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Tamaki A, Zender CA. Free Flap Donor Sites in Head and Neck Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00047-6. [PMID: 37173238 DOI: 10.1016/j.otc.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Microvascular free tissue transfer, also referred to as free flaps surgery, is a reconstructive technique that has become a foundational component of complex head and neck reconstruction. There have been considerable advancements in the field over the last 30 years including the number and variety of free flaps. Each of these free flaps has unique characteristics that must be considered for the defect when selecting a donor site. Here, the authors focus on the most common free flaps used in head and neck reconstruction.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, LKS 5045, Cleveland, OH 44106, USA.
| | - Chad A Zender
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati Medical Center, 231 Albert Sabin Way, MSB 6408, Cincinnati, OH 45229, USA
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2
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Archibald H, Stanek J, Hamlar D. Free Flap Donor-Site Complications and Management. Semin Plast Surg 2023; 37:26-30. [PMID: 36776806 PMCID: PMC9911222 DOI: 10.1055/s-0042-1759795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Free flap harvest will occasionally result in donor-site complications and morbidity. Most of these complications are managed simply without producing lingering effects on activities of daily living. However, some patients will sustain limb weakness, gait issues, chronic pain, and nonhealing wounds. Frank preoperative discussion between surgeon and patient is essential to maximize postoperative outcome and manage expectations. Fastidious surgical technique will help minimize the risks of hematoma, seroma, and infection, while newer techniques can help prevent some issues with wound healing, limb weakness, and sensory changes. In this article, we describe the rates of common and rare complications at free flap donor sites, as well as techniques to prevent and manage them.
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Affiliation(s)
- Hunter Archibald
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Joel Stanek
- Department of Otolaryngology, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Otolaryngology, Regions Hospital, St. Paul, Minnesota
| | - David Hamlar
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota
- Department of Otolaryngology, Regions Hospital, St. Paul, Minnesota
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3
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Wolter GL, Swendseid BP, Sethuraman S, Ivancic R, Teknos TN, Haring CT, Kang SY, Old MO, Seim NB. Advantages of the scapular system in mandibular reconstruction. Head Neck 2023; 45:307-315. [PMID: 36336798 DOI: 10.1002/hed.27235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fibula free flaps (FFF) are often considered the first choice for mandibular reconstruction, but scapular system free flaps (SFF) have increased in popularity due to versatility, donor site advantages, and patient factors. METHODS Retrospective chart review of patients undergoing mandibulectomy with FFF or SFF reconstruction from 2016 to 2021. RESULTS Hundred and seventy-six patients (FFF n = 145, SFF n = 31) underwent the aforementioned procedures. Mean FFF operative time was 9.47 h versus 9.88 for SFF (p = 0.40). Two-flap reconstructions required 12.65 h versus 10.09 for SFF with soft tissue (p = 0.002). Donor site complications were identified in 65.6% of FFF with skin grafting. CONCLUSIONS These findings suggest that SFF requires similar operative time and results in reduced donor site morbidity as compared to FFF. Supine, concurrent harvesting of SFF allows for single-flap harvest with significantly shorter operative time. SFF could be considered a primary option for mandible reconstruction for complex defects and in select patients.
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Affiliation(s)
| | - Brian P Swendseid
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Ryan Ivancic
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew O Old
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nolan B Seim
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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McIlwain W, Inman J, Namin A, Kazi A, Shumrick C, Ducic Y. Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy. Semin Plast Surg 2023; 37:39-45. [PMID: 36776801 PMCID: PMC9911226 DOI: 10.1055/s-0042-1759797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.
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Affiliation(s)
- Wesley McIlwain
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Arya Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aasif Kazi
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Karadaghy OA, Mussatto CC, Schatz BA, Li J, Norris TW, Nallani R, Shnayder L, Kakarala K, Tsue TT, Girod DA, Li Y, Koestler DC, Villwock MR, Harn N, Bur AM. Rates of bone reabsorption and union in mandibular reconstruction using the osteocutaneous radial forearm free flap. Head Neck 2022; 44:420-430. [PMID: 34816528 DOI: 10.1002/hed.26939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Historical concerns over bone resorption and malunion of the osteocutaneous radial forearm free flap (OCRFFF) limited its widespread adoption for head and neck reconstruction, despite lack of outcomes data evaluating this notion. METHODS A retrospective cohort study was performed including patients 18 years or older who underwent reconstruction of the mandible using an OCRFFF. Linear modeling and logistic regression were used to evaluate the change in bone volume and union over time. RESULTS One hundred and twenty-one patients were included in the study. A mixed effects linear model incorporating age, sex, treatment type, and number of bone segments did not demonstrate a significant loss of bone volume over time. A logistic regression model identified lack of adjuvant treatment and time to be significantly associated with complete union. CONCLUSION This study supports that the OCRFFF is a stable form of osseus reconstruction for defects of the head and neck.
