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PURPOSE: Vascular perfusion research has been dedicated to identify inexpensive, effective, and easy to use methods to assess free flap perfusion for both buried and non-buried flaps. METHODS: Systematic review of complications in patients underwent Head and Neck microsurgical reconstruction and vascular implantable Doppler monitoring. RESULTS: Sixteen articles were included for qualitative analysis. 2535 (92.2%) patients received IDP monitorization. Venous thrombosis was the most common vascular complication effecting 28 (1.1%). Regarding complications potentially related to the use of the IDP, just one study described the presence of granuloma formation along the suture line in 2 (0.07%) patients. CONCLUSIONS: Our findings indicated that Cook-Swartz IDP will represents a safe and effective device for FF monitoring in HN reconstructive micro-surgery. A detailed prospective registration of the results and complications related to the use of IDP remains mandatory to precisely estimate results, cost, and complications.
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Retalhos de Tecido Biológico , Humanos , Estudos Prospectivos , Monitorização Fisiológica , Estudos Retrospectivos , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/irrigação sanguínea , Ultrassonografia Doppler/métodosRESUMO
INTRODUCTION: Functional neck dissection (FND) represents a surgical procedure usually associated with less morbidity. METHODS: An observational, retrospective, analysis of patients diagnosed with any type of head and neck malignancy was designed to summarize and report the incidence of postoperative complications in patients undergoing FND including just those levels described for selective neck dissections in a tertiary university hospital between June 2016 and June 2019. RESULTS: 131 patients met the inclusion criteria. The total number of sides studied was 200. 40.5% of the patients suffer a complication in the postoperative period, being the spinal accessory nerve (SAN) injury the most common complication (10%). We did not find any statistical -correlation between the previous organ-preservation treatments and surgical complications (p = 0.207). An advanced T stage (p = 0.009) and the need of bilateral FND (p = 0.034) were significantly correlated with a higher risk of surgical complications. CONCLUSION: FND represents a useful technique. In this study, 40.5% of the patients suffer a complication in the postoperative period, being the SAN injury the most common complication. However, these data contribute to increasing our knowledge about surgical complications related to FND.
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Traumatismos do Nervo Acessório , Neoplasias de Cabeça e Pescoço , Nervo Acessório , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Esvaziamento Cervical/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Perforator free flap-based reconstruction of the head and neck is a challenging surgical procedure and needs a steep learning curve. A reproducible mammal large animal model with similarities to human anatomy is relevant for perforator flap raising and microanastomosis. The aim of this study was to assess the feasibility of a swine model for perforator-based free flaps in reconstructive microsurgery. METHODS: Eleven procedures were performed under general anesthesia in a porcine model, elevating a skin flap vascularized by perforating musculocutaneous branches of the superior epigastric artery to evaluate the relevance of this model for head and neck reconstructive microsurgery. RESULTS: The anterior abdominal skin perforator-based free flap in a swine model irrigated by the superior epigastric artery was elevated in eleven procedures. In six of these procedures, we could perform an arterial and venous microanastomosis to the great vessels located in the base of the neck. CONCLUSIONS: The porcine experimental model of superior epigastric artery perforator-based free flap reconstruction offers relevant similarities to the human deep inferior epigastric artery perforator flap. We could demonstrate this model as acceptable for perforator free flap training due to the necessity of perforator and pedicle dissection and transfer to a distant area.
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Retalhos de Tecido Biológico/transplante , Microcirurgia/métodos , Modelos Animais , Retalho Perfurante/transplante , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos , Animais , Artérias Epigástricas/transplante , Estudos de Viabilidade , Cabeça/cirurgia , Microcirurgia/instrumentação , Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/instrumentação , Transplante de Pele/instrumentação , Sus scrofa , Veias/transplanteRESUMO
BACKGROUND: The Basque Country has one of the highest rates of head and neck squamous cell carcinoma (HNSCC) in Europe, although tobacco and alcohol consumption are not high when compared to other European countries where HNSCC incidence is lower. Our aim was to determine the role of genetic variation with regard to the metabolism of alcohol and carcinogens from tobacco smoke in the Basque Country. METHODS: Fourteen polymorphisms in alcohol or tobacco metabolism genes were genotyped in 84 HNSCC patients and 242 healthy individuals from the Basque Country. RESULTS: ADH1B histidine allele (rs1229984), CYP2E1 rs3813867 heterozygous genotype, and GSTT1 deletion conferred protection against HNSCC (OR: 0.318 [0.04-0.75], OR: 0.13 [0.02-0.94], and OR: 0.12 [0.02-0.60], respectively) while GSTP1 (rs1695) Val/Val genotype was related to an increased risk (OR: 4.12 [1.11-15.31]). Regarding alcohol and tobacco habits, GSTT1 deletion was associated with tobacco usage, while the 3 polymorphisms tested in ALDH2 were associated with alcohol consumption. However, genotypic distributions of these 7 SNPs did not differ from those observed for other Caucasian populations where HNSCC incidence is lower. CONCLUSIONS: The identified genotypic variations in alcohol and tobacco metabolizing genes only by themselves do not seem to be responsible for the higher incidence of HNSCC observed in the Basque Country.
