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Advances in Midface Reconstruction.
The complexity of the midface structure and its importance to a multitude of functions present the reconstructive surgeon with unique challenges. The midface is an area that is crucial both functionally and esthetically. Midface reconstruct…
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Flow-Through Flaps as a Robust Method for Advanced Free Flap Reconstruction in the Head and Neck: A Multi-Institutional Experience.
[BACKGROUND] Flow-through flaps (FTFs) are an advanced technique in which a free flap is anastomosed to the pedicle of another free flap to reconstruct extensive head and neck defects when recipient vessels are scarce. [METHODS] A multi-in…
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Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients.
[OBJECTIVE] To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and seco…
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Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis.
[OBJECTIVES] Microvascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to d…
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Microvascular reconstruction of medication related osteonecrosis of the head and neck.
[BACKGROUND] Medication related osteonecrosis of the jaw (MRONJ) requiring free flap (FF) reconstruction is uncommon with limited reported findings. [METHODS] Multicenter, retrospective case series of 49 consecutive adult patients presenti…
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Comparing the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis.
[BACKGROUND] This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN). [METHODS] Retrospective review of patients undergoing OC-R…
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Microvascular reconstruction of midface osteoradionecrosis.
[BACKGROUND] Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population. [METHODS] Retrospectiv…
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Free flap reconstruction following head and neck trauma.
[BACKGROUND] Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon. [METHODS] Multi-institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103). [RESULTS…
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Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction.
[OBJECTIVE] Determine which variables impact postoperative discharge destination following head and neck microvascular free flap reconstruction. [STUDY DESIGN] Retrospective review of prospectively collected databases. [METHODS] Consecuti…
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Postoperative analysis of osseous midface reconstructions: The value of imaging and a novel scoring system for complexity and operative success.
[BACKGROUND] Few standardized methods exist for evaluating the postoperative outcomes of osteocutaneous free flaps. We propose an anatomic-based scoring system for midface free flap reconstruction. [METHODS] One hundred and twelve patients…
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Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors.
[OBJECTIVE(S)] Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergo…
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Clinical outcomes following intraoperative pedicle disruption in fibula free flaps.
[OBJECTIVES] Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following acciden…
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Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With Surgery and Free Flap Reconstruction.
[OBJECTIVE] Patients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free-flap reconstruction. Resection and reconstruction can impact function, leading to tube depende…
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Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction.
[BACKGROUND] Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes. [METHODS] Multi-institutional, …
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Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction.
[OBJECTIVE] Determine if age correlated with surgical or medical complications following head and neck free flap reconstruction. [STUDY DESIGN] Retrospective review of prospectively collected databases. [METHODS] Patients undergoing head …
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Analysis of cost and outcomes in bony versus soft tissue midface free flap reconstruction.
[BACKGROUND] Outcomes and cost of soft tissue versus bony midface free flap reconstruction (MR) with and without virtual surgical planning (VSP) were evaluated. [METHODS] Retrospective review of MR including ischemic time (IT), operative d…
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Management of the Acute Loss of a Free Flap to the Head and Neck-A Multi-institutional Review.
[OBJECTIVES/HYPOTHESIS] To review the management of failed free tissue transfers among four large institutions over a 13-year period to provide data and analysis for a logical, algorithmic, experience-based approach to the management of fai…
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Anastomotic Revision in Head and Neck Free Flaps.
[OBJECTIVES/HYPOTHESIS] Predictors of free tissue transfer (FTT) failure and the need for postoperative revision (POR) have been extensively studied; however, there are little data evaluating outcomes when intraoperative revision (IOR) at i…
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Outcomes of Venous End-to-Side Microvascular Anastomoses of the Head and Neck.
[OBJECTIVES/HYPOTHESIS] The literature on outcomes of end-to-side (ETS) anastomoses for microvascular reconstruction of the head and neck is limited. This series reviews ETS in free tissue transfer (FTT) across multiple institutions to bett…
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Microvascular Reconstruction of Osteonecrosis: Assessment of Long-term Quality of Life.
[OBJECTIVE] Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. [STUDY DESIGN] Retrospective multi-institutional review. [SETTING] Tertiary care centers. [METHODS] Patients include…
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Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction.
[OBJECTIVES] Mid and upper face free flaps frequently are associated with challenges due to pedicle length. We sought to evaluate the frequency at which alternative pedicle maneuvers were required for these reconstructions and determine if …
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Long-Term Complications of Osteocutaneous Free Flaps in Head and Neck Reconstruction.
[OBJECTIVE] To determine the frequency at which patients with osteocutaneous free flap reconstruction of the head and neck develop long-term complications and identify predisposing perioperative factors. [STUDY DESIGN] A prospectively main…
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Natural History and Consequences of Nonunion in Mandibular and Maxillary Free Flaps.
[OBJECTIVE] To describe the natural history of bone segment union in head and neck free flap procedures and detail the association of poor segment union with postoperative complications. [STUDY DESIGN] Case series with chart review. [SETT…
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Factors impacting successful salvage of the failing free flap.
[BACKGROUND] Understanding factors impacting successful salvage of a compromised free flap. [METHODS] Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764). [RESULTS] Free flap compromise rate: 9% (n…