A Rare Entity Developing After Breast Reconstruction: Pyoderma Gangrenosum.

Pyoderma gangrenosum (PG) is a rare and persistent neutrophilic dermatosis with an unknown cause. The condition typically manifests clinically as a pustule or plaque that quickly evolves into a necrotic ulcer with undermined violet-colored margins. A surgical debridement might worsen the disease due to the pathergy phenomenon. This case report presents a 48-year-old woman who underwent a late breast reconstruction with a transverse rectus abdominis myocutaneous flap and was subsequently diagnosed with PG. The report details the delays in the diagnosis and management of the disease, providing a comprehensive account of the course of events.

Emergency Foot Fillet Free Flap Based on Posterior Tibial Vessels for Reconstruction of Contralateral Heel and Sole: A Unique Spare Part Surgery.

Introduction: Reconstruction of the sole is an extremely challenging problem for a reconstructive microsurgeon. The specialized nature of its skin and subcutaneous tissue makes reconstruction arduous. When posed with complex bilateral lower extremity trauma where one limb was nonsalvageable, we harvested the uninjured foot fillet flap for free flap cover to reconstruct the contralateral sole. We report two such cases with follow-up assessment. Patients and Methods: Two cases of sole reconstruction with emergency foot fillet free flap scavenged from the amputated contralateral limb were retrospectively analyzed. In both the patients, foot fillet free flap based on the posterior tibial neurovascular bundle was used. The follow-up assessment data collected included flap status, presence of any complications and prosthesis use, and functional status of the limbs at final follow-up. Results: Both the free flaps survived. Postoperative period was uneventful. No complications such as wound infection, delayed healing, flap necrosis, or scar breakdown were noted. The plantar flaps had recovery of protective sensation. Both the patients are ambulant; the first man with a fitted prosthesis and the second woman with the aid of a walker. Conclusion: The opportunity to utilize spare tissue from the amputated limb should be seized. Loss of the plantar aspect of foot poses a real challenge. The plantar foot fillet free flap is a durable flap with preservation of plantar sensations. It is probably the best choice as it replaces "like with like." Prerequisites for utilizing the "spare part surgery" concept are meticulous initial debridement as well as emergency free tissue transfer, which require senior input and excellent infrastructure.

Effects of popliteal nerve blocks on postoperative pain management in fibula-free flap patients for head and neck cancer reconstruction.

Objective: To determine if performing popliteal nerve blocks preoperatively in patients undergoing fibula-free flap surgery for head and neck cancer reconstruction decreases subjective pain scores decreases narcotic usage, and improves mobility in the acute postoperative time period when compared to alternative pain control regimens. Methods: A retrospective review of the medical records of patients who underwent fibula-free flap reconstruction for head and neck malignancy at SUNY Upstate Medical University during the time period from 2015 to 2022 was performed. Collected data consisted of patient demographics and clinical characteristics, postoperative pain management modalities, reported pain scores, postoperative narcotic usage, length of hospital stay, and days until out of bed without personal assistance. Results: A total of 40 patients were included in the study. The average reported pain score was reduced in the nerve block group compared to the control group (1.7 vs. 4.0, p-value = .003). Similarly, the average maximum reported pain score was also lower in patients who received a nerve block (3.4 vs. 6.9, p-value = .002). None of the patients who received popliteal nerve blocks required pain control with parenteral narcotics postoperatively, whereas 82.9% of patients without a nerve block did. Patients who received a popliteal nerve block consumed an average of 103.5 MME, whereas those who did not receive a block consumed an average of 523.0 MME. No statistically significant difference was found between the groups regarding time from surgery until transfer without personal assistance or length of hospital stay. Conclusion: Popliteal nerve blocks can reduce postoperative pain in patients undergoing fibula-free flap reconstruction for head and neck cancer.

Chimeric versus Multiple Flaps for Composite Oral Cavity Defects: A Systematic Review and Meta-Analysis.

