Enhanced recovery after surgery for head and neck free flap reconstruction: A systematic review and meta-analysis

Oral Oncology ◽  
2021 ◽  
Vol 113 ◽  
pp. 105117
Author(s):  
Kevin Chorath ◽  
Beatrice Go ◽  
Justin R. Shinn ◽  
Leila J. Mady ◽  
Seerat Poonia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

scholarly journals Antibiotic prophylaxis in clean-contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta-analysis

Head & Neck ◽  
2017 ◽  
Vol 40 (2) ◽  
pp. 417-427 ◽  
Author(s):  
Yarah M. Haidar ◽  
Prem B. Tripathi ◽  
Tjoson Tjoa ◽  
Sartaaj Walia ◽  
Lishi Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Prophylaxis ◽  
Head And Neck ◽  
Free Flap ◽  
Meta Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Clean Contaminated ◽  
Microvascular Free Flap

scholarly journals Enhanced Recovery After Surgery–Based Perioperative Protocol for Head and Neck Free Flap Reconstruction

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2093103 ◽  
Author(s):  
Caitlin Bertelsen ◽  
Kevin Hur ◽  
Margaret Nurimba ◽  
Janet Choi ◽  
Joseph R. Acevedo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Control Group ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Monitoring

Objectives Evaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol implemented at our center. Study Design Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group. Setting Tertiary care academic medical center. Participants and Methods All patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared. Results Sixty-one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P = .04) and postoperative (49.2% vs 27.2%, P = .026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P < .01) and ventilator support (63.9% vs 9.8%, P < .01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P = .017). Length of stay, readmissions, and complication rates did not significantly differ between groups. Conclusion ERAS-based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor-intensive flap monitoring, without adverse effects on outcomes.

Influence of preoperative radiotherapy on head and neck free‐flap reconstruction: Systematic review and meta‐analysis

Head & Neck ◽  
2020 ◽  
Vol 42 (8) ◽  
pp. 2165-2180 ◽  
Author(s):  
Ainiwaer Mijiti ◽  
Nazuke Kuerbantayi ◽  
Zhi Q. Zhang ◽  
Ming Y. Su ◽  
Xiao H. Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Preoperative Radiotherapy ◽  
Meta Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

scholarly journals Naso- or Orbitocutaneous Fistulas after Free Flap Reconstruction of Orbital Exenteration Defects: Retrospective Study, Systematic Review, and Meta-Analysis

2017 ◽  
Vol 78 (04) ◽  
pp. 337-345 ◽  
Author(s):  
Kurren Gill ◽  
David Hsu ◽  
Gurston Nyquist ◽  
Howard Krein ◽  
Jurij Bilyk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Free Flap ◽  
Meta Analysis ◽  
Fistula Formation ◽  
Wound Complications ◽  
Orbital Exenteration ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Orbital Wall

Objective Naso- or orbitocutaneous fistula (NOF) is a challenging complication of orbital exenteration, and it often requires surgical repair. We sought to identify the incidence and risk factors for NOF after orbital exenteration. Study Design Retrospective chart review, systematic review, meta-analysis. Setting Tertiary care center. Participants Patients undergoing free flap reconstruction following orbital exenteration. Records were reviewed for clinicopathologic data, operative details, and outcomes. Main Outcome Measures Univariate analysis was used to assess risk factors for incidence of postoperative NOF. PubMed and Cochrane databases were searched for published reports on NOF after orbital exenteration. Rates of fistula and odds ratios for predictive factors were compared in a meta-analysis. Results Total 7 of 77 patients (9.1%) developed NOF; fistula formation was associated with ethmoid sinus involvement (p < 0.05) and minor wound break down (p < 0.05). On meta-analysis, pooled rates of fistula formation were 5.8% for free flap patients and 12.5% for patients receiving no reconstruction. Conclusion Immediate postoperative wound complications and medial orbital wall resection increased the risk for NOF. On review and meta-analysis, reconstruction of orbital exenteration defects decreased the risk for fistula formation, but published series did not demonstrate a significant decrease in risk with free flaps compared with other methods of reconstruction.

Postoperative anticoagulation after free flap reconstruction for head and neck cancer: A systematic review

2017 ◽  
Vol 128 (2) ◽  
pp. 412-421 ◽  
Author(s):  
Blair M. Barton ◽  
Charles A. Riley ◽  
John C. Fitzpatrick ◽  
Christian P. Hasney ◽  
Brian A. Moore ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

scholarly journals Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2852
Author(s):  
Rosie Twomey ◽  
T. Wayne Matthews ◽  
Steven Nakoneshny ◽  
Christiaan Schrag ◽  
Shamir P. Chandarana ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Enhanced Recovery ◽  
Early Mobilization ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Prolonged Length ◽  
Major Complications ◽  
The Impact

Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16–2.57) and more major complications (OR = 1.76; 95% CI = 1.00–3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10–6.21) and prolonged length of stay (>10 days; OR = 2.85, 95% CI = 1.41–5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.

Outcome predictors in elderly head and neck free flap reconstruction: A retrospective study and systematic review of the current evidence

2018 ◽  
Vol 71 (5) ◽  
pp. 719-728 ◽  
Author(s):  
Cindy Siaw-Lin Goh ◽  
Yee-Onn Kok ◽  
Cheryl Pei-Chyi Yong ◽  
Esther Wan-Xian Tan ◽  
Lee-Gan Goh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Retrospective Study ◽  
Head And Neck ◽  
Free Flap ◽  
Current Evidence ◽  
Outcome Predictors ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction
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