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95. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Chairs

NUR Wissenschaftliches Programm/ ONLY Scientific Program

Interdisciplinary Plastic and Reconstructive Surgery of Head and Neck Squamous Cell Carcinomas

Univ.-Prof. Dr.

Dr. med.

Prof. Dr.

Referat / Keynote lecture

The Scapula Flap – a Versatile Reconstruction Option for Head and Neck Defects

Invited lecture

The CAMR (Computer-Assisted Mandibular Reconstruction) – Long-Term Results

Prof.

The anterolateral thigh flap with vascularized fascia lata applied in head and neck defects

Multimodal / Interdisziplinär

Introduction The study is to assess outcomes of patients undergoing reconstruction with the anter-olateral thigh flap with vascularized fascia lata (ALT-FL) in the subsequent of oncologic resection for carcinoma of oral cavity, oropharynx, and maxillary, as well as osteoradionecrosis debridement of the skull base. Materials and Methods It is a retrospective study of 38 patients underwent on-cologic resection, including 11 oropharynx, 5 oral cavity, 3 maxillary, as well as 18 nasopharyngeal skull base defects after osteoradionecrosis debridement, in the subsequent reconstruction with the ALT-FL flap from May 2019 to June 2022. A series of cases with notes of surgical techniques, peri-operative treatment and outcomes were also presented. Results Average hospital stay was 10.8 days. Total operative time was 10.3 hours. There were two serious complications, include one mortality because of sepsis and one carotid artery hemorrhage because of pseudoaneurysm. Visualized in oral cavity and oropharynx, ALT-FL flap would be epithelialized in post-operative 4 to 6 months. For maxillary defects, anastomosis between ALT-FL free flap and residual mucosal simply by using several needles could fill fascial component and and prevent the orocutaneous and nasocutaneous fistula. The most satisfied results were found in oradionecrosis patients: 89.4% had headache and foul odor relief. Conclusions The ALT-FL flap is a reliable flap for defects of oral cavity, orophar-ynx, and maxillary and for osteoradionecrosis debridement.The authors declare that there is no conflict of interest

Kopf-Hals-Onkologie

Free lecture

Prof. Dr. med.

PD Dr. med.

The submental arterial island flap for reconstruction in oropharyngeal carcinoma

Tumorchirurgie / funktionell rekonstruktive Chirurgie

Das submentale Arterieninseltransplantat in der Rekonstruktion bei Oropharynxkarzinomen – onkologisches und funktionelles Outcome

