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Late-Breaking Scientific Oral Presentations

Head and Neck Surgery

Session: Late-Breaking Scientific Orals: Head and Neck Surgery

Lower Extremity Assessment for Head and Neck Reconstruction: A Scoping Review and American Head and Neck Society Member Survey

Sunday, September 29, 2024

4:12 PM – 4:18 PM EDT

Location: MBCC, 222

Disclosure(s):

David Z. Allen, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Aatin K. Dhanda, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Microvascular free flaps are increasingly utilized in the reconstructive toolbox for head and neck oncology. Fibula free flaps (FFF) can lead to significant donor site morbidity for which no preoperative screening guidelines currently exist. The study described herein depicts the current literature and practice patterns of head and neck surgeons for the evaluation of lower extremity donor sites for microvascular free flap reconstruction, the first study of its kind.

Methods: An electronic survey of AHNS members was performed in July 2023. Surgeon data were assessed along with patterns for preoperative donor site assessments. A scoping review was also conducted in September 2023 using the PubMed and Medline databases. Studies were included if they discussed an imaging or other assessment modality for the preoperative assessment of donor sites for FFF.

Results: There were a total of 118 surgeons surveyed. Most surgeons were fellowship trained (91%) and the majority of responders utilized computed tomography angiography (CTA) followed by duplex ultrasound (11%) when assessing lower extremity anatomy. Peripheral vascular disease (70%) and venous insufficiency (57%) were found to be the most common relative contraindications. Surgeons more often used virtual surgical planning (VSP) in the setting of prior radiation (15% vs, 0%; p < 0.0001) and a prior head and neck free flap (21.5% vs 0%; p < 0.0001). Surgeons with more than 300 total free flaps were less likely to utilize CTA (79% vs 96%, p = 0.01) and were more likely to utilize magnetic resonance angiography (MRA; 24% vs 1.2%, p < 0.0001). The scoping review included 10 articles included within the analysis, of which 70% were retrospective chart reviews. CTA and MRA were described as the main preoperative evaluation in four studies. No trends were noted through literature review.

Conclusions: Evidence for specific imaging modalities and current practice patterns demonstrate heterogeneity in the preoperative evaluation of free flap donor sites. A need exists for evidence-based guidelines to ensure the health of donor sites and viability of the free flap.

Presenting Author(s)

DA

David Z. Allen, MD

Resident
Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center in Houston
Houston, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Daniel Gorelik, MD, MPH

Resident Physician
Department of Otolaryngology - Head and Neck Surgery / Houston Methodist Hospital
Houston, TX, United States

Disclosure information not submitted.
AD

Aatin K. Dhanda, MD

Resident
Department of Otolaryngology - Head and Neck Surgery / Houston Methodist Hospital
Houston, Texas, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Laura M. Kim, MD, MSc

Assistant professor
Department of Otolaryngology - Head and Neck Surgery / Houston Methodist Hospital
Houston, Texas, United States

Disclosure information not submitted.

Senior Author(s)

Joshua J. Kain, MD

Head and Neck Surgeon
The Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
Charlotte, NC, United States

Disclosure information not submitted.