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Affiliation(s)
- Omar A Karadaghy
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Benjamin A Schatz
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer Li
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Taylor W Norris
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Rohit Nallani
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lisa Shnayder
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Terance T Tsue
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Douglas A Girod
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yanming Li
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Devin C Koestler
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R Villwock
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nick Harn
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M Bur
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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O'Connell JE, Koumoullis H, Lowe D, Rogers SN. A 31-year Review of Composite Radial Forearm Free Flaps for Head and Neck Reconstruction. Br J Oral Maxillofac Surg 2022; 60:915-921. [DOI: 10.1016/j.bjoms.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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Le JM, Morlandt AB, Gigliotti J, Park EP, Greene BJ, Ying YP. Complications in oncologic mandible reconstruction: A comparative study between the osteocutaneous radial forearm and fibula free flap. Microsurgery 2021; 42:150-159. [PMID: 34792210 DOI: 10.1002/micr.30841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/31/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The osteocutaneous radial forearm free flap (OC-RFFF) has been proposed as a safe and reliable free flap for head and neck reconstruction with low donor site morbidity. The purpose of this study is to compare the late complications (>30 days) associated with using the OC-RFFF versus the free fibula flap (FFF) for mandibular reconstruction following oncologic segmental resection. METHODS We conducted a single-institution, retrospective study composed of patients who underwent oncologic microvascular composite mandibular reconstruction with either the OC-RFFF or FFF. The primary predictor variable was the type of free flap used. The outcome variable was late complication postoperatively (>30 days). RESULTS A total of 93 patients (28, OC-RFFF and 65, FFF) were analyzed. The majority of patients were male (62%) and with AJCC stage T4a disease (72%). Mean hospital length of stay was comparable between the two flap groups (p = .50). OC-RFFF was associated with more late complications (p = .03) compared to FFF. Nonunion occurred in 10.7% of OC-RFFF and 0% of FFF. Partial or complete flap failure was seen in 7.1% and 0% in the OC-RFFF and FFF, respectively. Two-year disease-free survival was comparable in both groups (p > .05). CONCLUSIONS The results of this study suggest that the rate of nonunion and odds of having a late complication were significantly greater in the OC-RFFF compared to the FFF following oncologic mandibular reconstruction. However, flap success, early complications (<30 days), and length of hospital stay were comparable between the two flaps.
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Affiliation(s)
- John M Le
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anthony B Morlandt
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jordan Gigliotti
- Department of Oral and Maxillofacial Surgery, McGill University, Montreal, Quebec, Canada
| | - Earl P Park
- Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Benjamin J Greene
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yedeh P Ying
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rubin SJ, Sayre KS, Kovatch KJ, Ali SA, Hanks JE. Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty. Curr Opin Otolaryngol Head Neck Surg 2021; 29:407-418. [PMID: 34387289 DOI: 10.1097/moo.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Options for segmental mandibular reconstruction in patients poorly suited to undergo fibula free flap (FFF). RECENT FINDINGS Although FFF is the current 'gold standard' for segmental mandibular reconstruction, other reconstructive options must be considered when FFF is contraindicated or disfavoured and/or patient frailty precludes a lengthy anaesthetic. In addition to various nonvascularized and soft tissue only reconstructions, excellent osseous free flap alternatives for functional segmental mandibular reconstruction may be employed. The subscapular system free flaps (SSSFF) may be ideal in frail and/or elderly patients, as SSSFF allows for early mobility and does not alter gait. In extensive and/or symphyseal defects, functional mandibular reconstruction in lieu of a free flap is extremely limited. Pedicled segmental mandibular reconstructions remain reasonable options, but limited contemporary literature highlights unpredictable bone graft perfusion and poor long-term functional outcomes. SUMMARY There are several excellent free flap alternatives to FFF in segmental mandibular reconstruction, assuming adequate cervical recipient vessels are present. On the basis of the current literature, the optimal mandibular reconstruction for the medically frail, elderly and/or patients with extreme vessel-depleted necks is limited and debatable. In qualifying (i.e. limited, lateral) defects, soft tissue only reconstructions should be strongly considered when osseous free flaps are unavailable.
