Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting

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dc.contributor.advisorHudson, Donalden_ZA
dc.contributor.authorDos Passos, Garyen_ZA
dc.date.accessioned2017-01-17T12:16:56Z
dc.date.available2017-01-17T12:16:56Z
dc.date.issued2016en_ZA
dc.description.abstractBackground: Free tissue transfer has become the standard of care for the reconstruction of head and neck oncological defects. The Groote Schuur Hospital provides a microsurgical reconstructive service in a resource-limited setting, without access to venous couplers, invasive monitoring devices, modern microscopes or sophisticated pre-operative imaging. The reconstructive surgeons perform all anastomoses under x4.5 loupe magnification. Methods: A retrospective chart review was undertaken of cases performed by the service over a 3-year period. Demographic factors, indications for flap cover, operative details (flap used, duration and lowest recorded temperature), intensive care and hospital length of stay, and other outcomes were recorded and evaluated (including flap and systemic complications, donor site morbidity, haematomas as well as returns to theatre). Results: Over a 36-month period, 109 flaps for head and neck reconstruction were performed. The main indication for surgery was squamous cell carcinoma of the oral cavity. The mean operating time for resection and reconstruction was 6.02 h (range of 4 to 12 h). Virtually, all reconstructions were performed using one of either radial forearm, free fibula or anterolateral thigh flaps. We report a complete flap loss rate of 6 %. All four successful salvages were undertaken in the early (less than 24 h) post-operative period. Hypothermia intra-operatively appears to correlate very closely with pejorative outcomes. Conclusions: By restricting reconstructive options to three main 'workhorse' flaps and by utilising a simultaneous two-team approach for tumour ablation and flap elevation, success rates comparable to international standards have been achieved. Limited resources should not be regarded as an impassable barrier to providing a successful microvascular head and neck reconstructive service.en_ZA
dc.identifier.apacitationDos Passos, G. (2016). <i>Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Plastic and Reconstructive Surgery. Retrieved from http://hdl.handle.net/11427/22754en_ZA
dc.identifier.chicagocitationDos Passos, Gary. <i>"Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Plastic and Reconstructive Surgery, 2016. http://hdl.handle.net/11427/22754en_ZA
dc.identifier.citationDos Passos, G. 2016. Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Dos Passos, Gary AB - Background: Free tissue transfer has become the standard of care for the reconstruction of head and neck oncological defects. The Groote Schuur Hospital provides a microsurgical reconstructive service in a resource-limited setting, without access to venous couplers, invasive monitoring devices, modern microscopes or sophisticated pre-operative imaging. The reconstructive surgeons perform all anastomoses under x4.5 loupe magnification. Methods: A retrospective chart review was undertaken of cases performed by the service over a 3-year period. Demographic factors, indications for flap cover, operative details (flap used, duration and lowest recorded temperature), intensive care and hospital length of stay, and other outcomes were recorded and evaluated (including flap and systemic complications, donor site morbidity, haematomas as well as returns to theatre). Results: Over a 36-month period, 109 flaps for head and neck reconstruction were performed. The main indication for surgery was squamous cell carcinoma of the oral cavity. The mean operating time for resection and reconstruction was 6.02 h (range of 4 to 12 h). Virtually, all reconstructions were performed using one of either radial forearm, free fibula or anterolateral thigh flaps. We report a complete flap loss rate of 6 %. All four successful salvages were undertaken in the early (less than 24 h) post-operative period. Hypothermia intra-operatively appears to correlate very closely with pejorative outcomes. Conclusions: By restricting reconstructive options to three main 'workhorse' flaps and by utilising a simultaneous two-team approach for tumour ablation and flap elevation, success rates comparable to international standards have been achieved. Limited resources should not be regarded as an impassable barrier to providing a successful microvascular head and neck reconstructive service. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting TI - Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting UR - http://hdl.handle.net/11427/22754 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22754
dc.identifier.vancouvercitationDos Passos G. Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Plastic and Reconstructive Surgery, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/22754en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Plastic and Reconstructive Surgeryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherPlastic and Reconstructive Surgeryen_ZA
dc.titleMicrovascular free tissue transfer for the head and neck reconstructive in a resource-limited settingen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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