Int J Stomatol ›› 2023, Vol. 50 ›› Issue (2): 127-137.doi: 10.7518/gjkq.2023040

• Expert Forum •     Next Articles

Complications prevention and treatment after free flap reconstructive surgery for oral and maxillofacial tumor patients

Li Chunjie(),Bi Xiaoqin(),Zhu Guiquan.   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-12-02 Revised:2023-01-19 Online:2023-03-01 Published:2023-03-14
  • Contact: Xiaoqin Bi E-mail:lichunjie@scu.edu.cn;hxbxq@163.com
  • Supported by:
    Department of Science and Technology Application Fundamental Project of Sichuan Pro-vince(2021YJ0129);National Natural Science Foundation of China(U1813213);Sichuan Science and Technology Plan Project(2022JDKP0007)

Abstract:

Enhanced recovery is important for head and neck tumor patients, especially for those with free flap reconstruction which have numerous complications after surgery. Prevention and treatment of postoperative complications an important part for enhanced recovery after free flap reconstruction of head and neck tumor patients. In this article, we summarized the experiences in some published articles and authors’ clinical practice for the reference of related doctors, including airway management, hemorrhage control, prevention of postoperative infection, prevention of complications related to free flap reconstruction and functional complications prevention in oral and maxillofacial surgery, which could promote the application of enhanced recovery in free flap reconstructive surgery for oral and maxillofacial tumor patients.

Key words: free flap, enhanced recovery after surgery, head and neck neoplasm, reconstructive surgery, oral and maxillofacial defect, complication

CLC Number: 

  • R 622

TrendMD: 

Fig 1

A simple nasopharyngeal airway could be established by retrac-ting the tracheal tube to pharyngeal cavity"

Fig 2

Overhanging the floor of mouth muscles"

Fig 3

Layering of the effusion in the drainage tube"

Fig 4

Placing of the drainage tube under the flap"

Fig 5

Elimination of the dead space"

Fig 6

Close the suture via skin flap transplantation after fibular flap harvesting"

Fig 7

Feeding tube to assist feeding"