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Affiliation(s)
- Samuel J Rubin
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine
| | - Kelly S Sayre
- Department of Oral and Maxillofacial Surgery, Boston University School of Dentistry
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center
| | - S Ahmed Ali
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System
| | - John E Hanks
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine
- Department of Otolaryngology-Head and Neck Surgery, VA Boston Medical Center, MA, USA
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9
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Khadembaschi D, Russell P, Beech N, Batstone MD. Osseointegrated implant survival, success and prosthodontic outcomes in composite free flaps: A 10-year retrospective cohort study. Clin Oral Implants Res 2021; 32:1251-1261. [PMID: 34352129 DOI: 10.1111/clr.13822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate implant survival, success and prosthodontic outcomes in a variety of composite free flaps. MATERIAL AND METHODS A retrospective analysis of patient records was used for data collection of implants placed into flaps. Free flap donor sites included fibula, iliac crest, scapula, medial femoral condyle and radial forearm. Kaplan-Meier survival curves were used to estimate survival. Cox regression was used to assess variables affecting survival, and binary logistic regression was utilised to determine effect of variables on prosthodontic outcomes. RESULTS There were 150 implants placed into 45 fibula, 98 implants into 29 iliac crest, 62 implants into 22 scapula, 6 implants into 3 medial femoral condyle and 2 implants in radial forearm composite free flaps. There was no difference in survival or success between or within the various flaps. Active smoking, increasing age, male gender and radiotherapy were associated with implant failure. Of patients completing prosthodontic rehabilitation, 93% were successful. There was no difference in likelihood of failure between different flap types. Fixed implant-supported dentures were associated with poor oral hygiene compared with removable designs (OR2.9, 95%CI 1.1-7.8, p = .03). CONCLUSIONS There is adequate survival and success of implants in common flaps. Caution is required when planning implants in patients exposed to radiotherapy and smokers. Ability to maintain adequate oral hygiene is an important prosthetic design consideration.
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Affiliation(s)
- Darius Khadembaschi
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Peter Russell
- Metro North Oral Health Centre, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Nicholas Beech
- School of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- School of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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The Role of Folded Multi-Island Vertical Rectus Abdominis Myocutaneous Flap in Reconstruction of Complex Maxillectomy and Midfacial Defects. J Craniofac Surg 2021; 32:1913-1917. [PMID: 33290331 DOI: 10.1097/scs.0000000000007319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The rationale and outcomes for reconstruction of complex maxillectomy and midfacial defects using a folded multi-island vertical rectus abdominis myocutaneous free flap (MI-VRAM) are analyzed in this study.A retrospective review of prospectively collected database was conducted on all VRAM free flaps used in head and neck reconstruction from 2013 to 2019. A total of 39 cases were identified, of which 21 patients underwent immediate VRAM flap reconstruction for complex maxillectomy and midfacial defects. Variables including age, sex, pathologic subtypes, tumor staging, type of resection, defect classification, adjuvant therapy, complications, follow-up time, and reconstructive details were collected.Single skin-island VRAM was used in 10 (47.6%) patients. Eleven (52.4%) patients required the use of folded MI-VRAM flap. In 6 (28.6%) patients a triple skin-island VRAM was used and 5 (23.8%) received a double skin-island VRAM. The average size of harvested skin paddle was 15 × 7.2 cm. Secondary flap contouring was required in 6 (28.6%) patients. There were no cases of total flap loss and no major donor site complications recorded.Folded MI-VRAM flap is a reliable method for reconstruction of complex maxillectomy and midfacial defects. It provides multiple independent skin islands with excellent plasticity and abundant volume of tissue for restoration of facial contours.
