Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck. (April 2017)

• Record Type: Journal Article
• Authors: Sweeny, Larissa; Rosenthal, Eben L.; Light, Tyler; Grayson, Jessica; Petrisor, Daniel; Troob, Scott H.; Greene, Benjamin J.; Carroll, William R.; Wax, Mark K.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 156:Number 4(2017)
• Page Start: 627
• Page End: 635
• Publication Date: 2017-04
• Subjects: overlapping operations -- head and neck reconstruction -- surgical complications; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599817691746
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To compare outcomes after microvascular reconstructions of head and neck defects between overlapping and nonoverlapping operations. Study Design: Retrospective cohort study. Setting: Tertiary care center. Subjects and Methods: Patients undergoing microvascular free tissue transfer operations between January 2010 and February 2015 at 2 tertiary care institutions were included (n = 1315). Patients were divided into 2 cohorts by whether the senior authors performed a single or consecutive microvascular reconstruction (nonoverlapping; n = 773, 59%) vs performing overlapping microvascular reconstructions (overlapping; n = 542, 41%). Variables reviewed were as follows: defect location, indication, T classification, surgical details, duration of the operation and hospitalization, and complications (major, minor, medical). Results: Microvascular free tissue transfers performed included radial forearm (49%, n = 639), osteocutaneous radial forearm (14%, n = 182), anterior lateral thigh (12%, n = 153), fibula (10%, n = 135), rectus abdominis (7%, n = 92), latissimus dorsi (6%, n = 78), and scapula (<1%, n = 4). The mean duration of the overlapping operations was 21 minutes longer than nonoverlapping operations ( P = .003). Mean duration of hospitalization was similar for nonoverlapping (9.5 days) and overlapping (9.1 days) cohorts ( P = .39). There was no difference in complication rates when stratified by overlapping (45%, n = 241) and nonoverlapping (45%, n = 344) ( P = .99). Subset analysis yielded similar results when minor, major, and medical complications between groups were assessed. The overall survival rate of free tissue transfers was 96%, and this was same for overlapping (96%) and nonoverlapping (96%) operations ( P = .71). Conclusions: Patients had similar complication rates and durations of hospitalization for overlapping and nonoverlapping operations.