Free flap reconstruction in paediatric patients with head and neck cancer: clinical considerations for comprehensive care |
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| Affiliation: | 1. Department of Maxillofacial Surgery, Jiamusi Central Hospital, Heilongjiang, China;2. Department of Oral and Maxillofacial–Head and Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Centre of Stomatology, Shanghai, China;3. Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Huangpu District, Shanghai, China;1. Department of Oral and Maxillofacial Surgery, Dental Research Centre, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;2. Department of Oral and Maxillofacial Pathology, Dental Research Centre, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;3. Department of Oral and Maxillofacial Surgery, Dental School, Shahrekord University of Medical Sciences, Shahrekord, Iran;4. Department of Prosthodontics, Dental School, Isfahan University of Medical Sciences, Isfahan, Iran;1. Division of Plastic and Reconstruction Surgery, Department of Surgery, University of Nebraska Medical Center, 984125, Specialist surgery pavilion - Room 2018, Nebraska Medicine, Omaha, NE 68198-4125, USA;2. Division of OMFS–Head and Neck Surgery, Head and Neck Oncology and Microvascular Reconstructive Surgery, Department of Surgery, University of Nebraska Medical Center, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA;1. Federal State Autonomous Institution “National Medical Research Centre of Children’s Health”, Russian Federation Ministry of Health, Moscow, Russia;2. Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov, First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia;1. Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, Besançon, France;2. Medical Faculty, University of Franche-Comté, Besançon, France;3. University of Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France;4. Hospices Civils de Lyon — Université Claude Bernard Lyon 1, Maxillofacial and Stomatology, Lyon-Sud Hospital Center, Pierre-Benite, France;5. Nanomedicine Lab, Imagery and Therapeutics, EA 4662, Medical Faculty, University of Franche-Comté, Besançon, France;6. Department of Oral and Maxillofacial Surgery, University of Pierre Marie Curie-Paris 6, Pitié-Salpêtrière Hospital, Paris, France;7. Department of Maxillofacial and Plastic Surgery, University Hospital, and UFR Medicine, University of Strasbourg, Strasbourg, France;8. University of Strasbourg, Faculty of Medicine, Strasbourg, France;9. Laboratory of Engineering Science, Computer Science and Imaging, CNRS, ICUBE University of Strasbourg, Strasbourg, France;10. INSERM (French National Institute of Health and Medical Research), ‘Regenerative Nanomedicine’ Laboratory, UMR 1260, Faculty of Medicine, Strasbourg, France |
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| Abstract: | Free flap reconstruction after resection in paediatric patients with head and neck cancer (HNC) has various clinical challenges, which have not yet been fully investigated. This retrospective study was implemented to investigate these factors. Paediatric patients (≤14 years old) who underwent free flap reconstructions following surgery for HNC at a tertiary referral centre during the years 2009–2018 were included. Clinical, pathological, and imaging data were collected and analysed. Overall, 47 patients were included, 26 male and 21 female. Thirty-four patients were ASA status I and 13 were ASA status II. The median operative time was 415 minutes, while the median intraoperative blood loss was 500 ml. Seventeen patients had a tracheotomy. Fourteen medical complications (six pulmonary infection, six diarrhoea, two pulmonary aspiration) and six surgical complications (one haematoma beneath flap, two wound dehiscence, one salivary fistula, one effusion, one tracheotomy haemorrhage) were observed. Tracheotomy was associated with medical complications (P = 0.003) and total complications (P = 0.024). It was confirmed that microvascular reconstruction can be adopted in paediatric HNC patients, while tracheotomy and nasal feeding tubes should be used with caution. Comprehensive preoperative assessment, gentle handling of the tissues during operative procedures, and appropriate postoperative management will reduce the risk of complications. |
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| Keywords: | paediatric patients head and neck cancer free flap reconstruction |
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