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Fundamentals of Success in Microvascular Head and Neck Reconstruction

  • Vijay V. Haribhakti
Chapter

Abstract

The very high success rates for microvascular reconstruction at most major centers today is attributable to numerous factors, which are discussed at length in this chapter by Prof. Matthew Hanasono.

Exhaustive pre-operative evaluation to assess potential risk factors is crucial and includes obtaining a detailed past history that may reveal high risk factors (co-morbidities, smoking, uncontrolled diabetes, extreme old age with severe atherosclerosis, systemic conditions causing hypercoagulability and previous free flap loss), detailed physical examination and careful selection of the best alternative in a given case.

Pre-operative imaging is also essential, not only for optimal excision plans but also assessment of the neck for possible recipients, especially in previously treated, vessel depleted necks.

A very detailed plan is made to ensure tension-free anastomosis and absence of kinks and pressure points over anastomosed vessels.

The use of anti-platelet agents is considered helpful in selected circumstances, and a careful post-operative vigil is maintained in all cases. If microvascular thrombosis is suspected, immediate re-exploration is the only way out, as timing is crucial and the patient must be re-explored before the ‘no reflow’ phenomenon sets in, indicating microcirculatory failure. Salvage is generally successful if early (within the first 48-72 hours) rather than delayed (over five days) following initial surgery.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Vijay V. Haribhakti
    • 1
  1. 1.Department of OncologySir HN Reliance Foundation HospitalMumbaiIndia

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