Buried free flaps in head and neck reconstruction

TY - JOUR

T1 - Buried free flaps in head and neck reconstruction

T2 - higher risk of free flap failure?

AU - Reiter, M

AU - Harréus, U

AU - Kisser, U

AU - Betz, C S

AU - Baumeister, Ph

PY - 2017/1

Y1 - 2017/1

N2 - Thrombosis of the pedicle is central to free flap failure, and early revision of a compromised flap is the key to successfully salvage a flap. Therefore, the majority of free flaps in reconstructive head and neck surgery are used with the ability to visually examine the flap. Sometimes, due to intra-operative circumstances, it is necessary to use a flap that cannot be monitored externally. These flaps are called buried flaps and have the reputation of being put at risk. The current literature provides only limited data to support or disprove this position. A single institution retrospective review of patient charts between 2007 and 2015 was performed. Flap monitoring was carried out with hand-held Doppler of the pedicle hourly for the first 72 h in all cases. Additional duplex ultrasound was performed in the majority of buried flaps. A total of 437 flaps were included into the study. 37 flaps (7.8 %) were identified to fulfill the criteria of a buried free flap. In total, four patients had complications, three of which required operative reexploration. All interventions were successful, resulting in no flap loss in our series. An accurate operation technique combined with meticulous monitoring protocols supported by duplex ultrasound can result in satisfactory outcome of buried flaps. No enhanced risk of flap loss of buried flaps was found in our cohort.

AB - Thrombosis of the pedicle is central to free flap failure, and early revision of a compromised flap is the key to successfully salvage a flap. Therefore, the majority of free flaps in reconstructive head and neck surgery are used with the ability to visually examine the flap. Sometimes, due to intra-operative circumstances, it is necessary to use a flap that cannot be monitored externally. These flaps are called buried flaps and have the reputation of being put at risk. The current literature provides only limited data to support or disprove this position. A single institution retrospective review of patient charts between 2007 and 2015 was performed. Flap monitoring was carried out with hand-held Doppler of the pedicle hourly for the first 72 h in all cases. Additional duplex ultrasound was performed in the majority of buried flaps. A total of 437 flaps were included into the study. 37 flaps (7.8 %) were identified to fulfill the criteria of a buried free flap. In total, four patients had complications, three of which required operative reexploration. All interventions were successful, resulting in no flap loss in our series. An accurate operation technique combined with meticulous monitoring protocols supported by duplex ultrasound can result in satisfactory outcome of buried flaps. No enhanced risk of flap loss of buried flaps was found in our cohort.

KW - Free Tissue Flaps

KW - Graft Survival

KW - Head and Neck Neoplasms

KW - Humans

KW - Point-of-Care Systems

KW - Reconstructive Surgical Procedures

KW - Retrospective Studies

KW - Ultrasonography, Doppler, Duplex

KW - Journal Article

U2 - 10.1007/s00405-016-4214-z

DO - 10.1007/s00405-016-4214-z

M3 - SCORING: Journal article

C2 - 27423643

VL - 274

SP - 427

EP - 430

JO - EUR ARCH OTO-RHINO-L

JF - EUR ARCH OTO-RHINO-L

SN - 0937-4477

IS - 1

ER -