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  • Wiley  (3)
  • Greene, Benjamin J.  (3)
  • 1
    Online Resource
    Online Resource
    Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction
    Wiley ; 2020
    In:  The Laryngoscope Vol. 130, No. 2 ( 2020-02), p. 347-353
    Details
    In: The Laryngoscope, Wiley, Vol. 130, No. 2 ( 2020-02), p. 347-353
    Abstract: Analyze the cause and significance of a shift in the timing of free flap failures in head and neck reconstruction. Study Design Retrospective multi‐institutional review of prospectively collected databases at tertiary care centers. Methods Included consecutive patients undergoing free flap reconstructions of head and neck defects between 2007 and 2017. Selected variables: demographics, defect location, donor site, free flap failure cause, social and radiation therapy history. Results Overall free flap failure rate was 4.6% (n = 133). Distribution of donor tissue by flap failure: radial forearm (32%, n = 43), osteocutaneous radial forearm (6%, n = 8), anterior lateral thigh (23%, n = 31), fibula (23%, n = 30), rectus abdominis (4%, n = 5), latissimus (11%, n = 14), scapula (1.5%, n = 2). Forty percent of flap failures occurred in the initial 72 hours following reconstruction (n = 53). The mean postoperative day for flap failure attributed to venous congestion was 4.7 days (95% confidence interval [CI], 2.6–6.7) versus 6.8 days (CI 5.3–8.3) for arterial insufficiency and 16.6 days (CI 11.7–21.5) for infection ( P 〈  .001). The majority of flap failures were attributed to compromise of the arterial or venous system (84%, n = 112). Factors found to affect the timing of free flap failure included surgical indication ( P = .032), defect location ( P = .006), cause of the flap failure ( P 〈  .001), and use of an osteocutaneous flap ( P = .002). Conclusion This study is the largest to date on late free flap failures with findings suggesting a paradigm shift in the timing of flap failures. Surgical indication, defect site, cause of flap failure, and use of osteocutaneous free flap were found to impact timing of free flap failures. Level of Evidence 4 Laryngoscope , 130:347–353, 2020
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v130.2
    DOI: 10.1002/lary.28177
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2026089-1
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  • 2
    Online Resource
    Online Resource
    Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck
    Wiley ; 2017
    In:  Otolaryngology–Head and Neck Surgery Vol. 156, No. 4 ( 2017-04), p. 627-635
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 156, No. 4 ( 2017-04), p. 627-635
    Abstract: To compare outcomes after microvascular reconstructions of head and neck defects between overlapping and nonoverlapping operations. Study Design Retrospective cohort study. Setting Tertiary care center. Subjects and Methods Patients undergoing microvascular free tissue transfer operations between January 2010 and February 2015 at 2 tertiary care institutions were included (n = 1315). Patients were divided into 2 cohorts by whether the senior authors performed a single or consecutive microvascular reconstruction (nonoverlapping; n = 773, 59%) vs performing overlapping microvascular reconstructions (overlapping; n = 542, 41%). Variables reviewed were as follows: defect location, indication, T classification, surgical details, duration of the operation and hospitalization, and complications (major, minor, medical). Results Microvascular free tissue transfers performed included radial forearm (49%, n = 639), osteocutaneous radial forearm (14%, n = 182), anterior lateral thigh (12%, n = 153), fibula (10%, n = 135), rectus abdominis (7%, n = 92), latissimus dorsi (6%, n = 78), and scapula ( 〈 1%, n = 4). The mean duration of the overlapping operations was 21 minutes longer than nonoverlapping operations ( P =. 003). Mean duration of hospitalization was similar for nonoverlapping (9.5 days) and overlapping (9.1 days) cohorts ( P =. 39). There was no difference in complication rates when stratified by overlapping (45%, n = 241) and nonoverlapping (45%, n = 344) ( P =. 99). Subset analysis yielded similar results when minor, major, and medical complications between groups were assessed. The overall survival rate of free tissue transfers was 96%, and this was same for overlapping (96%) and nonoverlapping (96%) operations ( P =. 71). Conclusions Patients had similar complication rates and durations of hospitalization for overlapping and nonoverlapping operations.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599817691746
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2008453-5
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  • 3
    Online Resource
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    Outcomes and cost implications of microvascular reconstructions of the head and neck
    Wiley ; 2019
    In:  Head & Neck Vol. 41, No. 4 ( 2019-04), p. 930-939
    Details
    In: Head & Neck, Wiley, Vol. 41, No. 4 ( 2019-04), p. 930-939
    Abstract: Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost. Methods Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects ( n  = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization ( n  = 400). Results Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 ( n  = 183), osteocutaneous RFFF (OCRFFF) $125 456 ( n  = 70), anterior lateral thigh $133 781 ( n  = 54), fibula $140 747 ( n  = 42), latissimus $208 890 ( n  = 24), rectus $169 637 ( n  = 18), scapula $128 712 ( n  = 4), and ulna $110 716 ( n  = 5; P  = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 ( P   〈  .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P   〈  .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P  = .03) and T4 lesions ($142 183; P  = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization ( P   〈  .018). Conclusion Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.
    Type of Medium: Online Resource
    ISSN: 1043-3074 , 1097-0347
    URL: Issue
    URL: Article
    DOI: 10.1002/hed.v41.4
    DOI: 10.1002/hed.25424
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2001440-5
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