OBJECTIVE: Although functional and esthetic results after the use of a scapular tip free flap (STFF) in head and neck reconstruction, and the related donor-site morbidity, have been extensively described, data regarding acute postoperative donor-site pain management are lacking. Purpose of this study is to explore the use of mini-catheters to administer local anesthetics for donor-site pain management after reconstruction using STFF.
METHODS: Patients who underwent head and neck reconstruction using a STFF were prospectively enrolled and, through a perineural catheter placed in the donor site during the surgical procedure, a bolus of chirochaine was injected before the patient regained consciousness and at 8, 16, and 24 h postoperatively. Before and 40 min after each dose administration, donor-site pain on a numerical rating scale (NRS; 0-10) was evaluated.
RESULTS: Study population consisted of 20 patients (40-88 years). At 8 h, the pain scores before and after the injection were 0-10 (mean 3.35) and 0-5 (mean 1.25), respectively. At 16 h, the pain scores before and after the injection were 0-8 (mean 2.55) and 0-4 (mean 0.55), respectively. At 24 h, the pain scores before and after the injection were 0-8 (mean 1.30) and 0-4 (mean 0.30), respectively.
CONCLUSIONS: Statistical analysis confirmed a significant difference between the pain scores before and after administration at 8, 16, and 24 h (p < 0.001, p < 0.001, and p = 0.003, respectively). Mini-catheters for local anesthetic administration represent an effective strategy for pain control after STFF harvesting for head and neck reconstruction.

La sutura barbed nella ricostruzione del cavo orale: risultati preliminari.
UNASSIGNED: Il presente studio ha lo scopo di analizzare le potenzialità e la sicurezza della sutura unidirezionale barbed (V-Loc) rispetto alla sutura convenzionale monofilamento (vicryl) nella chirurgia ricostruttiva del cavo orale con lembo libero. Sono stati valutati i seguenti parametri: percentuale di complicanze, tempi intra-operatori, tempi di ospedalizzazione e costi della procedura. La coorte di studio (gruppo A), costituita da 20 pazienti consecutivi in cui è stata utilizzata la sutura barbed per suturare il lembo libero alla mucosa del cavo orale, è stata confrontata con la coorte di controllo (gruppo B), costituita da 20 pazienti consecutivi, in cui è stata invece utilizzata la sutura convenzionale Vycril. Tutti i pazienti, affetti da carcinoma squamocellulare della lingua, sono stati sottoposti a chirurgia compartimentale della lingua e successiva ricostruzione con lembo libero radiale di avambraccio o antero-laterale di coscia. La nostra analisi dimostra l’efficacia della sutura barbed se confrontata con quella convenzionale, in termini di minore percentuale di complicanze post-operatorie (15% gruppo A, 30% gruppo B), tempi intraoperatori di chiusura (486 minuti gruppo A, 517 minuti gruppo B), e tempi di ospedalizzazione (tempo medio di ospedalizzazione: 14,60 giorni gruppo A, 16,85 gruppo B). Questi fattori, associati al minor numero di fili barbed utilizzati durante la sutura, potrebbero compensare il costo maggiore della sutura barbed rispetto a quella convenzionale. In conclusione, questo studio dimostra che l’utilizzo della sutura unidirezionale barbed nella sutura del lembo libero alla mucosa del cavo orale riduce la percentuale di complicanze post-operatorie, principalmente in termini di deiscenza e fistola, i tempi intra-operatori e la durata dell’ospedalizzazione. Basandosi su questi risultati e sulla letteratura, si può concludere che l’utilizzo della sutura barbed rappresenta un’alternativa sicura ed efficace rispetto alla sutura convenzionale nella chirurgia ricostruttiva del cavo orale.
The purpose of this study is to evaluate the efficacy and safety of unidirectional barbed suture (V-Loc) compared to a standard monofilament stitch (Vicryl) in suturing of a free flap to local tissue after head and neck surgery for squamous cell carcinoma of the oral cavity. Complication rates, operative closure time, length of hospitalisation and costs were evaluated. The study cohort (group A) of 20 consecutive patients reconstructed using barbed stitches for suturing was prospectively compared to a control cohort (group B) of 20 consecutive patients reconstructed using conventional vicryl stitches. All patients were affected by squamous cell carcinoma of the tongue and underwent different types of glossectomy and reconstruction with free flaps. This analysis demonstrates the efficacy of the barbed suture compared with a standard monofilament stitch in terms of lower complication rate (15% group A, 30% group B), intra-operative closure times (486 minutes group A, 517 minutes group B), and length of hospitalisation (average length of hospitalisation 14.60 days group A, 16.85 days group B). These factors coupled with the use of a lower number of stitches compared with the standard stitches may compensate the increased cost of the barbed suture. In conclusion, this study demonstrates that the use of unidirectional barbed stitches for suturing of a free flap to the recipient site reduces the complication rate, principally in terms of dehiscence and fistula incidence, and reduces intra-operative time and length of hospitalisation. Based on these results and on the literature, the use of unidirectional barbed stitches can be considered as a safe and efficient alternative to conventional stitches for suturing of free flaps to local tissue.