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Abbate V, Iaconetta G, Sani L, Bonavolontà P, Di Lauro AE, Masone S, Califano L, Orabona GDA. The Use of Dermal Substitutes for Donor Site Closure After Radial Forearm Free Flap Harvesting. J Craniofac Surg 2021; 32:e205-e208. [PMID: 33705075 DOI: 10.1097/scs.0000000000006808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of our study was to analyze the aesthetic and functional outcome in the radial forearm free flap donor site using a simple split thickness skin grafting (STSG) closure compared with the use of dermal scaffold supporting the STSG closure. METHODS The study analyzed 18 patients, divided in 2 groups based on the donor site closure modality. In STSG group, a simple STSG was used to cover the defect. In the DS + STSG group, the defect was covered by the use of dermal substitute (MatriDerm) supporting the STSG. Groups were compared on the following outcome variable: scar status; hand function; circumferences at most proximal and most distal point of the graft. All patients were followed up 1, 6, and 12 months post-operative. RESULTS Nine patients from STSG group showed a difference in circumference between the operated and contralateral limbs respectively of 2.9 mm proximal and 1.2 mm distal; in the 9 patients of DS + STGS group the difference was respectively of 1.2 mm proximal and 1.3 mm distal. Welch unequal variances t-test demonstrated statistical significance of the values with P < 0.004 (P < 0.5). The average VSS was 1.82 ± 0.2 for STSG group and 1.75 ± 0.2 for DS + STGS group. The DASH score was 21.8% in STSG group and 19.4% in DS + STGS group. CONCLUSION Our study shows that patients treated with Matriderm + STSG obtained a better result both in esthetic and functional outcomes.
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Affiliation(s)
- Vincenzo Abbate
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | | | - Lorenzo Sani
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | - Paola Bonavolontà
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | - Alessandro E Di Lauro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II;"
| | - Stefania Masone
- University of Naples "Federico II", Department of Clinical Medicine and Surgery, General Surgery Unit, Naples, Italy
| | - Luigi Califano
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
| | - Giovanni D A Orabona
- University of Naples "Federico II," Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, Naples
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Khadembaschi D, Brierly GI, Chatfield MD, Beech N, Batstone MD. Systematic review and pooled analysis of survival rates, success, and outcomes of osseointegrated implants in a variety of composite free flaps. Head Neck 2020; 42:2669-2686. [PMID: 32400954 DOI: 10.1002/hed.26238] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 09/19/2023] Open
Abstract
The aim of this review was to provide an update on survival rates of osseointegrated implants into common composite free flaps used for maxillary and mandibular reconstructions and identify factors affecting outcomes. PubMed, Medline, Embase, and Cochrane databases were searched. Included studies reported implant survival by flap type. Results were pooled and survival was estimated with the Kaplan-Meier method. Variables affecting survival were assessed using Cox regression. Thirty-two of the 2631 articles retrieved were included, totaling 2626 implants placed into fibula, iliac crest, scapula, and radial forearm free flaps. Pooled survival showed 94% 5-year survival of implants in fibula and iliac crest with no difference between groups (P = .3). Factors effecting survival included radiotherapy (HR 2.3, 95% CI 1.2-4.6, P = .027) and malignant disease (HR 2.2, 95%CI 1.6-3.1, P < .001). Implant survival appears adequate across common flap types; however, there are limited numbers reported in less common flaps.
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Affiliation(s)
- Darius Khadembaschi
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gary I Brierly
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Mark D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Nicholas Beech
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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13
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Chala A. Modalities and State of Art in Oral Cancer Reconstruction. Oral Dis 2020. [DOI: 10.5772/intechopen.91049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shokri T, Wang W, Cohn JE, Kadakia S, Ducic Y. Premaxillary Deficiency: Techniques in Augmentation and Reconstruction. Semin Plast Surg 2020; 34:92-98. [PMID: 32390776 DOI: 10.1055/s-0040-1709175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.