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Consumo de Bebidas Alcoólicas/genética , Carcinoma de Células Escamosas/genética , Neoplasias de Cabeça e Pescoço/genética , Fumar/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Álcool Desidrogenase/genética , Álcool Desidrogenase/metabolismo , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/metabolismo , Aldeído Desidrogenase/genética , Aldeído Desidrogenase/metabolismo , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/metabolismo , Estudos de Casos e Controles , Feminino , Deleção de Genes , Frequência do Gene , Predisposição Genética para Doença , Glutationa Transferase/genética , Glutationa Transferase/metabolismo , Neoplasias de Cabeça e Pescoço/etiologia , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Fumar/efeitos adversos , Fumar/metabolismo , Espanha , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
Introduction: Machine learning (ML)-based facial nerve injury (FNI) forecasting grounded on multicentric data has not been released up to now. Three distinct ML models, random forest (RF), K-nearest neighbor, and artificial neural network (ANN), for the prediction of FNI were evaluated in this mode. Methods: A retrospective, longitudinal, multicentric study was performed, including patients who went through parotid gland surgery for benign tumors at three different university hospitals. Results: Seven hundred and thirty-six patients were included. The most compelling aspects related to risk escalation of FNI were as follows: (1) location, in the mid-portion of the gland, near to or above the main trunk of the facial nerve and at the top part, over the frontal or the orbital branch of the facial nerve; (2) tumor volume in the anteroposterior axis; (3) the necessity to simultaneously dissect more than one level; and (4) the requirement of an extended resection compared to a lesser extended resection. By contrast, in accordance with the ML analysis, the size of the tumor (>3 cm), as well as gender and age did not result in a determining favor in relation to the risk of FNI. Discussion: The findings of this research conclude that ML models such as RF and ANN may serve evidence-based predictions from multicentric data regarding the risk of FNI. Conclusion: Along with the advent of ML technology, an improvement of the information regarding the potential risks of FNI associated with patients before each procedure may be achieved with the implementation of clinical, radiological, histological, and/or cytological data.
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INTRODUCTION: Pharyngocutaneous fistula (PCF) remains the most frequent complication following total laryngectomy (TL). Pharyngeal closure with a surgical stapler (SAPC) has been proposed as an effective closure technique that decreases the rate of PCF, reduces surgical time, decreases the length of hospital stay, and shortens the time required before safely initiating oral feeding. METHODS: This study involved a systematic review and meta-analysis of patients with laryngeal cancer who underwent TL and with subsequent stapler pharyngeal closure, in order to analyse the current literature regarding the role of SAPC after TL. RESULTS: The incidence of PCF in the stapler-assisted suture group (SASG) was 9.5% (95% CI 8.2-15.9%), with a mean absolute deviation of 1.12, while in the hand-suture group (HSG) group the incidence was 23.4% (95% CI 23-26.1%), with a mean absolute deviation of 5.71 (p = 0.01). CONCLUSIONS: SAPC may decrease the risk of PCF in patients following TL. Based on the current data, SAPC appears to shorten the surgical time and the length of hospital stay. Nevertheless, prospective randomized trials are required to validate these findings.
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INTRODUCTION: Radial forearm free flap (RFFF) and supraclavicular artery island flap (SCAIF) are some of the most common fasciocutaneous flaps used for head and neck (H&N) reconstruction. MATERIAL AND METHODS: A retrospective analysis of clinical data and outcomes of 31 consecutive patients who underwent H&N reconstruction using either SCAIF or RFFF over a three-year period, aiming to compare the surgical outcomes of the SCAIF and the RFFF in H&N reconstruction. RESULTS: Thirty-two flaps were performed in 31 patients (17 SCAIFs and 15 RFFFs). There was no difference in patient demographics between both groups. Hospital stay was longer in the SCAIF group (30.7 ± 18.2 days (min: 9/max: 60) versus 19.2 ± 15.8 days (min: 7/max: 72). Patients who underwent reconstruction with a SCAIF had shorter reconstructive procedure time; 74.4 min (min: 60/max: 93) versus 147.8 min (min: 140/max: 187). Overall morbidity was not significantly different (SCAIF 52.7% vs RFFF 39.9%, p = NS). Global flap survival was higher without statistical significance in the RFFF group (100%) versus the SCAIF group (70.7%). CONCLUSION: Despite the advantages related to the use of SCAIF like regarding the time spent in the reconstructive procedure. In our experience, the RFFF continues to be the most successful technique with similar perioperative outcomes and fewer complication rates. In this vein, both techniques can be reasonably used to reconstruct post-ablative H&N defects. However, in our experience, the use of SCAIF may lengthen hospital length of stay probably due to the augmented risk of flap failure.
