Abstract: Postoperative Management after Total Pharyngolaryngectomy Using the Free Ileocolon Flap: A 5-Year Surgical Intensive Care Unit Experience (Plastic Surgery The Meeting)

Sunday, September 25, 2016: 10:30 AM

Oscar J Manrique, MD , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Pedro Ciudad, MD, PhD , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Ketan M Patel, MD , Plastic Surgery, University of Southern California, Los Angeles, CA

Federico Lo Torto, MD , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Mouchammed Agko, MD , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Hsu-Tang Cheng, MD , Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University School of Medicine, Taichung, Taichung City, Taiwan

Hung-Chi Chen, MD, PhD, FACS , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Presentation PDF file

Background and Purpose

Operative management after total pharyngolaryngectomy with free ileocolon flaps can be challenging and complex. Adequate postoperative surgical ICU guidelines are essential in order to avoid postoperative complications. Additional factors such as agitation, hypotension or prolonged mechanical ventilation might compromise final outcomes. The purpose of this study is to describe our long-term experience in the early postoperative care of patients after total pharyngolaryngectomy with immediate reconstruction using free ileocolon flap transfer.

Methods

During 2010 and 2015, all patients who underwent total pharyngolaryngectomy and immediate reconstruction using free Ileocolon flap were analyzed. Etiology of resection, neo-adjuvant therapy, surgical time, method of sedation, postoperative episodes of hypotension (MAP <60 mm Hg) requiring vasopressors, length of ICU stay, time of extubation and complications were recorded.

Results

During this 5-year period, a total of 34 free ileocolon flaps were performed. The most common cause of total pharyngolaryngectomy was cancer. 28 patients had neo-adjuvant therapy. The average surgical time was 11.5 hours (range: 8-14.5 hours). The most common sedatives during surgery and during the ICU period were Midazolam and Dexmedetomidine. The average length of ICU stay was 3 days (2-15 days) with an average time for extubation of 3 days (1-20 days). In terms of complications, 3 patients required vasopressors due to hypotension (MAP<60 mm Hg), 2 had none planned/attempt-self extubation, 2 presented with postoperative bleeding/hematoma, 1 had pneumonia, 4 required unplanned return to the OR, 2 had partial flap loss and 1 had complete flap loss. Univariate analysis showed that factors such as hypotension with vasopressor requirements (p<0.05) and none planned/attempt-self extubation (p<0.04) was associated with unplanned return to the operating room.

Conclusion

Our data suggests that episodes of hypotension and unplanned extubation could lead to irreparable surgical complications. As other free enteric flaps, Ileocolon flap tolerates only a short ischemia time. It also harbors a great amount of bacteria, which would initiate autolysis when the ischemia starts. Therefore, special attention should be given to these patients and rigorous postoperative guidelines are essential in order to minimize complications.

30016 Postoperative Management after Total Pharyngolaryngectomy Using the Free Ileocolon Flap: A 5-Year Surgical Intensive Care Unit Experience