Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review.
Microvascular free tissue transfer is a reliable technique for head and neck reconstruction with success rates of 90-99%. Currently, there is no consensus concerning antithrombotic agents, antibiotics, or monitoring techniques. Therefore, the aim of this study was to review current literature dealing with microvascular free-tissue transfer and factors influencing the outcome. In addition to excellent microsurgical techniques, coupling devices are a promising new technique, but are not useful in all arteries. Antibiotics should be given in three doses, as a more lengthy dosage time seems to have no advantage. The risk for elderly patients can be best assessed by the American Society of Anesthesiologists (ASA) score, but early mobilization, including intense chest physiotherapy, is important. Anticoagulation can be considered in cases of small vessels, significant size mismatch, vein graft, or vessels of poor quality. Monitoring should be done hourly during the first 24 hours and then every 4 hours for the next 2 postoperative days.
Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstr. 24, CH-8091 Zurich, Switzerland. astrid.kruse@usz.ch
Astrid L D
AL
Kruse
Heinz T
HT
Luebbers
Klaus W
KW
Grätz
Joachim A
JA
Obwegeser
D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D000925:Anticoagulants / Q000008:administration & dosage; D048909:Diabetes Complications; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008866:Microsurgery; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011878:Radiotherapy; D019651:Plastic Surgery Procedures; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000098:blood supply*; D013536:Suture Techniques / Q000295:instrumentation; D014022:Tissue Survival / Q000528:radiation effects; D014656:Vascular Surgical Procedures
D000900:Anti-Bacterial Agents; D000925:Anticoagulants