Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos
ilustraciones, fotografías, graficas
- Autores:
-
Espinel Pinzón, Daniel Alejandro
- Tipo de recurso:
- Fecha de publicación:
- 2023
- Institución:
- Universidad Nacional de Colombia
- Repositorio:
- Universidad Nacional de Colombia
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unal.edu.co:unal/83392
- Palabra clave:
- 610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología
Colgajo Perforante
Necrosis
Simpatectomía
Perforator Flap
Sympathectomy
Colgajo keystone
Colgajos de perforantes
Simpatectomía quirúrgica
Angiotoma
Cirugía reconstructiva
Keystone flap
Perforator flaps
Surgical sympathectomy
Angiotome
Reconstructive surgery
- Rights
- openAccess
- License
- Reconocimiento 4.0 Internacional
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| dc.title.spa.fl_str_mv |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos |
| dc.title.translated.eng.fl_str_mv |
Ubiquitous nanoperforator aleatoric loco-regional (UNAL) flaps: case series |
| title |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos |
| spellingShingle |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos 610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología Colgajo Perforante Necrosis Simpatectomía Perforator Flap Sympathectomy Colgajo keystone Colgajos de perforantes Simpatectomía quirúrgica Angiotoma Cirugía reconstructiva Keystone flap Perforator flaps Surgical sympathectomy Angiotome Reconstructive surgery |
| title_short |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos |
| title_full |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos |
| title_fullStr |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos |
| title_full_unstemmed |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos |
| title_sort |
Colgajos de nanoperforantes ubicuas de localización aleatoria: serie de casos |
| dc.creator.fl_str_mv |
Espinel Pinzón, Daniel Alejandro |
| dc.contributor.advisor.none.fl_str_mv |
Gómez Díaz, Oswaldo Javier |
| dc.contributor.author.none.fl_str_mv |
Espinel Pinzón, Daniel Alejandro |
| dc.contributor.researchgroup.spa.fl_str_mv |
Plasticun |
| dc.contributor.orcid.spa.fl_str_mv |
Espinel Pinzon, Daniel [0000000341823057] |
| dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología |
| topic |
610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología Colgajo Perforante Necrosis Simpatectomía Perforator Flap Sympathectomy Colgajo keystone Colgajos de perforantes Simpatectomía quirúrgica Angiotoma Cirugía reconstructiva Keystone flap Perforator flaps Surgical sympathectomy Angiotome Reconstructive surgery |
| dc.subject.other.spa.fl_str_mv |
Colgajo Perforante Necrosis Simpatectomía |
| dc.subject.other.eng.fl_str_mv |
Perforator Flap Sympathectomy |
| dc.subject.proposal.spa.fl_str_mv |
Colgajo keystone Colgajos de perforantes Simpatectomía quirúrgica Angiotoma Cirugía reconstructiva |
| dc.subject.proposal.eng.fl_str_mv |
Keystone flap Perforator flaps Surgical sympathectomy Angiotome Reconstructive surgery |
| description |
ilustraciones, fotografías, graficas |
| publishDate |
2023 |
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2023-02-08T20:52:10Z |
| dc.date.available.none.fl_str_mv |
2023-02-08T20:52:10Z |
| dc.date.issued.none.fl_str_mv |
2023-02-07 |
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Trabajo de grado - Especialidad Médica |
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info:eu-repo/semantics/masterThesis |
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info:eu-repo/semantics/acceptedVersion |
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Text |
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http://purl.org/redcol/resource_type/TM |
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acceptedVersion |
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https://repositorio.unal.edu.co/handle/unal/83392 |
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Universidad Nacional de Colombia |
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Repositorio Institucional Universidad Nacional de Colombia |
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https://repositorio.unal.edu.co/ |
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https://repositorio.unal.edu.co/handle/unal/83392 https://repositorio.unal.edu.co/ |
