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To determine factors associated with restarting therapeutic antibiotics within 30 days of head and neck microvascular free tissue transfer (HN-MFTT).Retrospective study of consecutive HN-MFTTs performed from January 2015 to July 2020.Tertiary academic medical center.Thirty-day postoperative antibiotic use and post-HN-MFTT surgical and medical complications were assessed. Univariable analyses and multivariable logistic regression were used to evaluate risk factors associated with restarting antibiotics.overall 482 patients with 501 HN-MFTTs were stratified by duration of prophylaxis: ≤24 hours (n = 136, 27.1%), 25-72 hours (n = 54, 10.8%), and72 hours (n = 311, 62.1%). Antibiotics were restarted in 199 patients (209 procedures, 42%). The most common indications for antibiotic reinitiation were flap recipient site infection (n = 59, 28%); hospital-acquired pneumonia (n = 44, 21%); and wound dehiscence, fluctuance, or change in quality of drain output (n = 44, 21%). Shorter antibiotic prophylaxis (≤24 hours) (odds ratio [OR], 1.95; 95% CI, 1.2-3.0;Aerodigestive reconstruction, 24-hour postoperative antimicrobial prophylaxis, American Society of Anesthesiologists class 3 and 4, prior chemotherapy/immunotherapy, cardiovascular disease, and osteocutaneous flaps are associated with reinitiation of antibiotics within 30 days of HN-MFTT.

Objective Compare the efficiency of remote telehealth flap assessments with traditional in-person flap assessments. Study Design Observational study with retrospective review. Setting Tertiary academic medical center. Subjects and Methods All patients undergoing head and neck free tissue transfer were included in the study. All patients whose surgery was performed at hospital A underwent an in-person flap check overnight. Those at hospital B received a remote flap assessment. The primary outcome was total time spent performing the midnight flap assessment, including travel time. Data were gathered prospectively using an online survey. Results Sixty consecutive patients met inclusion criteria. On the night of the surgery, 31 had an in-person flap check while 29 had a video telehealth flap check. There were no partial or total flap losses or take-backs resulting from the flap checks. Mean (SD) times for in-person and remote assessments were 34 (16) minutes (range, 10-60 minutes) and 13 (8) minutes (range, 5-35 minutes), respectively ( P < .001). House staff unanimously felt the remote telehealth system improved their quality of life without affecting their perception of the quality of the flap assessment ( P = .001). Conclusion Compared with in-person flap assessments in this cohort, telehealth assessments allowed more efficient examination of free tissue reconstructions while yielding seemingly equivalent information. Therefore, remote telehealth flap checks may provide useful information supporting the use of high-fidelity remote data-streaming technology in the delivery of complex care to patients distant from their care provider.

Objective The objective of this study was to assess registration error due to fiducial configuration for the ENT headsets for the CBYON Suite (CBYON, Mountain View, CA) and InstaTrak (GEMS Navigation and Visualization, Waukesha, WI). Study design Axial CT scans (1-mm slice thickness) were obtained of for 24 cadaveric heads using the CBYON headset and for 23 cadaveric heads using the GEMS headset. The CBYON and GEMS NAV software were used to calculate the fiducial registration error (FRE). Fiducial localization error (FLE) was estimated from FRE. Theoretical target registration error (TRE) was calculated at 11 targets. Results The FRE for CBYON and GEMS NAV was 0.69 mm and 0.27 mm, respectively. The theoretical TRE for CBYON and GEMS NAV was 0.41 mm and 0.30 mm, respectively. The theoretical TRE was greater at targets posterior in the sinus cavities. Conclusion Theoretical TRE values for both ENT headsets are less than clinically observed TRE. Clinically observed TRE is likely due to repositioning accuracy. EBM rating: B-2.

Objectives:(1) Describe locoregional and distant disease recurrence patterns among patients undergoing maxillectomy from 2001-2011 at Cleveland Clinic and UCSF Medical Center. (2) Analyze the pattern of recurrence in this cohort in order to evaluate whether microvascular reconstruction may delay clinical detection of early cancer recurrence.Methods:Retrospective review of patients undergoing inferior, subtotal, or total maxillectomy, with or without reconstruction, for control of malignant disease from 2001-2011 from 2 tertiary centers (Cleveland Clinic and University of California, San Francisco).Results:A total of 76 patients across the 2 institutions met the inclusion criteria for the study. Squamous cell carcinoma was the most prevelant pathologic diagnosis with overall disease progression of 29%. Recurrence at the skull base and regional lymphatic spread were the most common patterns identified (18 and 32%, respectively). Surveillance imaging, rather than direct observation on physical examination, r...

Objective: To investigate and characterize a novel tyramine-based hyaluronan/gelatin (THA/G) composite material. First, we demonstrate the ability of THA/G to adhere and maintain respiratory epithelial cells in an in vitro model. Second, we assess the feasibility of THA/G as a biologic cartilage substitute in a rabbit model of tracheal reconstruction.Method: Immortalized human tracheal epithelial cells were grown on various concentrations of THA/G composites in vitro. Cricotracheal resection with replacement by THA/G was performed in 4 New Zealand white rabbits with auricular cartilage as control in 2 animals. Tracheal patency, graft retention, and mucosalization were evaluated via endoscopy, imaging, and histopathology.Results: Epithelial cell growth was demonstrated on THA/G composites in vitro. In the rabbit model, all composites remained intact within the tracheal resection. However, the limited shear strength of the THA/G posed difficulties in securing the construct. At 3 and 6 weeks postimplantation...

Problem: A mouse anti-rat T-cell receptor monoclonal antibody (TCR) has great potential in the development of long-term immunologic tolerance. Combination therapy with FK-506 and TCR may enable the establishment of long-term immunotolerance while reducing dose-related toxicities. The use of combined TCR and FK-506 in a completely allogeneic model permits a rigorous evaluation of potential synergism. Methods: Nineteen Brown Norway larynges were transplanted to Lewis recipients. Treatment consisted of 7 days of FK-506 (1.2 mg/kg/day) alone and in combination with TCR (0.5 mL/day). Control groups consisted of untreated animals, as well as 11 Lewis-Brown Norway larynges transplanted to Lewis recipients and treated with FK-506 monotherapy. Each group consisted of 6–11 rats. Median duration of engraftment was 44 days (range, 14–106 days). Graft histopathology was graded according to an established 31-point scale in a blinded fashion. Long-term grafts (>75 days) were followed with serum PTH levels. Results: Untreated controls experienced almost complete rejection (mean score, 27, SD 0). Allogeneic transplants treated with FK-506 monotherapy experienced near-complete rejection (mean score, 25.2, SD 2.1). Allogeneic transplants treated with combination therapy and followed for a median duration of 100 days demonstrated significantly better rejection scores than controls (mean score, 11.1, SD 1.7; P = 0.003). Combination therapy was also significantly more effective in preventing acute rejection than monotherapy with FK-506 in a semi-allogeneic model (mean score, 22.1, SD 4.6; P < 0.04). Conclusion: Short-term combination therapy with FK-506 and TCR prevents rejection in an allogeneic model for up to 100 days. This regimen was associated with significantly better histopathologic rejection scores than monotherapy with either agent, or monotherapy with FK-506 in a semi-allogeneic model. Significance: The blockade of primary antigen recognition with TCR may prevent the need for daily immunosuppressive therapy, thereby limiting treatment-associated toxicities. Pulsing protocols may also provide a mechanism for intermittent immunomodulation with this regimen. Support: None reported.