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Cristóbal L, Linder S, Lopez B, Mani M, Rodríguez-Lorenzo A. Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes. Microsurgery 2016; 37:479-486. [PMID: 27501201 DOI: 10.1002/micr.30086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area. METHODS Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function. RESULTS There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one. CONCLUSION Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.
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Affiliation(s)
- Lara Cristóbal
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Sora Linder
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Beatriz Lopez
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Maria Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Andres Rodríguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
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Somuk BT, Çiftçi O, Aygenç E. Evaluation of Cases Who Underwent Reconstruction Through Pectoralis Major Myocutaneous Flap after Laryngopharyngectomy. Turk Arch Otorhinolaryngol 2016; 54:58-62. [PMID: 29392018 DOI: 10.5152/tao.2016.1603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/07/2016] [Indexed: 11/22/2022] Open
Abstract
Objective In this retrospective study, we discussed the results of patients who underwent hypopharynx reconstruction through a pectoralis major myocutaneous flap (PMMF) after laryngopharyngectomy. Methods Twenty-three patients who underwent total laryngectomy, subtotal pharyngectomy, and/or esophagus upper segment resection due to advanced-stage (T3 and T4) laryngeal, hypopharyngeal, and esophagus upper segment-located squamous cell carcinoma and subsequent reconstruction with PMMF were retrospectively evaluated. While the minor complications were determined to be wound site infection, hemorrhage, and disruption of suture at the donor site, major complications were determined to be anastomotic line disruption, fistula, and dysphagia. Results Eighteen (78.2%) patients were male and five (21.7%) were female; their ages varied between 33 and 72 years (mean: 60.1). According to lesion localization, 11 patients were evaluated as having laryngeal cancer, seven as having hypopharyngeal cancer, and five as having esophagus upper segment-located cancer. The rate of minor complications was 30.4%: fistula was observed in 11 (47.8%) patients and 13 (56.5%) patients mentioned difficulty swallowing only solid foods. The total follow-up period ranged from 4 to 60 (mean: 31.6) months. Conclusion PMMF is continuing to be a good alternative reconstruction method for the reconstruction of partial hypopharyngeal defects because it is easily obtainable, one surgical team is sufficient when using the flap, and it is associated with low morbidity and mortality rates.
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Affiliation(s)
- Battal Tahsin Somuk
- Department of Otorhinolaryngology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Onur Çiftçi
- Department of Otorhinolaryngology, Private Güven Hospital, Ankara, Turkey
| | - Erdinç Aygenç
- Department of Otorhinolaryngology, Private Güven Hospital, Ankara, Turkey
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Chang EI, Hanasono MM. State-of-the-art reconstruction of midface and facial deformities. J Surg Oncol 2016; 113:962-70. [DOI: 10.1002/jso.24150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Edward I. Chang
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Matthew M. Hanasono
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
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Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction. Eur Arch Otorhinolaryngol 2016; 273:4403-4412. [PMID: 27170317 DOI: 10.1007/s00405-016-4092-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
Over the last 20 years, free flaps have represented the gold standard for moderate to large head and neck reconstruction. However, regional flaps continue to evolve and still play an important role in a reconstructive surgeon's armamentarium, especially for the more delicate patients who would certainly benefit from simpler surgical procedures. The supraclavicular artery island flap (SCAIF) is a pedicled flap that has recently gained great popularity for reconstruction of most head and neck sites, because of its unusual versatility and wide arc of rotation. SCAIF is a fasciocutaneous flap that is very reliable and both easy and quick to harvest. It is pedicled on the supraclavicular artery, which is a branch of the transverse cervical artery. Between October 2012 and July 2015, at Ospedale San Raffaele (Milan, Italy) and Policlinico San Matteo (Pavia, Italy), we used the SCAIF procedure on 14 patients with cervical and facial skin, oral cavity, oropharyngeal, and hypopharyngeal defects after oncologic surgery or as revision surgery after free-flap failure. The presence of the supraclavicular artery was demonstrated preoperatively by computed tomography angiography. Harvesting time never exceeded 50 min. Functional outcomes were excellent, and the donor site was always closed. We reported only one case of tip desquamation, which was treated conservatively, and two cases of partial flap necrosis, which required revision surgery. In our opinion, SCAIF should be considered to be a valid alternative to free-flap reconstruction, especially for facial and cervical skin, floor-of-mouth, and hypopharyngeal defects; oropharyngeal defects may be harder to reconstruct.
