamination due to prior flap failure or chronic pharyngocutaneous fistula with vessel depleted neck (7 of 55 [13%]). Flaps included radial forearm (33 of 55 [60%]), jejunum (9 of 55 [16]), ulnar (5 of 55 [9%]), and other (8 of 55 [14%]). No vein grafts were used. Pneumothorax developed in 1 patient (2%). Postoperative fistulas were observed in 14 of 48 patients (29%); the fistulas healed conservatively in 7 patients (50%), rotation of flap tissue was required in 2 patients (14%), and the fistulas persisted in 5 patients (36%). The flap survival rate was 98%. Conclusion Internal mammary vessels provide reliable recipient vessels for cervical and sternal Microvascular Reconstruction.
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simplifying head and neck Microvascular Reconstruction
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2004Co-Authors: Eben L Rosenthal, William R Carroll, Mathew Dobbs, Scott J Magnuson, Glenn E PetersAbstract:Background. Free-tissue transfer has become the preferred method of head and neck Reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified Microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to Microvascular Reconstruction. Complications and functional results are comparable to previously published results. © 2004 Wiley Periodicals, Inc. Head Neck26: 930–936, 2004
David W Chang - One of the best experts on this subject based on the ideXlab platform.
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upper extremity limb salvage with Microvascular Reconstruction in patients with advanced sarcoma
Plastic and Reconstructive Surgery, 2004Co-Authors: Vairavan Subramanian, Adel Yousef, Bruce A Rogers, Geoffrey L Robb, David W ChangAbstract:Limb salvage is a viable alternative to amputation in many cases of advanced sarcoma. The authors examined their experience with Microvascular Reconstruction of upper extremity defects after sarcoma resection, focusing on oncologic and functional outcomes. A retrospective analysis yielded 17 patients who underwent 18 free flap procedures and met the inclusion criteria. Most patients (71 percent, n = 12) had recurrent sarcoma at presentation to the authors' institution. Malignant fibrous histiocytoma was the most common pathologic subtype (n = 6). High-grade tumors were present in 94 percent of patients (n = 16). The free flap survival rate was 100 percent. The rectus abdominis flap was the most common free flap used (39 percent; n = 7). Local recurrence occurred in nine flaps (50 percent), and five patients ultimately required amputations. Six patients (35 percent) had distant recurrence. The mean Enneking score for limb function was 73 percent of the maximum (21.9 of 30). The 5-year disease-specific survival rate was 61.3 percent. In select patients with advanced upper extremity sarcoma undergoing limb salvage, Microvascular flap Reconstruction can provide reliable, safe coverage with reasonable preservation of function.