OBJECTIVES: Complex head and neck defects involving composite defects can be reconstructed using chimeric flaps or multiple flaps with separate anastomoses. Limited comparisons exist between chimeric and multiple flap reconstructions. We compare outcomes between chimeric and multiple flap reconstructions in oral cavity reconstruction. DATA SOURCES: PubMed (NLM), Embase (Elsevier), Web of Science (Clarivate Analytics), and Cochrane CENTRAL (Wiley). METHODS: A systematic review was conducted, including English articles reporting outcomes of oral cavity reconstruction with either chimeric flaps or multiple flaps. Data extraction included patient characteristics, flap type, and outcomes such as flap survival, partial flap loss, operating room time, hospital length of stay, and postoperative complications. RESULTS: Forty-seven articles comprising 1435 patients were included. Notably, 552 patients underwent multiple flaps, while 883 received chimeric flaps. Meta-analysis revealed no statistically significant difference in flap survival between chimeric and multiple flap patients (98% vs. 99%, p = 0.198). Multiple flap patients had higher rates of operating room take-backs for anastomotic issues and longer hospital stays compared with chimeric flap patients. There were no significant differences in partial flap failure, resumption of diet and speech, need for subsequent flaps, fistula formation, or general complications. CONCLUSION: This large-scale meta-analysis demonstrates equivalent flap survival between chimeric and multiple flaps in the reconstruction of composite oral cavity defects. Both approaches appear to be safe and acceptable, with comparable outcomes in terms of diet and speech resumption, rates of fistulization, and general postoperative complications. Multiple flap patients had higher rates of operating room take-backs and longer hospital stays. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Bone reconstruction using CAD/CAM technology in head and neck surgical oncology. A narrative review of state of the art and aesthetic-functional outcomes.

Bone defects following resections for head and neck tumours can cause significant functional and aesthetic defects. The choice of the optimal reconstructive method depends on several factors such as the size of the defect, location of the tumour, patient's health and surgeon's experience. The reconstructive gold standard is today represented by revascularised osteo-myocutaneous or osteomuscular flaps with osteosynthesis using titanium plates. Commonly used donor sites are the fibula, iliac crest, and lateral scapula/scapular angle. In recent years, computer-aided design (CAD)/computer assisted manufacturing (CAM) systems have revolutionised the reconstructive field, with the introduction of stereolithographic models, followed by virtual planning software and 3D printing of plates and prostheses. This technology has demonstrated excellent reliability in terms of accuracy, precision and predictability, leading to better operative outcomes, reduced surgical times and decreased complication rates. Among the disadvantages are high costs, implementation times and poor planning adaptability. These problems are finding a partial solution in the development of "in house" laboratories for planning and 3D printing. Strong indications for the use of CAD/CAM technologies today are the reconstruction of total or subtotal mandibular or maxillary defects and secondary bone reconstructions.

Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making.

This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author's expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps.

The Effect of Regional Anaesthesia on Free Flap Survival in Lower Extremity Reconstructions.

Background: The effect of different modalities of anaesthesia in microvascular free flap surgery has been a topic of ongoing debate. Comparative data to study the effect of general anaesthesia and regional anaesthesia in the form of peripheral nerve blocks (PNBs) on lower extremity free flap survival is lacking to date. This study aims to elucidate the effect of regional anaesthesia on flap survival in lower extremity free flap reconstructions. Methods: A retrospective cohort study of all patients who underwent free vascularised flap reconstruction of the lower extremities between 2012 and 2021 at the Amsterdam University Medical Centre (UMC), The Netherlands, and between 2019 and 2021 at the Radboud UMC, Nijmegen, The Netherlands. In this cohort, we analysed partial and total flap failures. Results: In this cohort, 87 patients received a total of 102 microvascular free flap reconstructions of the lower extremity. In 20.5% of these operations, patients received a supplemental PNB. Total flap failure was 23.8% in the regional anaesthesia group compared to 21% in the group with general anaesthesia only (p = 0.779). Operation time was longer for patients with regional anaesthesia (p = 0.057). Length of stay was on average 2 days shorter for patients with supplemental regional anaesthesia (p = 0.716). Discussion: This is the largest cohort comparing flap survival in patients receiving general anaesthesia to general anaesthesia with a PNB in lower extremity reconstructions to date. We cannot attribute a significant beneficial or detrimental effect of regional anaesthesia to flap survival. High failure rates stress the need for future studies. How to cite this article: Koster ITS, den Os MM, Rutten MVH, et al. The Effect of Regional Anaesthesia on Free Flap Survival in Lower Extremity Reconstructions. Strategies Trauma Limb Reconstr 2024;19(1):15-20.

Microvascular Muscle vs. Fascio-Cutaneous Free Flaps for Reconstruction of Plantar Load-Bearing Foot Defects-An International Survey.

Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, we conducted an international survey among plastic surgeons querying them about their recommendations and experiences. Results: The survey revealed that the most common strategies for reconstruction of the foot sole are locoregional and microvascular free flaps, emphasizing the relevance of plastic surgery. Among microvascular free flaps, muscle and fascio-cutaneous free flaps are by far the most frequently used. The target qualities of the reconstructed tissue to be considered are manifold, with adherence being the most frequently mentioned. We observed a noteworthy correlation between the utilization of muscle flaps and a preference for adherence. In addition, we identified a substantial correlation between the usage of fascio-cutaneous free flaps and further target qualities, such as good skin quality and sensitivity. Conclusions: Our findings provide insights into the clinical reality and highlight important aspects that must be considered in reconstruction of the weight-bearing areas of the foot providing support in the selection of the appropriate therapy.

Expanding the Armamentarium of Donor Sites in Microvascular Head and Neck Reconstruction.

The field of microsurgical head and neck reconstruction has witnessed tremendous advancements in recent years. While the historic goals of reconstruction were simply to maximize flap survival, optimizing both aesthetic and functional outcomes has now become the priority. With an increased understanding of perforator anatomy, improved technology in instruments and microscopes, and high flap success rates, the reconstructive microsurgeon can push the envelope in harvesting and designing the ideal flap to aid patients following tumor extirpation. Furthermore, with improvements in cancer treatment leading to improved patient survival and prognosis, it becomes increasingly important to have a broader repertoire of donor sites. The present review aims to provide a review of newly emerging soft tissue flap options in head and neck reconstruction. While certainly a number of bony flap options also exist, the present review will focus on soft tissue flaps that can be harvested reliably from a variety of alternate donor sites. From the upper extremity, the ulnar forearm as well as the lateral arm, and from the lower extremity, the profunda artery perforator, medial sural artery perforator, and superficial circumflex iliac perforator flaps will be discussed, and we will provide details to aid reconstructive microsurgeons in incorporating these alternative flaps into their armamentarium.

Bilobed Pectoralis Major Myocutaneous Flap Reconstruction: a Single Institution Experience of 150 Patients and Methods to Prevent Complications.

Introduction: Bilobed PMMC flap is done for patients who have diseases that require resection of oral cavity mucosa along with the overlying skin, either because of direct tumor invasion to the skin or for achieving adequate tumor-free base of resection. The versatility of the flap allows it to be used to cover both inner and outer linings for a full-thickness defect. Materials and Methods: This was a single-center, retrospective, observational study carried out in the Department of Head and Neck Oncology at a regional cancer center from January 2019 to December 2019. A minimum follow-up duration for all patients was 6 months. The primary endpoint was to study the results and complications associated with bilobed PMMC flap reconstruction and factors affecting it, as well as their management. Results: The median age was 45 years [24-71 years]. There were 96(64%) males and 54(36%) females. The most common sites reconstructed were lower gingivobuccal sulcus (39.1%), buccal mucosa (30.2%), and lower alveolus (16.7%). The overall complication rate was 41.3%, with 10(6.6%) patients requiring re-exploration. The average hospital stay was 11 days [5-28 days]. On doing a multivariate analysis, for various factors affecting flap necrosis, none of the factors reached statistical significance (p value > 0.05). Conclusion: PMMC flap remains the workhorse of head and neck reconstruction. In cases of full-thickness defects in oral cancer patients, in our country, in the setup which lacks the expertise in microvascular anastomosis and with immense caseload in the head and neck cancer department, bilobed PMMC flap remains a safe and favorite alternative method for reconstruction.

Reconstructive Options for Basal Cell Carcinoma Defects in the Head and Neck Region: An Institutional Experience.

Basal cell carcinoma (BCC) is the most common skin cancer with more than 80% occurring on the face occurring mainly due to exposure to ultraviolet rays in the elderly due to cumulative exposure of the UV rays during their lifetime. Though various treatment modalities are available for the treatment of basal cell carcinomas, wide local excision is the standard line of management. However, reconstruction of facial BCC poses a challenge to the reconstructive surgeon. Over a 4-year-old period from 2017 to 2021, a total of 30 patients of head and neck basal cell carcinoma were surgically excised in our institution. We have explored all modes of reconstruction from small to large BCC defects in terms of cosmesis, form and function. Four patients underwent primary closure, 8 patients underwent skin grafting, 13 patients underwent closure by local and advancement flaps and 5 patients with large defects underwent free flap reconstruction. No flap loss was reported. None reported any functional deficit. To achieve adequate aesthetic surgical outcomes after reconstruction, knowledge of facial aesthetic regions is of utmost importance. The size and location of the defect and the presence of vital structures adjacent to the defect should be assessed to determine the kind of reconstruction that should be carried out without adversely affecting adjacent structures. For greater patient satisfaction, the method of reconstruction should be tailor made, where donor tissue resembles native tissue with good contour and texture match, suture line scars are camouflaged, and complications are nil.