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Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia |
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spa |
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spa |
| dc.relation.references.spa.fl_str_mv |
1. Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg. 2011 Jan;127 Suppl 1:205S-212S. 2. Gottlieb LJ, Krieger LM. From the reconstructive ladder to the reconstructive elevator. Plast Reconstr Surg. 1994;93:1503– 1504. 3. Gillies HD, Millard DR. The principles and art of plastic surgery. Boston: Little and Brown; 1957. 4. McGregor IA, Jackson IT. The groin flap. Br J Plast Surg. 1972;25:3–16. 5. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: Experimental study and clinical applications. Br J Plast Surg. 1987;40:113–141. 6. Koshima I, Soeda S. Inferior epigastric artery skin flap without rectus abdominis muscle. Br J Plast Surg. 1989;42:645–648. 7. Orticochea M. The musculo-cutaneous flap method: An immediate and heroic substitute for the method of delay. Br J Plast Surg. 1972;25:106–110. 8. Rubino C, Coscia V, Cavazzuti AM, et al. Haemodynamic enhancement in perforator flaps: The inversion phenomenon and its clinical significance. A study of the relation of blood velocity and flow between pedicle and perforator vessels in perforator flaps. J Plast Reconstr Aesthet Surg. 2006; 59:636–643. 9. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg. 2004;114:910–916. 10. Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e419-e426. 11. Aho JM, Laungani AT, Herbig KS, Wong C, Kirchoff RW, Saint-Cyr M. Lumbar and thoracic perforators: vascular anatomy and clinical implications. Plast Reconstr Surg. 2014 Oct;134(4):635e-645e. 12. Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg. 2009 Apr;123(4):132e-145e. 13. Yamamoto T, Yamamoto N, Kageyama T, et al. Definition of perforator flap: what does a "perforator" perforate?. Glob Health Med. 2019;1(2):114-116. doi:10.35772/ghm.2019.01009 14. Mohan AT, Sur YJ, Zhu L, Morsy M, Wu PS, Moran SL, Mardini S, Saint-Cyr M. The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction. Plast Reconstr Surg. 2016 Oct;138(4):710e-729e. 15. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg. 2003;73:112–120. 16. Behan F, Wilson I. The principle of the angiotome, a system of linked axial pattern flaps. Paper presented at the Sixth International Congress of Plastic and Reconstructive Surgery; 1975; Paris. 17. Milton SH. Experimental studies on island flaps 1. The surviving length. Plast. Reconstr. Surg. 1971; 48: 574–8. 18. Mešić H, Kirkebøen KA, Bains R. The importance of a skin bridge in peripheral tissue perfusion in perforator flaps. Plast Reconstr Surg. 2012 Mar;129(3):428e-434e 19. Behan FC. The fasciocutaneous island flap: an extension of the angiotome concept. Aust N Z J Surg. 1992 Nov;62(11):874-86. 20. HYNES W. The blood-vessels in skin tubes and flaps. Br J Plast Surg. 1950 Oct;3(3):165-75. 21. Finseth F, Cutting C. An experimental neurovascular island skin flap for the study of the delay phenomenon. Plast Reconstr Surg. 1978 Mar;61(3):412-20. 22. Siemionow M, Andreasen T, Chick L, Lister G. Effect of muscle flap denervation on flow hemodynamics: a new model for chronic in vivo studies. Microsurgery. 1994;15(12):891-4. 23. Banbury J, Siemionow M, Porvasnik S, Petras S, Zins JE. Muscle flaps' triphasic microcirculatory response to sympathectomy and denervation. Plast Reconstr Surg. 1999 Sep;104(3):730-7. 24. Lecoq JP, Joris JL, Nelissen XP, Lamy ML, Heymans OY. Effect of adrenergic stimulation on cutaneous microcirculation immediately after surgical adventitiectomy in a rat skin flap model. Microsurgery. 2008;28(6):480-6. 25. Karayel H, Kaya B, Caydere M, Terzioğlu A, Aslan G. Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study. Plast Surg (Oakv). 2015 Fall;23(3):177-82. 26. Behan FC, Lo CH. Vascular dynamics of the keystone island flap: ongoing observations similar to sympathectomy. ANZ J Surg. 2009 Nov;79(11):861. 27. Coventry BJ, Walsh JA. Cutaneous innervation in man before and after lumbar sympathectomy: evidence for interruption of both sensory and vasomotor nerve fibres. ANZ J Surg. 2003 Jan-Feb;73(1-2):14-8. 28. van Dielen FM, Kurvers HA, Dammers R, oude Egbrink MG, Slaaf DW, Tordoir JH, Kitslaar PJ. Effects of surgical sympathectomy on skin blood flow in a rat model of chronic limb ischemia. World J Surg. 1998 Aug;22(8):807-11. 