OBJECTIVE: Evaluate the effect of functional status and patient factors on delays in treatment with adjuvant therapy.
METHODS: Retrospective chart review (2020-2022) was conducted at a single tertiary referral center. Data were collected between January 2020 and October 2022, and 63 patients underwent free flap reconstructive surgery of the head and neck due to the presence of cancer and received adjuvant radiation therapy (RT). The main outcomes measured were Area Deprivation Index (ADI), Beale scores, distance to radiation center, functional status, patient demographics, gender, and length from surgery to initiation of RT.
RESULTS: Of the 63 patients who were reviewed, the average age was 65.5 years old and 63.8% were male. The average ADI state score was 5.6 and the national percentile of 77.1. The average Beale score was 3.7. The average distance traveled was 101.1 miles. Thirty-five patients were living independently, 16 were living in assisted living or received home care, and 15 were dependent or lived in a nursing home. Mann-Whitney U analysis revealed a significant association of increasing levels of dependence to delays in treatment compared to on-time treatment (p = 0.002). The odds of treatment delay were increased almost 10-fold for every additional increase in dependency level (OR = 9.87, 95% CI = 1.42-68.83).
CONCLUSIONS: Degree of dependent functional status correlates with delays in postoperative adjuvant RT in patients undergoing free tissue transfer for head and neck cancer. Preoperative risk stratification allows for physicians to address barriers to adjuvant therapy prior to delay.
METHODS: Level 3 Laryngoscope, 2024.

Circular pharyngolaryngectomy for oncologic resection requires a tubular reconstruction. Different options can be proposed to the patient: digestive free flap, fasciocutaneous flap, or musculocutaneous flap. The jejunum free flap is a tubular flap commonly used in esophageal and pharyngeal reconstruction with good functional outcomes and an acceptable rate of complications. Reconstruction with a jejunum free flap is an ideal choice. Patients at Gustave Roussy Institute (Villejuif, France) were offered a jejunum flap free flap for all circular pharyngolaryngectomies. The surgical technique is explained with a step-by-step video. The jejunum flap free flap has many advantages in circular pharyngolaryngectomy. This video article explains surgical steps for other teams.

BACKGROUND: Different factors can affect the quality of life of patients treated for head and neck cancer undergoing major surgical intervention. However, it remains unclear which specific factors and what possible interventions could have the greatest influence on quality of life postoperatively for patients undergoing surgical resection with free flap reconstruction. The objective of our systematic review was to identify which factors, at the time of surgical treatment, are associated with a worse postoperative quality of life for patients undergoing surgical resection with free flap reconstruction for head and neck cancer.
METHODS: We performed a systematic review of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), from their inception through November 2021. We included peer reviewed studies that evaluated the impact of specific factors on quality of life for adult patients who underwent surgery with free flap reconstruction for head and neck cancer. Two reviewers independently screened citations for eligibility and extracted data. Risk of bias of each study was evaluated using the New-Castle Ottawa Scale. Vote counting and qualitative review were used to synthesize results. All relevant findings were reported.
RESULTS: We initially identified 1971 articles. We included 22 articles in our systematic review, totaling 1398 patients. There was a high level of variability for factors evaluated throughout studies and many studies presented small sample sizes. However, some factors were associated with worse long-term quality of life, including older age, radiotherapy, higher tumor stage, dysphagia, anxiety as well as depressive symptoms. Very few articles analyzed their data for specific tumor subsites and the impact of psychosocial factors was rarely evaluated throughout studies.
CONCLUSIONS: For patients with head and neck cancer requiring free flap reconstruction, some specific factors may correlate with changes in quality of life. However, these findings are based on very few and mostly underpowered studies. A better understanding of factors affecting quality of life could allow a more personalized and overall better quality of care for patients.

Hyperspectral imaging (HSI) is a new emerging modality useful for the noncontact assessment of free flap perfusion. This measurement technique relies on the optical properties within the tissue. Since the optical properties of hemoglobin (Hb) and melanin overlap, the results of the perfusion assessment and other tissue-specific parameters are likely to be distorted by the melanin, especially at higher melanin concentrations. Many spectroscopic devices have been shown to struggle with a melanin related bias, which results in a clinical need to improve non-invasive perfusion assessment, especially for a more pigmented population. This study investigated the influence of skin tones on tissue indices measurements using HSI. In addition, other factors that might affect HSI, such as age, body mass index (BMI), sex or smoking habits, were also considered. Therefore, a prospective feasibility study was conducted, including 101 volunteers from whom tissue indices measurements were performed on 16 different body sites. Skin tone classification was performed using the Fitzpatrick skin type classification questionnaire, and the individual typology angle (ITA) acquired from the RGB images was calculated simultaneously with the measurements. Tissue indices provided by the used HSI-device were correlated to the possible influencing factors. The results show that a dark skin tone and, therefore, higher levels of pigmentation influence the HSI-derived tissue indices. In addition, possible physiological factors influencing the HSI-measurements were found. In conclusion, the HSI-based tissue indices can be used for perfusion assessment for people with lighter skin tone levels but show limitations in people with darker skin tones. Furthermore, it could be used for a more individual perfusion assessment if different physiological influencing factors are respected.