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Affiliation(s)
- Tom Shokri
- Department of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Worley ML, Patterson TM, Graboyes EM, Wu Y, Brody RM, Hornig J, Walton Z. Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity and Assessment of Prophylactic Fixation. JAMA Otolaryngol Head Neck Surg 2019; 144:769-775. [PMID: 30054621 DOI: 10.1001/jamaoto.2018.1014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance The chimeric anterolateral thigh osteomyocutaneous (ALTO) free flap is a recently described microvascular option for head and neck osseous defects associated with complex soft-tissue requirements. To date, the association of ALTO flap harvest with femur structural integrity and the need for routine prophylactic fixation following harvest has been incompletely described. Objective To investigate the association of ALTO flap harvest, with and without prophylactic fixation, on femur structural integrity as measured by 4-point bend and torsional biomechanical testing. Design and Setting At a research laboratory, 24 synthetic fourth-generation composite femurs with validated biomechanical properties underwent 10-cm-long, 30% circumferential osteotomies at the proximal middle third of the femur; 6 femurs served as controls. Osteotomized femurs with and without fixation underwent torsional and 4-point bend biomechanical testing. Femur fixation consisted of intramedullary nail and distal interlock screw placement. Main Outcomes and Measures Force and torque to fracture (expressed in kilonewtons [kN] and Newton meters [N∙m], respectively) were compared between controls, osteotomized femurs without fixation, and osteotomized femurs with fixation. Additional outcome measures included femur stiffness and fracture patterns. Results On posterior to anterior (PA) 4-point bend testing, force to fracture of osteotomized femurs was 22% of controls (mean difference, 8.3 kN; 95% CI, 6.6-10.0 kN). On torsional testing the torque to fracture of osteotomized femurs was 12% of controls (mean difference, 351.1 N∙m; 95% CI, 307.1-395.1 N∙m). Following fixation there was a 67% improvement in PA force to fracture and a 37% improvement in torque to fracture. However, osteotomized femurs with fixation continued to have a reduced PA force to fracture at 37% of controls (mean difference, 6.8 kN; 95% CI, 4.5-9.2 kN) and torque to fracture at 16% of controls (mean difference, 333.7 N∙m; 95% CI, 306.8-360.6 N∙m). On torsional testing, all osteotomized femurs developed similar spiral fractures through a corner of the distal osteotomy site. This fracture pattern changed after prophylactic fixation with femurs developing nondisplaced fractures through the proximal osteotomy site. There were no underlying hardware failures during testing of osteotomized femurs with fixation. Conclusions and Relevance Anterolateral thigh osteomyocutaneous flap harvest results in significant changes in the structural integrity of the femur. Postoperative stabilization should be strongly considered, with future research directed at investigating the clinical significance of residual biomechanical changes following femur fixation.
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Affiliation(s)
- Mitchell L Worley
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Travis M Patterson
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Cancer Control Program, Hollings Cancer Center, Charleston, South Carolina
| | - Yongren Wu
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston
| | - Robert M Brody
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Joshua Hornig
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Zeke Walton
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston
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Alfouzan AF. Review of surgical resection and reconstruction in head and neck cancer. Traditional versus current concepts. Saudi Med J 2019; 39:971-980. [PMID: 30284578 PMCID: PMC6201028 DOI: 10.15537/smj.2018.10.22887] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review summarizes the development of head and neck cancer resection and reconstruction. The developments in the treatment of cancer patients are reflected in their surgical outcomes, in addition to functional and aesthetic improvements. New technologies, such as surgical simulation and planning, minimally invasive surgery, and microsurgery have been added to the field to improve surgical resection of the tumor and reconstruction. The field is still growing to optimize the management of head and neck cancer.
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Affiliation(s)
- Afnan F Alfouzan
- Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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17
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Single-Unit 3D-Printed Titanium Reconstruction Plate for Maxillary Reconstruction: The Evolution of Surgical Reconstruction for Maxillary Defects-A Case Report and Review of Current Techniques. J Oral Maxillofac Surg 2018; 77:874.e1-874.e13. [PMID: 30615849 DOI: 10.1016/j.joms.2018.11.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/26/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023]
Abstract
The complex 3-dimensional anatomy of the facial skeleton creates a unique challenge for surgical reconstruction. Even more difficult is the precise reconstruction of the maxilla owing to its lack of solid bony support after large resections. Virtual surgical planning (VSP) technology has many applications in head and neck surgery, such as preoperative planning, fabrication of cutting guides and stereolithographic models, and fabrication of custom implants. We present the case of a patient who had undergone surgical resection of a mucoepidermoid carcinoma of the maxilla and immediate reconstruction with a vascularized free fibula flap using VSP. Using a custom 3-dimensional, titanium printed plate, which corresponded precisely with the surgical defect, the maxilla and midface were reconstructed to ideal dimensions with no unplanned surgical manipulation and a shorter overall operating time. We have described the technique and reviewed the pertinent reported data.
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Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options. Arch Plast Surg 2018; 45:495-503. [PMID: 30466228 PMCID: PMC6258970 DOI: 10.5999/aps.2017.01592] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/15/2018] [Indexed: 11/08/2022] Open
Abstract
With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.
