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      Microvascular reconstruction for maxillofacial defects: a retrospective analysis of outcomes and complications in 121 consecutive cases

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      , ,
      Maxillofacial Plastic and Reconstructive Surgery
      Springer Singapore

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          Abstract

          Background

          Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery.

          Methods

          This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed.

          Results

          Four different flap types were used for microvascular reconstruction: radial forearm ( n = 65), fibula ( n = 34), latissimus dorsi ( n = 21), and serratus anterior muscle with rib bone free flap ( n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min.

          Conclusions

          The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.

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          Most cited references41

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          General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay.

          Studies of specific procedures have shown increases in infectious complications with operative duration. We hypothesized that operative duration is independently associated with increased risk-adjusted infectious complication (IC) rates in a broad range of general surgical procedures. We queried the American College of Surgeons National Surgical Quality Improvement Program database for general surgical operations performed from 2005 to 2007. ICs (wound infection, sepsis, urinary tract infection, and/or pneumonia) and length of hospital stay (LOS) were evaluated versus operative duration (OD, ie, incision to closure). Multivariable regression adjusted for 38 patient risk variables, operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without intraoperative transfusion and with a clean or clean-contaminated wound class. In 299,359 operations performed at 173 hospitals, unadjusted IC rates increased linearly with OD at a rate of close to 2.5% per half hour (chi-square test for linear trend, p < 0.001). After adjustment, IC risk increased for each half hour of OD relative to cases lasting
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            The Impact of Operative Time on Complications After Plastic Surgery: A Multivariate Regression Analysis of 1753 Cases

            Little evidence within plastic surgery literature supports the precept that longer operative times lead to greater morbidity.
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              Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis.

              There is a general consensus among reconstructive surgeons that preoperative radiotherapy is associated with a higher risk of flap failure and complications in head and neck surgery. Opinion is also divided regarding the effects of radiation dose on free flap outcomes and timing of preoperative radiation to minimize adverse outcomes. Our meta-analysis will attempt to address these issues. A systematic review of the literature was conducted in concordance to PRISMA protocol. Data were combined using STATA 12 and Open Meta-Analyst software programmes. Twenty-four studies were included comparing 2842 flaps performed in irradiated fields and 3491 flaps performed in non-irradiated fields. Meta-analysis yielded statistically significant risk ratios for flap failure (RR 1.48, P = 0.004), complications (RR 1.84, P 60 Gy radiation had a non-statistically significant higher risk of flap failure (RR 1.61, P = 0.145). Preoperative radiation is associated with a statistically significant increased risk of flap complications, failure and fistula. Preoperative radiation in excess of 60 Gy after radiotherapy represents a potential risk factor for increased flap loss and should be avoided where possible. © 2014 Royal Australasian College of Surgeons.
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                Author and article information

                Contributors
                ahnkm@nate.com
                Journal
                Maxillofac Plast Reconstr Surg
                Maxillofac Plast Reconstr Surg
                Maxillofacial Plastic and Reconstructive Surgery
                Springer Singapore (Singapore )
                2288-8101
                2288-8586
                26 August 2020
                26 August 2020
                December 2020
                : 42
                : 1
                : 29
                Affiliations
                GRID grid.413967.e, ISNI 0000 0001 0842 2126, Department of Oral and Maxillofacial Surgery, College of Medicine, , University of Ulsan, Asan Medical Center, ; 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505 Korea
                Author information
                http://orcid.org/0000-0003-1215-5643
                Article
                273
                10.1186/s40902-020-00273-4
                7447709
                73a9b627-9a22-472d-8e52-2a9482666da0
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 9 July 2020
                : 12 August 2020
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                © The Author(s) 2020

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