Partial flap loss(skin involved)or fat necrosis following autologous breast reconstruction remains a dreaded postoperative complication despite significant advances in microsurgical techniques.Several strategies have ...Partial flap loss(skin involved)or fat necrosis following autologous breast reconstruction remains a dreaded postoperative complication despite significant advances in microsurgical techniques.Several strategies have been proposed in the preoperative and intraoperative period to prevent this complication ranging from preoperative imaging,intra-operative tissue perfusion assessment,appropriate perforator selection(location and number),maximizing inflow and outflow with additional anastomoses and/or pedicles,and minimizing ischemia time.Postoperative management of partial flap loss(when there is skin involvement)and fat necrosis remains a challenge,with very little published data focusing on classification,timing,and techniques.Early intervention versus close observation may depend on multiple patient factors and the degree or volume of necrosis.Secondary intervention options include hyperbaric oxygen therapy,fat aeration with a needle,liposuction,fat grafting,addition of another flap or implant,depending on the nature of the defect.This review summarizes the current evidence for each of these strategies to help the current surgeon understand their options in preventing and managing patients suffering from partial flap loss.展开更多
Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon’s inexperience and technique. However, ther...Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon’s inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon’s practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.展开更多
The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experienc...The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experience with the PMMF in head and neck reconstruction. One hundred and two patients who underwent the PMMF technique were reviewed on the clinical records. Postoperative complications were classified into flap loss, hemorrhage, infection, fistula formation, wound dehiscence and donor site complication. Eighty two patients (80.4%) demonstrated no complication. Six patients among 102 patients (5.9%) demonstrated total or partial skin necroses. Three female patients were completely dissatisfied with the cosmetic appearance after the PMMF. One of them required a reconstructive surgery with the latissimusdorsi flap. Without surgical expertise in plastic surgical field, an ear-nose-throat or an oral surgeon can performed the PMMF technique provided the operator is well aware of serious and frequent complications of this “workhorse” procedure.展开更多
文摘Partial flap loss(skin involved)or fat necrosis following autologous breast reconstruction remains a dreaded postoperative complication despite significant advances in microsurgical techniques.Several strategies have been proposed in the preoperative and intraoperative period to prevent this complication ranging from preoperative imaging,intra-operative tissue perfusion assessment,appropriate perforator selection(location and number),maximizing inflow and outflow with additional anastomoses and/or pedicles,and minimizing ischemia time.Postoperative management of partial flap loss(when there is skin involvement)and fat necrosis remains a challenge,with very little published data focusing on classification,timing,and techniques.Early intervention versus close observation may depend on multiple patient factors and the degree or volume of necrosis.Secondary intervention options include hyperbaric oxygen therapy,fat aeration with a needle,liposuction,fat grafting,addition of another flap or implant,depending on the nature of the defect.This review summarizes the current evidence for each of these strategies to help the current surgeon understand their options in preventing and managing patients suffering from partial flap loss.
文摘Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon’s inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon’s practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.
文摘The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experience with the PMMF in head and neck reconstruction. One hundred and two patients who underwent the PMMF technique were reviewed on the clinical records. Postoperative complications were classified into flap loss, hemorrhage, infection, fistula formation, wound dehiscence and donor site complication. Eighty two patients (80.4%) demonstrated no complication. Six patients among 102 patients (5.9%) demonstrated total or partial skin necroses. Three female patients were completely dissatisfied with the cosmetic appearance after the PMMF. One of them required a reconstructive surgery with the latissimusdorsi flap. Without surgical expertise in plastic surgical field, an ear-nose-throat or an oral surgeon can performed the PMMF technique provided the operator is well aware of serious and frequent complications of this “workhorse” procedure.