1 Chow LQM. Head and neck cancer[J]. N Engl J Med, 2020, 382(1): 60-72.
2 Takaya A, Higashino T, Oshima A, et al. Clinical assessment of early mobilization after head and neck free flap reconstruction: a retrospective case-control study[J]. J Plast Reconstr Aesthet Surg, 2022, 75(11): 3997-4002.
3 Bertelsen C, Hur K, Nurimba M, et al. Enhanced recovery after surgery-based perioperative protocol for head and neck free flap reconstruction[J]. OTO Open, 2020, 4(2): 2473974X20931037.
4 Madgar O, Livneh N, Dobriyan A, et al. Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory[J]. Braz J Otorhinolaryngol, 2022, 88(): S44-S49.
5 蔡天怡, 章文博, 于尧, 等. 头颈部游离组织瓣移植术后预防性气管切开的临床分析[J]. 北京大学学报(医学版), 2022, 54(2): 363-368.
Cai TY, Zhang WB, Yu Y, et al. Clinical analysis of selective tracheostomy necessary for patients undergoing head and neck surgery with free flap reconstruction[J]. J Peking Univ (Health Sci), 2022, 54(2): 363-368.
6 Singh T, Sankla P, Smith G. Tracheostomy or delayed extubation after maxillofacial free-flap reconstruction[J]. Br J Oral Maxillofac Surg, 2016, 54(8): 878-882.
7 Kwon MA, Song J, Kim S, et al. Airway management failure after delayed extubation in a patient with oral malignant melanoma who underwent partial mandibulectomy and reconstruction with a free flap[J]. Case Rep Dent, 2021, 2021: 7792843.
8 Rothweiler R, Gerlach V, Voss P, et al. Aspirin, he-parin and ischemia time in microvascular free flap surgery-their influence and an optimal anticoagulation protocol[J]. J Stomatol Oral Maxillofac Surg, 2022, 123(5): e556-e562.
9 Anagnos VJ, Brody RM, Carey RM, et al. Post-operative monitoring for head and neck microvascular reconstruction in the era of resident duty hour restrictions: a retrospective cohort study comparing 2 monitoring protocols[J]. Ann Otol Rhinol Laryngol, 2022: 34894221088176.
10 Meulemans J, Demarsin H, Debacker J, et al. Functional outcomes and complications after salvage total laryngectomy for residual, recurrent, and second primary squamous cell carcinoma of the larynx and hypopharynx: a multicenter retrospective cohort stu-dy[J]. Front Oncol, 2020, 10: 1390.
11 Kuo PJ, Wu SC, Chien PC, et al. Artificial neural network approach to predict surgical site infection after free-flap reconstruction in patients receiving surgery for head and neck cancer[J]. Oncotarget, 2018, 9(17): 13768-13782.
12 Gearing PF, Daly JF, Tang NSJ, et al. Risk factors for surgical site infection in free-flap reconstructive surgery for head and neck cancer: retrospective Australian cohort study[J]. Head Neck, 2021, 43(11): 3417-3428.
13 Goyal N, Emerick KS, Deschler DG, et al. Risk factors for surgical site infection after supraclavicular flap reconstruction in patients undergoing major head and neck surgery[J]. Head Neck, 2016, 38(11): 1615-1620.
14 李春洁, 韩波, 朱桂全. 口腔颌面部缺损游离皮瓣修复中血管吻合的技巧及关键点[J]. 华西口腔医学杂志, 2022, 40(3): 271-278.
Li CJ, Han B, Zhu GQ. Vessel anastomosis in free flap reconstruction for oral and maxillofacial defects: techniques and key points[J]. West China J Stomatol, 2022, 40(3): 271-278.
15 Sweeny L, Slijepcevic A, Curry JM, et al. Factors impacting discharge destination following head and neck microvascular reconstruction[J]. Laryngoscope, 2023, 133(1): 95-104.
16 Berzofsky C, Shin E, Mashkevich G. Leg compartment syndrome after fibula free flap[J]. Otolaryngol Head Neck Surg, 2013, 148(1): 172-173.
17 Sun GW, Yang XD, Wen JM, et al. Treatment of compartment syndrome in donor site of free fibula flap after mandibular reconstruction surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(5): e15-e18.
18 Kaleem A, Patel N, Schubert E, et al. Comparison of propeller flaps versus skin grafts for coverage of osteocutaneous fibula free flap donor site defects[J]. Head Neck, 2023, 45(1): 135-146.
19 Gong YP, Xu J, Shao J, et al. Prevention of seroma formation after mastectomy and axillary dissection by lymph vessel ligation and dead space closure: a randomized trial[J]. Am J Surg, 2010, 200(3): 352-356.
20 Le JM, Ying YP, Seri C, et al. Does early oral intake after microvascular free flap reconstruction of the oral cavity lead to increased postoperative complications[J]. J Oral Maxillofac Surg, 2022, 80(10): 1705-1715.
21 Stramiello J, Nuyen B, Saraswathula A, et al. Ti-ming of postoperative oral feeding after head and neck mucosal free flap reconstruction[J]. Laryngoscope Investig Otolaryngol, 2021, 6(5): 1031-1036.
22 Amendola F, Spadoni D, Losco L, et al. Soft palate reconstruction with free jejunum flap: impact on the velopharyngeal insufficiency[J]. J Plast Reconstr Aesthet Surg, 2022, 75(8): 2684-2690.
23 Dawson C, Adams J, Fenlon D. The experiences of people who receive swallow therapy after surgical treatment of head and neck cancer[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2019, 128(5): 456-463.
[1] Huangphattarakul Vicha,Man Yi.. Research progress on mucoperiosteum perforation in maxillary sinus elevation [J]. Int J Stomatol, 2023, 50(5): 552-557.
[2] Wang Renyi,Zhao Chengzhi,Pan Jian.. Research progress on the effects of prophylactic antibiotics on postoperative complications during the perioperative period of tooth extraction [J]. Int J Stomatol, 2023, 50(5): 558-565.
[3] Yashengjiang Muhesen,Tuerdi Maimaitituxun. Application of suture anchor in oral and maxillofacial surgery [J]. Int J Stomatol, 2023, 50(1): 114-119.
[4] Shen Dongni,Shi Ying,Fu Baiping. Research progress on posterior occlusal veneer [J]. Int J Stomatol, 2021, 48(3): 287-291.
[5] Wei Binbin,Hu Huiwei,Liu Yujuan,Sun Zhe,Yi Yuli. Meta-analysis and GRADE evaluation of the intervention effects of using amifostine before radiotherapy on xerostomia in patients with head and neck cancer [J]. Int J Stomatol, 2020, 47(5): 547-556.
[6] Tan Kaixuan,Li Fan,Zhang Lijuan,Li Shanshan,Lu Jie,Zhang Ying,Yang Fang. Root canal retreatment with subcutaneous emphysema: a case report [J]. Int J Stomatol, 2020, 47(5): 563-566.
[7] Tang Bei,Zhao Wenjun,Wang Hu,Zheng Guangning,You Meng. Inferior alveolar nerve injury due to apical overfilling: two cases reports [J]. Int J Stomatol, 2020, 47(3): 293-296.
[8] Chen Dong,Yang Zheng,Jiang Li. Research progress on the evaluation and management of radiation-induced xerostomia [J]. Int J Stomatol, 2019, 46(6): 711-717.
[9] Fu Xunan,Xie Zhigang. Research progress on abutment technical complications in fixed implant-supported prostheses [J]. Int J Stomatol, 2019, 46(5): 571-577.
[10] Zhang Rui1, Zhang Lingge1, Li Xihong1, Li Rui2. Influence of improved triangular flap on postoperative complications after mandibular third molar removal and its clinical application [J]. Inter J Stomatol, 2017, 44(2): 153-156.
[11] Tang Haikuo, Hou Jinsong.. Use of antibiotics following tooth extraction [J]. Inter J Stomatol, 2014, 41(5): 497-499.
[12] Li Wei, Jiang Wen. Head and neck intramuscular myxoma [J]. Inter J Stomatol, 2013, 40(6): 747-749.
[13] Wang Wentao, Wang Yongyue. Research progress on maxillary sinus membrane in maxillary sinus floor elevation [J]. Inter J Stomatol, 2013, 40(3): 391-394.
[14] Song YingLiang.. Causes and treatment of the common retaining complication for the implant supported edentulous [J]. Inter J Stomatol, 2013, 40(1): 3-5.
[15] Wang Jinjuan, Chen Jun. . Complications and preventation of distraction osteogenesis in oral and maxillofacial surgery [J]. Inter J Stomatol, 2012, 39(6): 818-823.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 458 -460 .
[8] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 452 -454 .
[9] . [J]. Inter J Stomatol, 2008, 35(S1): .
[10] . [J]. Inter J Stomatol, 2008, 35(S1): .