Flap blood glucose measurement for flap monitoring and early detection of circulatory problems.

Postoperative monitoring of skin flaps is subjective and cannot detect early circulatory problems in the flap. Early detection and rapid remedial re-exploration are important for flap salvage. We evaluated flap glucose measurement to monitor the flaps for early detection of circulatory problems. In total, 30 patients underwent cutaneous flap reconstruction. This is an easy, economic, objective, and reliable method for flap monitoring and can detect early venous congestion requiring remedial measures.

Optical Three-Dimensional Imaging for Objective Evaluation of the Donor Site after Anterolateral Thigh Flap Surgery.

Background: The high volume of the fasciomyocutaneous anterolateral thigh flaps (ALT) is suitable for the reconstruction of pronounced soft tissue defects. At the same time, harvesting ALT results in a drastic change in thigh shape. Here, we present an optical three-dimensional imaging method for thigh comparison, which can be an objective and reproducible method for evaluating donor sites after ALT harvesting. Methods: In total, 128 thighs were scanned with an optical three-dimensional scanner, Vectra XT ®. Sixty-eight non-operated right and left thighs were compared and served as a control. Sixty thighs were scanned in the ALT group. The average surface area deviations, thigh volume, thigh circumference, and flap ratio to thigh circumference were calculated. The results were correlated with Δthigh circumference and Δvolume of the unoperated thighs of the control group. Results: No significant difference between the thigh volumes of the right and left thighs was found in the control group. Removal of an ALT flap showed a significant (p < 0.007) volume reduction compared to unoperated thighs (2.7 ± 0.8 L and 3.3 ± 0.9 L, respectively). Flap area correlated strongly with the Δthigh circumference (r = 0.66, p < 0.001) and Δvolume (r = 0.68, p < 0.001). Strong correlations were observed between flap ratio and thigh circumference with Δhigh circumference (r = 0.57, p < 0.001) and Δvolume (r = 0.46, p < 0.05). Conclusions: Optical three-dimensional imaging provides an objective and reproducible tool for detecting changes in thigh morphology volume differences after ALT harvesting.

Outcomes of Head and Neck Free Tissue Transfer Requiring Vein Grafting: Systematic Review and Meta-analysis.

OBJECTIVE: To systematically review the literature to determine the prevalence of free flap failure in head and neck free flaps requiring vein grafting. DATA SOURCES: Search strategies created in collaboration with a medical librarian were implemented using PubMed, Cochrane, Scopus, Web of Science, and Google Scholar from inception to August 2022. REVIEW METHODS: The population of interest included adult and pediatric patients undergoing reconstruction of oncologic or traumatic head and neck defects with a free flap requiring a vein graft that presents the success/failure rate. The primary outcome was the flap failure rate, and the secondary outcome was the flap compromise/revision rate. Inclusion and exclusion criteria were designed to capture all study designs. Initially, 2778 articles were identified by the search strategy. Two reviewers independently performed the review, data extraction for analysis, and a quality assessment. Primary Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Meta-analysis was performed using a random effects model. RESULTS: Eleven studies of 789 flaps were included for data extraction. Random effects meta-analysis resulted in an estimated prevalence of free flap failure of 12.30% (95% confidence interval: 6.39%-19.49%, I2 = 77.4%). CONCLUSION: Taking into account that head and neck free tissue transfers that require a vein graft are typically associated with more challenging reconstructions and the lack of a suitable alternative, vein grafts appear to be a reliable method for bridging the gap between the flap and recipient vessels in head and neck free tissue transfer when indicated.

Free flap reconstruction at a rural-based tertiary medical college hospital: Barriers and outcomes.