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Fontana SC, Smith RB, Nazir N, Andrews BT. Biomechanical assessment of fixation methods for segmental mandible reconstruction with fibula in the polyurethane model. Microsurgery 2016; 36:330-3. [PMID: 27059150 DOI: 10.1002/micr.30052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/15/2016] [Accepted: 03/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND A variety of plating techniques are employed by microsurgeons to provide rigid fixation for vascularized bone constructs of the mandible. The aim of this study was to biomechanically compare three commonly utilized plating techniques for rigid fixation of fibula bone flaps in reconstructing lateral segmental mandibular defects. MATERIALS AND METHODS Polyurethane mandibles with 3-cm segmental defects were reconstructed using polyurethane fibula models. Three fixation techniques were compared (n = 5 models per group): Group 1 used two 2.0-mm miniplates at each osteotomy site, Group 2 used a single 2.3-mm plate, and Group 3 used a single 2.7-mm plate. Biomechanical testing of maximum force and displacement at failure for each plating technique was assessed and statistical comparison performed. RESULTS The average displacement for Group 1 was 14.08 ± 1.42 mm, Group 2 was 5.79 ± 0.89 mm, and Group 3 was 6.03 ± 1.59 mm. Group 1 had significantly greater (P < 0.05) displacement when compared with Group 2 and 3. Analysis of variance demonstrated the three groups varied significantly in mean displacement (0 < 0.01). The average force before failure for Group 1 was 616.4 ± 33.83N, Group 2 was 737.8 ± 72.57N, and Group 3 was 681.0 ± 67.98N. Group 2 withstood significantly greater force than Group 1 (P < 0.05), and withstood greater force than Group 3, although the difference was not significant. Analysis of variance showed the three groups varied significantly in mean force at failure (P < 0.05). CONCLUSION Reconstruction using a single 2.3-mm plate provided the best rigid fixation for lateral segmental defects of the mandible. © 2016 Wiley Periodicals, Inc. Microsurgery 36:330-333, 2016.
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Affiliation(s)
- Stefani C Fontana
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Russell B Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Niaman Nazir
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Brian T Andrews
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS
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Abstract
Oral cavity squamous cell carcinoma (OC-SCC) is the most common malignancy of the head and neck (excluding nonmelanoma skin cancer). Recent trends have shown a dramatic rise in the incidence of oropharyngeal squamous cell carcinoma (OP-SCC), with a marked increase in lesions related to human papillomavirus infection. This update presents the latest evidence regarding OC-SCC and OP-SCC. In particular, the authors compare and contrast tumors at these two sites with respect to epidemiology, etiopathogenesis, clinicopathologic presentation, clinical assessment, imaging, management, and prognosis. It is important for clinicians to be aware of differences between OC-SCC and OP-SCC so that appropriate patient education and multidisciplinary care can be provided to optimize outcomes.
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Affiliation(s)
- Angela C Chi
- Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
| | - Terry A Day
- Professor, Wendy and Keith Wellin Endowed Chair for Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Brad W Neville
- Distinguished University Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
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Principles and Practice of Reconstructive Surgery for Head and Neck Cancer. Surg Oncol Clin N Am 2015; 24:473-89. [DOI: 10.1016/j.soc.2015.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jacobsen HC, Wahnschaff F, Trenkle T, Sieg P, Hakim SG. Oral rehabilitation with dental implants and quality of life following mandibular reconstruction with free fibular flap. Clin Oral Investig 2015; 20:187-92. [DOI: 10.1007/s00784-015-1487-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
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Baas M, Duraku LS, Corten EML, Mureau MAM. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits? J Plast Reconstr Aesthet Surg 2015; 68:1025-35. [PMID: 26044088 DOI: 10.1016/j.bjps.2015.04.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tongue reconstruction after (hemi)glossectomy including sensory recovery is challenging. Although sensory recovery could improve functional outcome, no consensus on the need for reinnervation of the neo-tongue exists. Therefore, a systematic review was performed to determine if sensory reinnervation of free flaps in tongue reconstruction is better than no sensory reinnervation. The secondary study aim was to assess the effect of sensory reinnervation on overall functional outcome, such as speech and deglutition. METHODS Seven databases (Embase, Medline, Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar) were searched. Studies that reported the effect of sensory reinnervation on overall functional outcome were identified. RESULTS Fourteen articles were included in the systematic review, concerning a total of 271 tongue reconstructions. Free flaps that were used were the radial forearm (RF) flap (n = 137), the anterolateral thigh (ALT) flap (n = 65), the rectus abdominis (RA) flap (n = 20), and the tensor fascia latae (TFL) flap (n = 5). Seven out of seven articles directly comparing sensory reinnervation with no sensory reinnervation revealed superior sensibility in the reinnervated group. Moreover, the innervated RF and ALT flaps showed superior recovery of sensibility compared to other flaps used for the reconstruction of hemiglossectomy as well as total glossectomy defects. There are indications that sensory reinnervation may have a beneficial effect on overall tongue function. Age, smoking, and sex did not affect sensory recovery. Four out of five articles showed that postoperative radiotherapy does not have a long-term adverse effect on sensory recovery. CONCLUSIONS Sensory reinnervation of free flaps in the reconstruction of (hemi)glossectomy defects improves sensory recovery; however, evidence for beneficial effects on function is poor.
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Affiliation(s)
- Martijn Baas
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Liron S Duraku
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eveline M L Corten
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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