Application of microvascular coupler in anterolateral thigh flap for repairing postoperative defects after oral malignant tumor surgery

doi:10.19438/j.cjoms.2024.03.011

Abstract

Abstract: PURPOSE: By comparing the difference of vascular anastomosis methods in repairing oral defects after malignant tumors with anterolateral thigh flap, to analyze the effect of microvascular stapler and manual anastomosis on pulmonary infection, and to evaluate the risk factors related to pulmonary infection. METHODS: A retrospective analysis was conducted on 92 patients (42 in the stapler group and 50 in the manual anastomosis group) who underwent mandibular reconstruction with anterolateral thigh flaps in the Department of Oral and Maxillofacial Surgery of Qingdao University Affiliated Hospital from January 2019 to October 2022. A follow-up visit was conducted 12 months after surgery to assess the risk factors for postoperative pulmonary infection. SPSS 22.0 software package was used for data analysis. RESULTS: In microvascular coupler group, single-vein anastomoses were performed in 28 patients, double-vein anastomoses in 11 patients and both arterie and vein anastomoses in 3 patients. Anastomoses were completed successfully using the coupler in 54 out of 56 attempted cases (96.43%), 2 microvascular couplers were abandoned because 1 had arterial spasm and 1 had anastomotic stricture leading to coupler loose during the operation. As expected, no flap failures occurred in these cases, resulting in an overall flap success rate of 100%. Compared with the manual anastomosis group, there was no significant difference in postoperative pulmonary infection rate, but there was a significant decrease trend. In addition, in the stapler group, diabetes and postoperative albumin < 30 g/L were not risk factors for pulmonary infection, but were significantly associated with smoking, age, and ACE-27 score. The use of staplers helped reduce the average length of stay from 11.1 days to 8.9 days. CONCLUSIONS: Reasonable use of vascular coupler has a high flap survival rate and a positive effect on reducing postoperative pulmonary infection and the average length of hospital stay, but more large randomized clinical trials are still needed for further research.

Key words: Mandibular defect reconstruction, Microvascular coupler, Free flap, Pulmonary infection

CLC Number:

R782.05

MENG Yu-xiang, SONG Kai, HE Zong-xuan, WANG Lin, GE Sheng-you, WEI Chen-ke, SHANG Wei. Application of microvascular coupler in anterolateral thigh flap for repairing postoperative defects after oral malignant tumor surgery[J]. China Journal of Oral and Maxillofacial Surgery, 2024, 22(3): 268-273.

References

[1] Gundale AR, Berkovic YJ, Entezami P, et al.Systematic review of microvascular coupling devices for arterial anastomoses in free tissue transfer[J]. Laryngoscope Investig Otolaryngol, 2020, 5(4): 683-688.
[2] Rodi T, Geierlehner A, Mosahebi A, et al.Protocol for a systematic review of venous coupler devices versus hand-sewn anastomosis for microsurgical free flap reconstruction[J]. Syst Rev, 2018, 7(1): 186-190.
[3] Wang Y, Zhou B, Chen WL, et al.Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma[J]. Head Face Med, 2022,18(1): 39-47.
[4] Mickelson MA, Hardie RJ, Hespel AM, et al.Evaluation of a microvascular anastomotic coupler for end-to-side arterial and venous anastomosis for feline renal transplantation[J]. Vet Surg, 2021, 50(1): 213-222.
[5] Jaloux C, Bertrand B, Mayoly A, et al.Microvascular anastomotic coupler: an unexpected adverse event[J]. J Reconstr Microsurg, 2019, 35(1): e1-e2.
[6] Adam D, Broderick D, Kyzas P, et al.Microvascular anastomotic coupler devices versus hand-sewn technique for arterial anastomosis: a systematic review[J]. Br J Oral Maxillofac Surg, 2021, 59(5): 524-533.
[7] Li MM, Tamaki A, Seim NB, et al.Utilization of microvascular couplers in salvage arterial anastomosis in head and neck free flap surgery: case series and literature review[J]. Head Neck, 2020, 42(8): E1-E7.
[8] 林轶. 血管化游离皮瓣风险因素的回顾性研究及其分析体系的建立[D].杭州: 浙江大学, 2019.
Lin Y.Retrospective study on risk factors of vascularized free flap and establishment of analysis system[D]. Hangzhou: Zhejiang University, 2019.
[9] Arora R, Mishra KS, Bhoye HT, et al.Mechanical anastomotic coupling device versus hand-sewn venous anastomosis in head and neck reconstruction-an analysis of 1 694 venous anastomoses[J]. Indian J Plast Surg, 2021, 54(2): 118-123.
[10] Head LK, McKay DR. Economic comparison of hand-sutured and coupler-assisted microvascular anastomoses[J]. J Reconstr Microsurg, 2018, 34(1): 71-76.
[11] Pai K, Baaklini C, Cabrera CI, et al.The utility of comorbidity indices in assessing head and neck surgery outcomes: a systematic review[J]. Laryngoscope, 2022, 132(7): 1388-1402.
[12] Jan WL, Chen HC, Chang CC, et al.Modified clavien-dindo classification and outcome prediction in free flap reconstruction among patients with head and neck cancer[J]. J Clin Med, 2020, 9(11): 3370-3380.
[13] Wei R, Dong W, Shen H, et al.Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer[J]. Sci Rep, 2016, 6: 23636.
[14] 王尘帅. 口腔颌面部恶性肿瘤患者术后肺部感染的危险因素分析[J].医学理论与实践, 2021, 34(12): 2005-2008.
Wang CS.Analysis of risk factors for postoperative pulmonary infection in patients with oral and maxillofacial malignant tumors[J]. The Journal of Medical Theory and Practice, 2021, 34(12): 2005-2008.
[15] Larsen T, Lee A, Brooks D, et al.Effect of early mobility as a physiotherapy treatment for pneumonia: a systematic review and meta-analysis[J]. Physiother Can, 2019, 71(1): 82-89.
[16] Ishikawa S, Yamamori I, Takamori S, et al.Evaluation of effects of perioperative oral care intervention on hospitalization stay and postoperative infection in patients undergoing lung cancer intervention[J]. Support Care Cancer, 2021, 29(1): 135-143.
[17] Ji X, Cui W, Zhang B, et al.Effect of lung protective ventilation on perioperative pulmonary infection in elderly patients with mild to moderate COPD under general anesthesia[J]. J Infect Public Health, 2020, 13(2): 281-286.
[18] Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al.Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS^®) Society and the European Society of Thoracic Surgeons (ESTS)[J]. Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
[19] Wiedermann CJ.Hypoalbuminemia as surrogate and culprit of infections[J]. Int J Mol Sci, 2021, 22(9): 4496-4520.
[20] Thompson WR, Burns A, Endersby S, et al.Microvascular coupling devices: neglected resource with a short learning curve[J]. Br J Oral Maxillofac Surg, 2017, 55(4): 410-412.