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19
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Wang W, Xu B, Zhu J, Yang C, Shen S, Qian Y. Maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle. Med Oral Patol Oral Cir Bucal 2018; 23:e619-e624. [PMID: 30148478 PMCID: PMC6167095 DOI: 10.4317/medoral.22505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/04/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Maxillary reconstruction using various pedicled and free-tissue transfer techniques with bone graft or without bone graft has some drawbacks. In this study, we demonstrate maxillary reconstruction using femoris rectus muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle through the modified lateral lip-submandibular approach. MATERIAL AND METHODS Nine patients suffering from maxillary defects secondary to maxillary cancer ablation, who underwent maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle, were enrolled into this study between November 2015 and August 2017. RESULTS All patients who underwent the maxillary reconstruction using femoris rectus muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle presented satisfactory postoperative function, with adequate mouth opening, optimal esthetic outcome and no restrictions on the diet. Every rectus femoris muscle flaps mucosalized well within five weeks. No donor site functional impairment or complications were observed. CONCLUSIONS The technique is a feasible and acceptable technique for the maxillary reconstructions. It is safe, quick and simple to harvest. It also presents an optimal esthetic and satisfactory functional outcome with the advantage of low morbidity of the donor site. Combined with the three-dimension reconstruction, this technique can improve the postoperative outcomes.
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Affiliation(s)
- W Wang
- No. 1088 Mid Hai Yuan Road Gaoxin District, Kunming Yunnan 650106, China,
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20
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Connolly TM, Sweeny L, Greene B, Morlandt A, Carroll WR, Rosenthal EL. Reconstruction of midface defects with the osteocutaneous radial forearm flap: Evaluation of long term outcomes including patient reported quality of life. Microsurgery 2017; 37:752-762. [PMID: 28843005 DOI: 10.1002/micr.30201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 05/23/2017] [Accepted: 06/23/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC-RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. We aim to evaluate outcomes after midface reconstruction utilizing the OC-RFFF. METHODS Retrospective review of prospective database collected between 2005 and 2014 of midface reconstruction using OC-RFFF in a tertiary care centre. Donor site complications and acute and long-term recipient site complications were measured. Health related quality of life was assessed using the University of Washington Quality of Life (UW-QOL) Questionnaire. RESULTS A total of 68 midface defects were reconstructed using the OC-RFFF. Acute recipient site complications included three flap failures (4%), and two additional microvascular revision cases for vascular compromise. Late recipient complications included fistula (n = 10, 14%), ectropion (n = 7, 10%), diplopia (n = 6, 9%) and exposed hardware (n = 5, 7%). Resection of cheek skin or orbital rim correlated with orbital complications. The incidence of fistula was not affected by defect size or prior radiation. There were two donor site infections and no instances of forearm fracture. Patients undergoing OC-RFFF repair had mean scores for UW-QOL outcomes higher than published rates of obturator quality of life. CONCLUSION The OC-RFFF is suited to a variety of midface defects and can be combined with hardware to reconstruct the orbital floor. Recipient site complications are common, but donor site morbidity is low and outcomes, including HR-QOL, are acceptable.
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Affiliation(s)
- Timothy M Connolly
- Department of Otolaryngology-Head & Neck Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - Larissa Sweeny
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Benjamin Greene
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony Morlandt
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - William R Carroll
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eben L Rosenthal
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California
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Watfa W, di Summa PG, Meuli J, Raffoul W, Bauquis O. MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery. J Sex Med 2017; 14:1277-1284. [PMID: 28843466 DOI: 10.1016/j.jsxm.2017.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Phalloplasty with the radial forearm free flap is associated with a large donor site defect. AIM To compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm. METHODS Thirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure. All 37 patients were evaluated by questionnaire and by careful clinical examination. Pressure perception was assessed with the Semmes-Weinstein monofilament test. Sensory recovery, skin quality, and cosmetic result also were compared. The contralateral arm was used as the control. OUTCOMES Pressure perception values showed better sensory return in the MatriDerm group. Split-thickness skin grafting with MatriDerm achieved superior results in skin sensibility, superficial radial nerve recovery, and cosmetic aspect. RESULTS Our findings support the hypothesis that MatriDerm can be used to preserve sensory function and decrease morbidity of the donor site. CLINICAL IMPLICATIONS The use of a dermal substitute decreases the morbidity of the forearm free flap donor site. STRENGTHS AND LIMITATIONS The strength of this study is its retrospective nature conducted of a prospectively maintained database of 37 consecutive radial forearm free flaps with superimposable dimensions and location performed by the same surgeon, thus limiting biases. A limitation is its small sample (particularly for the control group). CONCLUSION Our experience showed that the combination of a split-thickness skin graft with MatriDerm substantially decreases postoperative complications at the donor site defect on the forearm of transgender patients. Watfa W, di Summa PG, Meuli J, et al. MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery. J Sex Med 2017;14:1277-1284.