29. Gómez OJ, Barón OI, Peñarredonda ML. Keystone Flap: Overcoming Paradigms. Plast Reconstr Surg Glob Open. 2019;7(3):e2126. 30. Gómez OG, Barón OI, Peñarredondo ML, Flórez SA. Colgajos tipo Keystone: cobertura estable con ahorro cutáneo. Rev Col Cirugía Plástica. 2018;24(1):18-26. 31. Riccio CA, Chang J, Henderson JT, Hassouba M, Ashfaq F, Kostopoulos E, Konofaos P. Keystone Flaps: Physiology, Types, and Clinical Applications. Ann Plast Surg. 2019 Aug;83(2):226-231. 32. Fang S, Li Y, Tang W, Zhu W, Zhuang W, Xing X, Yang C. The use of modified keystone flap in periarticular or large superficial tumor resection surgery. J Surg Oncol. 2020 Jun;121(7):1090-1096 33. Eskander A, Kang S, Tweel B, Sitapara J, Old M, Ozer E, Agrawal A, Carrau R, Rocco JW, Teknos TN. Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures. Otolaryngol Head Neck Surg. 2018 May;158(5):839-847. 34. Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg. 1990 Oct;160(4):352-5. 35. Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, Blackwell KE. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 2004 Aug;130(8):962-6. 36. Li D, Wang C, Wei W, Li B, Liu H, Cheng A, Niu Q, Han Z, Feng Z. Postoperative Complications of Free Flap Reconstruction in Moderate-Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study Based on Real-World Data. Front Oncol. 2022 Jun 24;12:792462. 37. Qian Y, Li G, Zang H, Cao S, Liu Y, Yang K, Mu L. A Systematic Review and Meta-analysis of Free-style Flaps: Risk Analysis of Complications. Plast Reconstr Surg Glob Open. 2018 Feb 8;6(2):e1651. 38. Brady JS, Desai SV, Crippen MM, Eloy JA, Gubenko Y, Baredes S, Park RCW. Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck. JAMA Facial Plast Surg. 2018 May 1;20(3):188-195. 39. Irawati N, Every J, Dawson R, Leinkram D, Elliott M, Ch'ng S, Low H, Palme CE, Clark J, Wykes J. Effect of operative time on complications associated with free flap reconstruction of the head and neck. Clin Otolaryngol. 2022 Nov 2. |
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Universidad Nacional de Colombia |
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Bogotá - Medicina - Especialidad en Cirugía Plástica |
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Facultad de Medicina |
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Bogotá, Colombia |
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Reconocimiento 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Gómez Díaz, Oswaldo Javierbcef53998fceadc06c3cbe77da3a285dEspinel Pinzón, Daniel Alejandro4c3826e2b0fc15f37bf538ab875b55fbPlasticunEspinel Pinzon, Daniel [0000000341823057]2023-02-08T20:52:10Z2023-02-08T20:52:10Z2023-02-07https://repositorio.unal.edu.co/handle/unal/83392Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, fotografías, graficasContexto: Los colgajos Keystone son colgajos de perforantes en isla fundamentados en el concepto vascular de angiotoma. Mediante la introducción de modificaciones que incluyen la introducción de los conceptos de área pedicular y diseño libre, se presenta el concepto de colgajos de nanoperforantes ubicuas de localización aleatoria, siendo colgajos en isla pediculados a partir de áreas pequeñas de localización aleatoria en cualquier región anatómica, vascularmente seguros, con arcos de movilidad amplios, y técnicamente sencillos. Métodos: Se presenta el concepto de colgajos de nanoperforantes ubicuas de localización aleatoria a través de una serie de casos retrospectiva de 150 pacientes, sin restricción de edad, ni localización anatómica, tratados entre 2012 y 2021. Se realiza una descripción de la técnica quirúrgica y se evalúan perfil demográfico, presentación clínica, características de los colgajos, procedimientos adicionales y desenlaces posoperatorios. Resultados: Se realizaron 211 colgajos en 184 defectos. Las etiologías más comunes de los defectos fueron tumores (30,4%) y trauma (23,3%). La mayoría de los colgajos se realizaron en cabeza y cuello (31%) y miembro inferior (30,4%). El área pedicular promedio de los colgajos fue de 33%, y el 82% de los colgajos fueron entre 1 y 2 veces el tamaño del defecto. Los movimientos más frecuentes fueron los tipos 1A y 4. El 35% de los colgajos presentó alguna complicación, las