Consideration in Microvascular Reconstruction during Times of Social Crises: Perspectives on Resource Utilization

Abstract

Reconstruction of head and neck surgical defects can be a complicated, costly process. While the era of cost-effective medicine has begun to broadly question the necessity of high-cost care, times of extraordinary sociomedical demand bring increased scrutiny to even routine costs and resource utilization. Within this context, we reviewed the advantages, drawbacks, and financial costs of both regional and free flap reconstructions, namely the decreased costs and hospital resource utilization that may be associated with reconstruction using regional flaps. Although beset by reports of partial necrosis in certain regional flaps—particularly the submental island, cervicofacial advancement, and supraclavicular artery island flaps—many reports have demonstrated complication and flap failure rates equivalent to those of free flaps. Additionally, regional flaps have been associated with decreased costs for hospital stay, most notably in cases of postoperative complications. In cases necessitating free flap reconstruction, cost-savings strategies such as bypassing postoperative intensive care unit admissions have been shown to provide satisfactory, safe outcomes. As the head and neck surgeon continues to adapt to the medical pressures of a global pandemic, resource-sparing approaches to oncologic care will persist in their newfound importance.

Keywords

microvascular - free flap - head and neck - pandemic

Publikationsverlauf

Artikel online veröffentlicht:
24. Dezember 2020

• References

• 1 Jørgensen MG, Tabatabaeifar S, Toyserkani NM, Sørensen JA. Submental island flap versus free flap reconstruction for complex head and neck defects. Otolaryngol Head Neck Surg 2019; 161 (06) 946-953
• 2 Aslam-Pervez N, Caldroney SJ, Isaiah A, Lubek JE. A retrospective volume matched analysis of the submental artery island pedicled flap as compared to the forearm free flap: is it a good alternative choice for the reconstruction of defects of the oral cavity and oropharynx?. J Oral Maxillofac Surg 2018; 76 (03) 656-663
• 3 Paydarfar JA, Patel UA. Submental island pedicled flap vs radial forearm free flap for oral reconstruction: comparison of outcomes. Arch Otolaryngol Head Neck Surg 2011; 137 (01) 82-87
• 4 Howard BE, Nagel TH, Barrs DM, Donald CB, Hayden RE. Reconstruction of lateral skull base defects: a comparison of the submental flap to free and regional flaps. Otolaryngol Head Neck Surg 2016; 154 (06) 1014-1018
• 5 Patel AV, Thuener JE, Clancy K, Ascha M, Manzoor NF, Zender CA. Submental artery island flap versus free flap reconstruction of lateral facial soft tissue and parotidectomy defects: comparison of outcomes and patient factors. Oral Oncol 2018; 78: 194-199
• 6 Howard BE, Nagel TH, Donald CB, Hinni ML, Hayden RE. Oncologic safety of the submental flap for reconstruction in oral cavity malignancies. Otolaryngol Head Neck Surg 2014; 150 (04) 558-562
• 7 Elzahaby IA, Roshdy S, Shahatto F, Hussein O. The adequacy of lymph node harvest in concomitant neck block dissection and submental island flap reconstruction for oral squamous cell carcinoma; a case series from a single Egyptian institution. BMC Oral Health 2015; 15: 80
• 8 Amin AA, Sakkary MA, Khalil AA, Rifaat MA, Zayed SB. The submental flap for oral cavity reconstruction: extended indications and technical refinements. Head Neck Oncol 2011; 3: 51
• 9 Richmon JD, Yarlagadda BB, Wax MK, Patel U, Diaz J, Lin DT. Locoregional and free flap reconstruction of the lateral skull base. Head Neck 2015; 37 (09) 1387-1391
• 10 McLean JN, Carlson GW, Losken A. The pectoralis major myocutaneous flap revisited: a reliable technique for head and neck reconstruction. Ann Plast Surg 2010; 64 (05) 570-573
• 11 Resto VA, McKenna MJ, Deschler DG. Pectoralis major flap in composite lateral skull base defect reconstruction. Arch Otolaryngol Head Neck Surg 2007; 133 (05) 490-494
• 12 Spoerl S, Schoedel S, Spanier G. et al. A decade of reconstructive surgery: outcome and perspectives of free tissue transfer in the head and neck. Experience of a single center institution. Oral Maxillofac Surg 2020; 24 (02) 173-179