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INTRODUCTION: Despite good results of transoral laser CO2 microsurgery (CO2TOLMS) of the larynx, a lack of data related to the safety of this technique as a day-case procedure across the literature is evident. MATERIALS AND METHODS: An observational, retrospective, non-randomized study. RESULTS: One hundred four (62.6%) patients met the inclusion criteria, 96 (92.3%) patients were male, and 8 (7.7%) patients were female. The mean age of the study group was 66 ± 11 years (min: 34/max: 90). All the patients underwent CO2TOLMS were treated as an outpatient procedure. The glottis was the most common location affecting 97 (93.3%) patients, regarding the need of readmission, just 4 (3.8%) patients needed to be readmitted after surgery due to dyspnea secondary to laryngeal edema in 2 cases by laryngeal bleeding, and cervical emphysema in one case, respectively. Being just necessary to reintubate 1 patient (<1%) to control the bleeding. We didn't find any statistical correlation between variables and the need for readmission of reintubation. CONCLUSION: According to our results, CO2TOLMS of the larynx can be safely performed as an outpatient procedure. To establish a proper protocol and to perform a careful preoperative assessment are essential to increase our success rate and to prevent any potential complication.
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Procedimentos Cirúrgicos Ambulatórios/métodos , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Lasers de Gás/uso terapêutico , Microcirurgia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Idoso , Dióxido de Carbono , Feminino , Glote/cirurgia , Humanos , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Boca/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: to review the modifications and advances in reconstructive surgery of the soft tissues of the oral cavity exclusively based on flaps that depend on the facial artery system. METHODS: review of the literature regarding oral cavity reconstructions based on main facial artery system flaps. DISCUSSION: The reconstruction of the soft tissues of the oral cavity, based on facial artery system flaps, offers satisfactory results and allows limited reconstructions avoiding the use of pedicled regional flaps or free flaps. CONCLUSIONS: Knowledge of reconstructive options using the facial artery system in oral cavity surgery allows expanding reconstructive options for head and neck surgeons, enabling safe, high quality and effective reconstructions, with limited resources consumption.
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Carcinoma de Células Escamosas/cirurgia , Artéria Maxilar , Neoplasias Bucais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/radioterapia , Nasofaringe/cirurgia , Necrose , Fístula Bucal/cirurgia , Palato/cirurgia , Estudos Prospectivos , Fístula do Sistema Respiratório/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/patologia , Deiscência da Ferida Operatória/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Functional free tissue transfer in the form of muscle free flap is a challenging surgical procedure and needs a steep learning curve. A porcine model for free muscle transfer and insetting in a distant area is of great interest in reconstructive microsurgery due to the experience and learning curve necessary to perform these surgeries. The aim of this study was to assess the feasibility of a swine model for gracilis muscle free transfer and to describe the donor site anatomy. METHODS: Ten gracilis free flap transfer surgery models were performed under general anesthesia in a porcine model, based on a vascular pedicle depending of the external iliac vessels and a branch of the obturator nerve with microsuture mediated connection to head and neck nerves and vessels. RESULTS: The gracilis myocutaneous or muscle-only free flap was successfully transferred in all cases using as receptors the vagus nerve, the common carotid artery, and the external or internal jugular veins. In two cases, nervous connection had to be redone. All vascular anastomoses were correctly functioning. CONCLUSIONS: Despite the anatomical and design variations, porcine gracilis free flap transferred to the head and neck area with microvascular anastomosis and nerve connection provides a suitable training model for functional reconstructive microsurgery.
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Retalhos de Tecido Biológico , Músculo Grácil/transplante , Procedimentos de Cirurgia Plástica/métodos , Sítio Doador de Transplante/anatomia & histologia , Animais , Modelos Animais de Doenças , Paralisia Facial/cirurgia , Estudos de Viabilidade , Cabeça/cirurgia , Microcirurgia/métodos , Pescoço/cirurgia , Sus scrofa , SuínosRESUMO
At this moment, the world lives under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that carry a particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures in demand at this moment is tracheostomy due the increasing ICU admissions. This review of international guidelines for tracheostomy in COVID-19 infected patients, aims to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy, from all over the world.
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Betacoronavirus/genética , Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Traqueostomia/métodos , Traqueotomia/métodos , COVID-19 , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Humanos , Otorrinolaringologistas/psicologia , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , SARS-CoV-2 , Testes Sorológicos , Cirurgiões/psicologiaRESUMO
INTRODUCTION: The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended. MATERIAL AND METHODS: We present our experience during the year 2016 in the application of the supraclavicular island flap in five cases as an alternative to microvascular reconstruction in several defects after resection of head and neck tumours. In two patients, the flap was used to close the surgical pharyngostoma after total laryngectomy with partial pharyngectomy. In one patient, it was used in lateral facial reconstruction after partial resection of the temporal bone. In one case, it was used to close a skin defect after total laryngectomy with prelaryngeal tissue extension. And in the last case to close a neck skin defect after primary closure of a pharyngo-cutaneous fistula. There were no flap complications, and the result was satisfactory in all cases. RESULTS: The supraclavicular artery island flap is useful and versatile in head and neck reconstruction. Operating room time in aged patients or those with comorbidities will be reduced compared to free flaps. The surgical technique is relatively easy and can be used for skin and mucosal coverage. CONCLUSION: The supraclavicular island flap could be a recommended option in head and neck reconstruction, its use seems to be increasing and provides a safe and time-saving option to free flaps in selected patients.