Introduction: Due to already extended tumor size at the time of first diagnosis, many oropharyngeal carcinomas (OPSCC) undergoing surgical resection require reconstruction. Besides the radial forearm flap, which is the most widely used flap for this indication, several pedicled flaps pose an alternative for reconstruction. In the present study we display early data on functional and oncologic outcomes of patients with OPSCC receiving a reconstruction with a submental arterial island flap. Methods: 10 patients with OPSCC received transoral surgical tumor resection and reconstruction with a pedicled submental arterial island flap. Besides postoperative complications, surgical margins and oncological outcome several functional parameters, like dependency on feeding tube, percentage of oral intake and a phoniatric swallowing examination were investigated. Results: No positive surgical margins resulted in the tumor resection and subsequent reconstruction. Extent of complete time in anesthesia was significantly lower than in comparable patients receiving a radial forearm flap. Loss of flap with need for another surgery occured in 1 patient, while a cervical wound healing disorder was found in another patient due to stiffness of the neck closure. 90% of the patients had complete oral intake prior to adjuvant therapy, and 80% 3 months after radiation. In the short follow-up until now, no recurrence took place in this cohort. Conclusion: The submental arterial island flap is a good alternative for reconstruction of defects after surgery of OPSCC. Due to the reduced surgical time compared to free flaps, it may especially be a good alternative for elderly or frail patients in reducing anesthesia-related complicationsEinleitung: Chirurgisch therapierte Oropharynxkarzinome benötigen in vielen Fällen eine rekonstruktive Defektdeckung. Neben dem hierfür am weitesten verbreiteten Radialistransplantat stehen auch gestielte Transplantate zur Verfügung. In dieser Studie sollen erste Ergebnisse einer Defektrekonstruktion bei Oropharynxkarzinomen mit einem submentalen Arterieninseltransplantat aus onkologischer und funktioneller Sicht dargestellt werden. Methoden: 10 Patienten mit Oropharynxkarzinom erhielten eine transorale Tumorresektion mit gleichzeitiger Defektrekonstruktion durch ein submentales Arterieninseltransplantat. Neben postoperativen Komplikationen, Resektionsstatus und onkologischem Outcome wurden die Abhängigkeit von der PEG und der Grad der oralen Ernährung bewertet. Ergebnisse: In allen Fällen gelang eine R0 Resektion. Die Dauer der Operation war im Gegensatz zu einer vergleichbaren Resektion mit Deckung durch ein Radialistransplantat um etwa 1,5-2 Stunden geringer. Bei einem Patient kam es zu einem Transplantatuntergang, was eine erneute Operation notwendig machte, bei einer Patientin fand sich eine zervikale Wundheilungsstörung aufgrund der Hautspannung nach primärem Verschluss des Hebedefektes. 9 von 10 Patienten konnten sich vor Beginn der adjuvanten Bestrahlung vollständig oral ernähren. 3 Monate nach Abschluss der Bestrahlung war dies bei 80 % der Patienten möglich. Bei aktuell nur kurzem Follow-up von median 6 Monaten traten bis jetzt keine Rezidive auf. Fazit: Das submentale Arterieninseltransplantat stellt eine gute Alternative für die Defektrekonstruktion nach Resektion von Oropharynxkarzinomen dar. Insbesondere für ältere und vorerkrankte Patienten kann die Reduktion der Narkosedauer im Vergleich zu mikrovaskulär-anastomosierten Transplantaten von Vorteil sein.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

PD Dr.

Risk factors for postoperative complications after reconstruction of head and neck defects with free and pedicled flaps

Risikofaktoren für postoperative Komplikationen nach der Rekonstruktion von Kopf- und Halsdefekten mit freien und gestielten Lappen

Introduction: Free and pedicled flap reconstructions of head and neck defects are highly successful. However, postoperative complications are common. The aim of this study is to investigate risk factors associated with complications after flap reconstruction. Methods: Monocentric retrospective study of free and pedicled flap reconstructions between 2019 - 2022. Primary outcome variables were surgical and medical postoperative complications and risk factors. Results: 125 patients underwent free (112), pedicled (13), or free and pedicled (3) flaps (male: 89 (71.2%); female: 36 (28.8%); mean age (range): 66 (37,93) years). Postoperative complications occurred in 29 (23.2%) patients: 23 (18.4%) surgical complications (hematoma, fistula, wound healing disorders, flap loss) and 10 (8%) medical complications (pulmonary embolism, resuscitation, stroke, myocardial infarction, death). The most common complications are hematoma (13; 10.83%), flap loss (6; 4.8%) and pulmonary embolism (5; 4%). Patients with pedicled flaps developed 17% fewer complications compared to free flaps. Several risk factors were identified, including obesity (19; 15.8%), diabetes mellitus (15; 12.5%) and administration of low-molecular-weight heparin at therapeutic doses (87; 71.9%). Peripheral arterial disease (7; 5.6%) is not a risk factor in this cohort. Obesity and low albumin (40; 32%) as a sign of impaired liver function or malnutrition were the strongest risk factors for surgical complications. Discussion/Conclusion: Risks factors for developing postoperative complications after reconstruction of head and neck defects with free or pedicled flaps were identified. Early identification of these risk factors, e. g. by adjusting anticoagulation or supporting liver function, will improve the prognosis.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

International Session 2
Interdisciplinary Plastic and Reconstructive Surgery of HNSCC

Appointment

Chairs

Topics

Language

Programme

International Session 2Interdisciplinary Plastic and Reconstructive Surgery of HNSCC

Appointment

Chairs

Topics

Language

Programme

International Session 2
Interdisciplinary Plastic and Reconstructive Surgery of HNSCC