BACKGROUND AND OBJECTIVES: In a rural-based setting, providing optimal treatment is often difficult owing to the limited resources and financial constraints being rampant in cancer care delivery. Oncological resections often result in large, complex defects requiring free flap reconstruction to achieve cosmetic and/or functional goals. This article focuses on our experience of starting and promoting microvascular reconstruction in a rural tertiary medical college hospital. METHODS: Retrospective observational study of patients undergoing free flap reconstruction for oncological indications was included. Standard oncological principles were followed for cancer extirpation. Free flap reconstruction was done using loupes of 4× magnification. Flap-related outcomes and barriers in doing free flap reconstruction were analysed. RESULTS: A total of 56 patients were included. The most common free flap undertaken was free anterolateral thigh flap in 21 (37.5%) patients. The mean duration of reconstruction was 438 min. Re-exploration was undertaken in 17 patients (30.4%). Nonsalvageable flap loss was 19.64%. Adjuvant treatment was administered in all patients as per oncological indications, albeit with some delay in 12.5%. Barriers to reconstruction were noted in the pre-, intra- and postoperative periods. CONCLUSION: Reconstruction with free flaps is feasible in a resource-constrained setup with careful planning and a multidisciplinary team approach to overcome the barriers.

Outcomes and influencing factors of dental implants in fibula, iliac crest, and scapula free flaps: a retrospective case-control study.

PURPOSE: Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient's quality of life. This retrospective case-control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors. METHODS: Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria. RESULTS: Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis (n = 24), insufficient osseointegration (n = 1), removal due to tumor recurrence (n = 1), and osteoradionecrosis (n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed (p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival (p = 0.034) and success (p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival (p = 0.014). CONCLUSION: Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge.

Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta-analysis.

OBJECTIVE: Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap-assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap-assisted closure. DATA SOURCES: Pubmed/Medline, CINAHL, and CENTRAL. REVIEW METHODS: An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted. RESULTS: Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure. CONCLUSION: The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.

A rapid recovery protocol for head and neck oncology patients undergoing resection, free flap reconstruction, and tracheostomy: a feasibility study.

Enhanced recovery after surgery (ERAS) for head and neck oncology patients was first introduced in 2017 and was found to improve patient outcomes, in line with results from other surgical specialties. This article presents a rapid recovery protocol (RRP) to further enhance perioperative care in conjunction with the ERAS protocol, for patients undergoing ablative surgery together with free flap reconstruction and tracheostomy. A prospective multidisciplinary approach was adopted to identify a specific cohort of patients who would benefit from the RRP. Of 26 patients who fulfilled the eligibility criteria, 16 completed the RRP. On average, these patients spent 5 days less with a tracheostomy and were discharged 7 days sooner when compared to a matched control group of nine patients on the standard postoperative care pathway. This resulted in an approximate monetary saving of £ 9955 per patient for the hospital trust. These results demonstrate that the feasibility study should be rolled out further, as the RRP not only decreased the length of stay but also provided substantial monetary savings without compromising patient outcomes.

Algorithm for the reconstruction of the parotid region: a single institution experience.

OBJECTIVE: This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects. MATERIALS AND METHODS: A retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data. RESULTS: Among the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received 125I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases. CONCLUSION: Immediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.

Postoperative outcomes of aspirin in microvascular free tissue transfer surgery-A systematic review and meta-analysis.

Microvascular free tissue transfer surgery is a frequently used technique for head and neck reconstruction involving anticoagulants, and the present study aimed to analyse the postoperative outcomes of aspirin use in conjunction with this procedure. We searched databases for articles published between 2007 and 2022 on microvascular free tissue transfer surgery using aspirin and assessed them for primary and secondary outcomes. Odds ratios (ORs) and 95 % confidence intervals (CIs) were determined through analyses, followed by constructing a forest plot for complication rates. A total of 617 articles were retrieved from the databases, including 14 original full-text articles. Overall complication rates ranged from 0.7-38 % (95 % CI, 17.85 ± 0.503 (±2.8 %) [17.347-18.353]), while flap survival rates ranged from 95-99.2 % (95 % CI, 96.28 ± 0.0956 (±0.10 %) [96.184-96.376]). Two studies reported similar complication rates of 38 %, the highest among all reported studies. The ORs between the studies for the complications and flap survival rates were 2.614 and 0.722, respectively. Although the complication rates associated with aspirin use were not significantly high among the studies, they cannot be ignored. Flap survival rates were independent of the dose and type of anticoagulants used during surgery.