• 13 Lynch JR, Hansen JE, Chaffoo R, Seyfer AE. The lower trapezius musculocutaneous flap revisited: versatile coverage for complicated wounds to the posterior cervical and occipital regions based on the deep branch of the transverse cervical artery. Plast Reconstr Surg 2002; 109 (02) 444-450
• 14 Seyfer AE. The lower trapezius flap for recalcitrant wounds of the posterior skull and spine. Ann Plast Surg 1988; 20 (05) 414-418
• 15 Seyfer AE, Joseph AS. Use of trapezius muscle for closure of complicated upper spinal defects. Neurosurgery 1984; 14 (03) 341-345
• 16 Cole I. The lower trapezius island myocutaneous flap for reconstruction of soft tissue of the lateral skullbase and neck. Aust N Z J Surg 1997; 67 (07) 452-456
• 17 Naalla R, Murthy V, Chauhan S, Chinta K, Singhal M. Revisiting the trapezius flap as a reconstructive option for cervico-occipital and thoracic spine regions. Indian J Plast Surg 2019; 52 (03) 322-323
• 18 Juri J, Juri C. Advancement and rotation of a large cervicofacial flap for cheek repairs. Plast Reconstr Surg 1979; 64 (05) 692-696
• 19 Sakellariou A, Salama A. The use of cervicofacial flap in maxillofacial reconstruction. Oral Maxillofac Surg Clin North Am 2014; 26 (03) 389-400
• 20 Jacono AA, Rousso JJ, Lavin TJ. Comparing rates of distal edge necrosis in deep-plane vs subcutaneous cervicofacial rotation-advancement flaps for facial cutaneous Mohs defects. JAMA Facial Plast Surg 2014; 16 (01) 31-35
• 21 Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99 (07) 1878-1884 , discussion 1885–1886
• 22 Sukato DC, Timashpolsky A, Ferzli G, Rosenfeld RM, Gordin EA. Systematic review of supraclavicular artery island flap vs free flap in head and neck reconstruction. Otolaryngol Head Neck Surg 2019; 160 (02) 215-222
• 23 Chiu ES, Liu PH, Friedlander PL. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg 2009; 124 (01) 115-123
• 24 Kokot N, Mazhar K, Reder LS, Peng GL, Sinha UK. Use of the supraclavicular artery island flap for reconstruction of cervicofacial defects. Otolaryngol Head Neck Surg 2014; 150 (02) 222-228
• 25 Gao LL, Basta M, Kanchwala SK, Serletti JM, Low DW, Wu LC. Cost-effectiveness of microsurgical reconstruction for head and neck defects after oncologic resection. Head Neck 2017; 39 (03) 541-547
• 26 Kozin ED, Sethi RK, Herr M. et al. Comparison of perioperative outcomes between the supraclavicular artery island flap and fasciocutaneous free flap. Otolaryngol Head Neck Surg 2016; 154 (01) 66-72
• 27 Spiegel JH, Polat JK. Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 2007; 117 (03) 485-490
• 28 Chang CS, Chu MW, Nelson JA. et al. Complications and cost analysis of intraoperative arterial complications in head and neck free flap reconstruction. J Reconstr Microsurg 2017; 33 (05) 318-327
• 29 Panwar A, Smith R, Lydiatt D. et al. Vascularized tissue transfer in head and neck surgery: is intensive care unit-based management necessary?. Laryngoscope 2016; 126 (01) 73-79
• 30 Riva G, Pizzo C, Fassone E, Pecorari G. Head and neck cancer surgery in COVID-19 pandemic in Northern Italy. Oral Oncol 2020; 107: 104835
• 31 Ralli M, Minni A, Candelori F, Cialente F, Greco A, de Vincentiis M. Effects of COVID-19 pandemic on otolaryngology surgery in Italy: the experience of our university hospital. Otolaryngol Head Neck Surg 2020; 163 (01) 86-88
• 32 Wu V, Noel CW, Forner D. et al. Considerations for head and neck oncology practices during the coronavirus disease 2019 (COVID-19) pandemic: Wuhan and Toronto experience. Head Neck 2020; 42 (06) 1202-1208
• 33 Mehanna H, Hardman JC, Shenson JA. et al. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. Lancet Oncol 2020; 21 (07) e350-e359
• 34 Wosik J, Fudim M, Cameron B. et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc 2020; 27 (06) 957-962
• 35 Yu PK, Sethi RKV, Rathi V. et al. Postoperative care in an intermediate-level medical unit after head and neck microvascular free flap reconstruction. Laryngoscope Investig Otolaryngol 2018; 4 (01) 39-42