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Affiliation(s)
- William Watfa
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
| | - Pietro G di Summa
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Joaquim Meuli
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Olivier Bauquis
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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22
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Ahmad FI, Means C, Labby AB, Troob SH, Gonzalez JD, Kim MM, Li RJ, Wax MK. Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction. Head Neck 2017; 39:1888-1893. [PMID: 28675554 DOI: 10.1002/hed.24863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/22/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The osteocutaneous radial forearm free flap (RFFF) is a versatile flap primarily used to reconstruct composite defects involving the mandible. The purpose of this study was to describe our experience with this flap for nonmandible reconstruction. METHODS All patients undergoing nonmandible osseous reconstruction with free-tissue transfer were reviewed. Patients with osteocutaneous RFFF reconstructions were evaluated. The retrospective review of all osteocutaneous RFFFs was performed from 1998 to 2014. RESULTS One hundred forty-two nonmandible osseous reconstructions were performed. Twenty-five patients underwent nonmandible osteocutaneous RFFF reconstruction. Eleven patients failed previous nonmicrovascular reconstruction. Reconstruction was for defects of the: palatomaxillary complex (n = 15), orbitomaxillary complex (n = 4), nasomaxillary complex (n = 4), larynx (n = 1), and clavicle (n = 1). There were no flap compromises. Postoperative complications included: 2 partial intraoral dehiscences; 1 recipient-site infection; and 1 seroma. Eight reconstructions required secondary procedures to improve functional and/or cosmetic outcomes. CONCLUSION The osteocutaneous RFFF is a robust flap that can be used to reconstruct composite defects involving bone and soft-tissue beyond the mandible.
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Affiliation(s)
- Faisal I Ahmad
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Casey Means
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Alex B Labby
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Scott H Troob
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Javier D Gonzalez
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Michael M Kim
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Ryan J Li
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Mark K Wax
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Reconstruction of a Post-Traumatic Maxillary Ridge Using a Radial Forearm Free Flap and Immediate Tissue Engineering (Bone Morphogenetic Protein, Bone Marrow Aspirate Concentrate, and Cortical-Cancellous Bone): Case Report. J Oral Maxillofac Surg 2017; 75:438.e1-438.e6. [DOI: 10.1016/j.joms.2016.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022]
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24
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Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
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25
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Henry A, McCaul JA. Osseocutaneous radial forearm flap with beavertail modification; a case report of a novel, single, reconstructive free flap for the tongue, floor of mouth and mandible. Int J Surg Case Rep 2016; 28:270-273. [PMID: 27756030 PMCID: PMC5067296 DOI: 10.1016/j.ijscr.2016.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Complex hard and soft tissue defects produced as a result of ablative resection of head and neck malignancy can represent a reconstructive challenge, especially when patients are medically compromised. PRESENTATION OF CASE We present the case of 72-year-old women presenting with an oral squamous cell carcinoma of the right floor of mouth invading the right mandible. Surgical management of the disease required ablative surgery with complex free tissue transfer reconstruction to provide restoration of form and function. Potential reconstructive options were limited by her medical comorbidities and poor vessel patency in the lower limbs, requiring novel thinking and adaptation of established techniques. DISCUSSION We describe the first reported use of an osseofasciocutaneous radial forearm flap with a 'beavertail modification' to provide a single and combined reconstructive option to reconstruct a complex hard and soft tissue defect. CONCLUSION This novel free-flap technique adds to the reconstructive armamentarium of the head and neck surgeon.
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Affiliation(s)
- Alastair Henry
- The Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, United Kingdom
| | - James A McCaul
- The Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, United Kingdom.