más frecuentes fueron las dehiscencias (18,5%), necrosis parcial o total (10,9%) y trastornos de cicatrización (6,6%). Hubo necrosis completa en 1,9% de los colgajos. Sólo 27% de las complicaciones requirieron reintervenciones, las más frecuentes consistieron en desbridamientos (28%) y avance de los colgajos (21%). Conclusiones: Con base en la presunción de existencia de nanoperforantes de forma universal, se presenta el concepto de colgajos de nanoperforantes ubicuas de localización aleatoria. En este estudio se demuestra no sólo la seguridad de la técnica, llegando a tener tasas de necrosis inferiores a la transferencia de tejido libre aun con áreas pediculares pequeñas, sino su inigualable versatilidad, lo cual los hace ideales para resolver todo tipo de problemas reconstructivos complejos. (Texto tomado de la fuente)Background: Keystone flaps, are island perforator flaps based on the vascular concept of angiotome. Through a series of modifications that include the introduction of the concepts of pedicle area and free design, the concept of Ubiquitous Nanoperforator Aleatoric Locoregional (UNAL) Flap is presented, being island flaps pedicled from small areas of random location in any anatomical region, vascularly safe, with wide arches of movement, and technically simple. Methods: The concept of Ubiquitous Nanoperforator Aleatoric Loco-regional flap is presented through a retrospective case series of 150 patients, without age or anatomical location restriction, treated between 2012 and 2021. A description of the surgical technique is made and demographic profile, clinical presentation, flap characteristics, additional procedures and postoperative outcomes are evaluated. Results: 211 flaps were performed in 184 defects. The most common etiologies were tumors (30.4%) and trauma (23.3%). Most flaps were performed on the head and neck (31%) and lower limb (30.4%). The average pedicle area of the flaps was 33%, and 82% of the flaps were between 1 and 2 times the size of the defect. The most frequent movements were types 1A and 4. 35% of the flaps presented some complication, the most frequent were dehiscences (18.5%), partial or total necrosis (10.9%) and healing disorders (6.6%). Complete necrosis occurred in 1.9% of flaps. Only 27% of complications required re-interventions, the most frequent consisted of debridement (28%) and flap advancement (21%) Conclusions: Based on the presumption of universal existence of nanoperforators, the concept of Ubiquitous Nanoperforator Aleatoric Loco-regional flap is presented. This study demonstrates not only the safety of the technique, reaching necrosis rates lower than free tissue transfer, even with small pedicle areas, but its unparalleled versatility, which makes them ideal for solving all kinds of complex reconstructive problems.Especialidades MédicasEspecialista en Cirugía PlásticaSe realizó una búsqueda en bases de datos personales de los autores para identificar pacientes adultos sometidos a cobertura de cualquier defecto con colgajos de nanoperforantes de localización aleatoria. Se incluyeron pacientes de cualquier edad, operados entre los años 2012 y 2022, con un tiempo mínimo de seguimiento de 2 meses, con defectos por cualquier etiología, y en cualquier localización. Se revisaron los registros de historia clínica y descripciones quirúrgicas, se extrajeron los datos relevantes para establecer un perfil demográfico (edad, género, comorbilidades), la presentación clínica inicial (número, etiología y localización de los defectos, tiempo de seguimiento, tratamientos previos) , las características de los colgajos (número de colgajos por defecto, área pedicular, relación de tamaño entre el colgajo y el defecto, tipo de movimiento), procedimientos adicionales requeridos, y los desenlaces postoperatorios (complicaciones mayores y menores, reintervenciones y estancia hospitalaria). Se utilizó estadística descriptiva para presentar las variables cuantitativas. Este estudio se adhiere a las guías STROBE, y a los principios éticos de la Declaración de Helsinki, contando con la aprobación del comité de ética de nuestra institución, a través del acta No. 005-041. No se utilizaron consentimientos para uso de fotografías en tanto no se utilizaron fotografías que revelen la identidad de los pacientes; se obtuvo consentimiento