Buccal mucosa is one of the common subsite for oral carcinoma. Following excision of the buccal mucosa tumor mass various pedicled and free flaps have been used to reconstruct the oral cavity defect. In this age of free flaps various locoregional pedicled flaps have been underrated and overlooked and supraclavicular flap is one of them. This flap meets the functional and cosmetic acceptance of the buccal mucosa defect reconstruction with minimal morbidity to the donor site. This paper presents author\'s experience of using supraclavicular flap in 10 patients of carcinoma buccal mucosa. In all cases surgical defect was completely covered by the flap, there was no necrosis of the flap. Functional and cosmetic outcome was acceptable in all the patients without compromising oncological clearance.

OBJECTIVE: To compare the postoperative complications of the fibular free flap (FFF), scapula free flap (SFF), and osteocutaneous radial forearm free flap (OCRFFF) following osseous reconstruction in the head and neck.
METHODS: PUBMED, EMBASE, Cochrane.
METHODS: A literature search and systematic review were performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A meta-analysis of proportions was conducted using a random effects model to compare operative time and postoperative complications.
RESULTS: The systematic review identified 26 studies comparing at least 1 variable of interest. The odds ratio estimates favored reduced rates of flap failure with the OCRFFF when compared to FFF (0.7, confidence interval [CI]: 0.29-1.11, P < .001), while FFF and SFF were similar. The mean difference estimates for operative time significantly favored FFF over SFF (-51.04 minutes, CI: -92.73 to -9.35, P = .016) and OCRFFF over FFF (66.77 minutes, CI: 52.74-80.8, P < .001). The FFF was more prone to hardware exposure, longer hospital stays, and donor site complications. Recipient wound complications and fistula rates were similar for all flap types.
CONCLUSIONS: Depending on the clinical context, the OCRFFF, FFF, and SFF are all robust options for reconstruction in the head and neck. The OCRFFF is associated with a reduced rate of flap failure and shorter operative times. The SFF requires longer operative times, although significant variation was observed between institutions. The FFF has broad reconstructive indications but is associated with more perioperative and long-term complications.

Free flaps are considered the gold standard for the reconstruction of various defects. Microvascular anastomosis is a very critical component of free flap surgery determining its success. The workhorse technique of hand suturing for microvascular anastomosis has consistently been used with excellent results. Recently, venous couplers are being increasingly used for performing venous anastomosis. We describe the case of a 14-year-old girl in which heel reconstruction was planned for an unstable scar and chronic osteomyelitis of the calcaneal region with a free latissimus dorsi muscle flap. Arterial anastomosis was done by hand suturing, while venous coupler (GEM coupler, Synovis Micro Companies Alliance) was used for venous anastomosis. Just before wound closure, the venous coupler spontaneously snapped open, resulting in disruption of the device and opening of the anastomosis. After securing hemostasis, the ring of the coupling device was tried to be removed, but it was adhered to the tunica externa due to the interlocking pins. Cutting the veins proximal to the rings would result in shortening of the vein with the requirement of a vein graft. The harvested latissimus dorsi muscle had a single vena comitans which had to be salvaged, so we improvised by everting the vein edges from the interlocking pins and completing the anastomosis by hand after freshening the margins. The interlocking rings were left as such in their place. Postoperative period was uneventful, and the flap survived with good results. Thus, this is a unique case where we report for the first time the disruption of a venous coupling device and subsequent salvage of free flap.

Recalcitrant clavicular nonunion is an uncommon but challenging problem. Vascularized bone reconstruction is not first-line therapy due to complexity and donor morbidity, though it has utility in select cases. A systematic review of Embase and Medline databases was undertaken for cases of medial femoral condyle reconstruction for clavicle nonunion. Ten studies met inclusion, encompassing 26 patients. Mean age was 38.9 years. Ten patients were male and 16 female. Mean time of nonunion was 37.79 months prior to intervention; mean time to union following medial femoral condyle flap was 7.60 months. Two patients did not achieve union. Of the 11 patients who previously had at least one failed fixation with bone graft, considered the current \"gold standard\", 9 patients (81.81%) went on to achieve union, while 2 patients (18.19%) did not. There were six reported complications in five patients. Medial femoral condyle flap is a valuable option in recalcitrant clavicle nonunion.

BACKGROUND: Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population.
METHODS: Retrospective multi-institutional review of FF reconstruction for midface ORN (2005-2022; n = 54).
RESULTS: The FF survival rate was 87% (n = 54). Patients were less likely to be tolerating a regular diet at 3 months postoperative if they had a preoperative history of prior head and surgery (80% vs. 95%; p = 0.02), a pathologic fracture (50% vs. 90%; p = 0.04), exposed bone intraorally (43% vs. 94%; p = 0.002), or a fistula (67% vs. 96%; p = 0.03). Mean albumin was higher in patients whose FF survived (3.6 ± 0.5 vs. 2.7 ± 1.4; p = 0.03). Patients with low prealbumin were more likely to undergo a hematoma evacuation (27% vs. 0%; p = 0.02).
CONCLUSIONS: In this series of midface ORN requiring FF reconstruction preoperative nutritional status impacted postoperative complications. Preoperative occurrence of a fistula, pathologic fracture, and intraoral bone exposure correlated with decreased tolerance of a regular diet following reconstruction.

Open tibia fractures are the most common open long bone injury. Most of these injuries involve a high-energy mechanism. Many standards for management have been created to provide guidance and a baseline for quality. There are several factors that must be considered when determining the timing of coverage for an open fracture with soft tissue compromise. Understanding the available options for soft tissue coverage, including local/rotational flaps and free tissue transfer, will allow for a tailored approach based on the personality of the injury. The aim of this review was to characterize the critical window of treatment based on the current literature and to provide a review of the available soft tissue coverage options.