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KMID : 0361020210640110811
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Korean Journal of Otolaryngology - Head and Neck Surgery
2021 Volume.64 No. 11 p.811 ~ p.819
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Risk of Microvascular Anastomosis Performed in Previous Treated Neck
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Hyun Se-Jin
Ahn Soon-Hyun
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Abstract
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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.
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KEYWORD
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Failure, Free flap, Microvascular anastomosis, Reoperation, Salvage
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