Risk of Microvascular Anastomosis Performed in Previous Treated Neck
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Background and Objectives This study aimed to determine if a microvascular anastomosison the neck, which had previously been treated, increases the risk of early complications,such as flap failure or hemorrhage and venous congestion that necessitates re-exploration. Subjects and Method A retrospective review was conducted on 274 cases of tumor resectionwith simultaneous free flap reconstruction from 2005 to 2019. Flap failure and re-explorationrate was evaluated according to the clinical variables including treatment history of recipientvessels. Results Twenty-one (7.7%) cases of flap failure were identified and re-exploration was conductedin 51 (18.6%) cases. Although the failure rate appeared to be high when micro-anastomosiswas performed in the neck, where neck dissection with radiotherapy was previouslyperformed (22.7%), there was no statistical significance compared with no previous treatmentgroup. Previous neck dissection with irradiation was found to influence re-exploration {oddsratio (OR)=3.674 [95% confidence interval (CI) 1.348–10.014, p=0.011]} compared to no treatment. However, previous radiotherapy or surgery only did not show any significant differencecompared to the untreated group. Venous congestion was the most common cause of re-exploration(50.1%), followed by hematoma (33.3%), and previous neck dissection with radiotherapyincreased the risk of both [OR for venous congestion=3.056 (95% CI 1.009–9.255)], p=0.048,OR for hematoma=6.286 (95% CI 1.679–23.526), p=0.006] compared with no previous treatment. Radiotherapy alone did not change the risk of early complication. Conclusion Micro-anastomosis in a previously treated neck is feasible in terms of flap failure. However, micro-anastomosis in a neck, where neck dissection with radiotherapy wereperformed, may be more likely to cause complications such as venous congestion and hematomathat necessitate re-exploration.
Abstract
Background and Objectives This study aimed to determine if a microvascular anastomosison the neck, which had previously been treated, increases the risk of early complications,such as flap failure or hemorrhage and venous congestion that necessitates re-exploration. Subjects and Method A retrospective review was conducted on 274 cases of tumor resectionwith simultaneous free flap reconstruction from 2005 to 2019. Flap failure and re-explorationrate was evaluated according to the clinical variables including treatment history of recipientvessels. Results Twenty-one (7.7%) cases of flap failure were identified and re-exploration was conductedin 51 (18.6%) cases. Although the failure rate appeared to be high when micro-anastomosiswas performed in the neck, where neck dissection with radiotherapy was previouslyperformed (22.7%), there was no statistical significance compared with no previous treatmentgroup. Previous neck dissection with irradiation was found to influence re-exploration {oddsratio (OR)=3.674 [95% confidence interval (CI) 1.348–10.014, p=0.011]} compared to no treatment. However, previous radiotherapy or surgery only did not show any significant differencecompared to the untreated group. Venous congestion was the most common cause of re-exploration(50.1%), followed by hematoma (33.3%), and previous neck dissection with radiotherapyincreased the risk of both [OR for venous congestion=3.056 (95% CI 1.009–9.255)], p=0.048,OR for hematoma=6.286 (95% CI 1.679–23.526), p=0.006] compared with no previous treatment. Radiotherapy alone did not change the risk of early complication. Conclusion Micro-anastomosis in a previously treated neck is feasible in terms of flap failure. However, micro-anastomosis in a neck, where neck dissection with radiotherapy wereperformed, may be more likely to cause complications such as venous congestion and hematomathat necessitate re-exploration.
참고문헌 (28)
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