verbal para utilizar las fotografías incluidas.Colgajos de nanoperforantes52 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en Cirugía PlásticaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiologíaColgajo PerforanteNecrosisSimpatectomíaPerforator FlapSympathectomyColgajo keystoneColgajos de perforantesSimpatectomía quirúrgicaAngiotomaCirugía reconstructivaKeystone flapPerforator flapsSurgical sympathectomyAngiotomeReconstructive surgeryColgajos de nanoperforantes ubicuas de localización aleatoria: serie de casosUbiquitous nanoperforator aleatoric loco-regional (UNAL) flaps: case seriesTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TM1. Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg. 2011 Jan;127 Suppl 1:205S-212S.2. Gottlieb LJ, Krieger LM. From the reconstructive ladder to the reconstructive elevator. Plast Reconstr Surg. 1994;93:1503– 1504.3. Gillies HD, Millard DR. The principles and art of plastic surgery. Boston: Little and Brown; 1957.4. McGregor IA, Jackson IT. The groin flap. Br J Plast Surg. 1972;25:3–16.5. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: Experimental study and clinical applications. Br J Plast Surg. 1987;40:113–141.6. Koshima I, Soeda S. Inferior epigastric artery skin flap without rectus abdominis muscle. Br J Plast Surg. 1989;42:645–648.7. Orticochea M. The musculo-cutaneous flap method: An immediate and heroic substitute for the method of delay. Br J Plast Surg. 1972;25:106–110.8. Rubino C, Coscia V, Cavazzuti AM, et al. Haemodynamic enhancement in perforator flaps: The inversion phenomenon and its clinical significance. A study of the relation of blood velocity and flow between pedicle and perforator vessels in perforator flaps. J Plast Reconstr Aesthet Surg. 2006; 59:636–643.9. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg. 2004;114:910–916.10. Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e419-e426.11. Aho JM, Laungani AT, Herbig KS, Wong C, Kirchoff RW, Saint-Cyr M. Lumbar and thoracic perforators: vascular anatomy and clinical implications. Plast Reconstr Surg. 2014 Oct;134(4):635e-645e.12. Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg. 2009 Apr;123(4):132e-145e.13. Yamamoto T, Yamamoto N, Kageyama T, et al. Definition of perforator flap: what does a "perforator" perforate?. Glob Health Med. 2019;1(2):114-116. doi:10.35772/ghm.2019.0100914. Mohan AT, Sur YJ, Zhu L, Morsy M, Wu PS, Moran SL, Mardini S, Saint-Cyr M. The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction. Plast Reconstr Surg. 2016 Oct;138(4):710e-729e.15. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg. 2003;73:112–120.16. Behan F, Wilson I. The principle of the angiotome, a system of linked axial pattern flaps. Paper presented at the Sixth International Congress of Plastic and Reconstructive Surgery; 1975; Paris.17. Milton SH. Experimental studies on island flaps 1. The surviving length. Plast. Reconstr. Surg. 1971; 48: 574–8.18. Mešić H, Kirkebøen KA, Bains R. The importance of a skin bridge in peripheral tissue perfusion in perforator flaps. Plast Reconstr Surg. 2012 Mar;129(3):428e-434e19. Behan FC. The fasciocutaneous island flap: an extension of the angiotome concept. Aust N Z J Surg. 1992 Nov;62(11):874-86.20. HYNES W. The blood-vessels in skin tubes and flaps. Br J Plast Surg. 1950 Oct;3(3):165-75.21. Finseth F, Cutting C. An experimental neurovascular island skin flap for the study of the delay phenomenon. Plast Reconstr Surg. 1978 Mar;61(3):412-20.22. Siemionow M, Andreasen T, Chick L, Lister G. Effect of muscle flap denervation on flow hemodynamics: a new model for chronic in vivo studies. Microsurgery. 1994;15(12):891-4.23. Banbury J, Siemionow M, Porvasnik S, Petras S, Zins JE. Muscle flaps' triphasic microcirculatory response to sympathectomy and denervation. Plast Reconstr Surg. 1999 Sep;104(3):730-7.24. Lecoq JP, Joris JL, Nelissen XP, Lamy ML, Heymans OY. Effect of adrenergic stimulation on cutaneous microcirculation immediately after surgical adventitiectomy in a rat skin flap model. Microsurgery. 2008;28(6):480-6.25. Karayel H, Kaya B, Caydere M, Terzioğlu A, Aslan G. 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Effect of operative time on complications associated with free flap reconstruction of the head and neck. 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