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Brown J, Schache A, Butterworth C. Liverpool Opinion on Unfavorable Results in Microsurgical Head and Neck Reconstruction. Clin Plast Surg 2016; 43:707-18. [DOI: 10.1016/j.cps.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Matthews J, Ng W, Archibald S, Levis C. The use of the radial styloid in the extended osteocutaneous radial forearm free flap. Plast Surg (Oakv) 2016; 24:89-95. [PMID: 27441191 DOI: 10.4172/plastic-surgery.1000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The osteocutaneous radial forearm free flap (OC-RFFF) remains a useful tool in head and neck reconstruction; however, it can be challenging to harvest sufficient bone for large reconstructions. The extended OC-RFFF is a modification that involves harvest of the distal border of the radius to the tip of the styloid. This increases the length of the bone flap by 2 cm to 3 cm, and the inherent contour of the styloid can be used to reconstruct the anterior curvature of the mandible or maxilla without additional osteotomies that may reduce blood supply. METHODS The key steps in harvesting the extended OC-RFFF are described. Six patients with mandibular or maxillary defects underwent reconstruction with the extended OC-RFFF. Patient data including demographics, defect features, reconstruction details and outcomes were collected. RESULTS Of the six patients who underwent the extended OC-RFFF, four had mandibular reconstruction and two had maxillary reconstruction. Two patients underwent reconstruction for osteoradionecrosis and the remainder for malignant disease. The average patient age at the time of surgery was 64.5 years. The length of radius harvested ranged from 8 cm to 14 cm (mean 9.7 cm). Two of six patients required a single osteotomy of their bone flap. Donor site complications included partial skin graft loss in 50% and a radius fracture in two patients. Recipient site complications included one patient with intraoral plate exposure. There have been no cases of nonunion. CONCLUSIONS The extended OC-RFFF was a safe and reliable option for bony reconstruction in the head and neck.
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Affiliation(s)
| | - Wendy Ng
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario
| | - Stuart Archibald
- Division of Otolaryngology Head & Neck Surgery; St Joseph's Hospital, McMaster University, Hamilton, Ontario
| | - Carolyn Levis
- Division of Plastic Surgery; St Joseph's Hospital; McMaster University, Hamilton, Ontario
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Matthews J, Ng W, Archibald S, Levis C. The use of the radial styloid in the extended osteocutaneous radial forearm free flap. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The osteocutaneous radial forearm free flap (OC-RFFF) remains a useful tool in head and neck reconstruction; however, it can be challenging to harvest sufficient bone for large reconstructions. The extended OC-RFFF is a modification that involves harvest of the distal border of the radius to the tip of the styloid. This increases the length of the bone flap by 2 cm to 3 cm, and the inherent contour of the styloid can be used to reconstruct the anterior curvature of the mandible or maxilla without additional osteotomies that may reduce blood supply. Methods The key steps in harvesting the extended OC-RFFF are described. Six patients with mandibular or maxillary defects underwent reconstruction with the extended OC-RFFF. Patient data including demographics, defect features, reconstruction details and outcomes were collected. Results Of the six patients who underwent the extended OC-RFFF, four had mandibular reconstruction and two had maxillary reconstruction. Two patients underwent reconstruction for osteoradionecrosis and the remainder for malignant disease. The average patient age at the time of surgery was 64.5 years. The length of radius harvested ranged from 8 cm to 14 cm (mean 9.7 cm). Two of six patients required a single osteotomy of their bone flap. Donor site complications included partial skin graft loss in 50% and a radius fracture in two patients. Recipient site complications included one patient with intraoral plate exposure. There have been no cases of nonunion. Conclusions The extended OC-RFFF was a safe and reliable option for bony reconstruction in the head and neck.
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Affiliation(s)
| | - Wendy Ng
- Division of Plastic Surgery, McMaster University
| | - Stuart Archibald
- Division of Otolaryngology Head & Neck Surgery; St Joseph's Hospital, McMaster University
| | - Carolyn Levis
- Division of Plastic Surgery; St Joseph's Hospital; McMaster University; Hamilton, Ontario
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The Use of a Superiorly Based Melolabial Interpolated Flap for Reconstruction of Anterior Oronasal Fistulas: An Easy and Practical Solution. Ann Plast Surg 2016; 75:163-9. [PMID: 24317248 DOI: 10.1097/sap.0000000000000059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to propose the use of a superiorly based melolabial interpolated flap for reconstruction of anteriorly located oronasal fistulas maxillary defects. MATERIALS AND METHODS Using a prospective study design, we evaluated indications and outcomes of the reconstructive technique using the interpolated melolabial flap in 6 patients affected by anteriorly located maxillary defects with naso-sinonasal communication. The cases differed in demographic characteristics and etiology of the defect. The outcome variables were flap vitality/failure and persistent/recurrent oronasal fistula. Both the outcomes were clinically evaluated. RESULTS No partial or total flap failures were recorded. Two patients experienced recurrent oronasal fistula after previous attempts of correction that required second surgery repair; in both cases, the melolabial flap was available and functional for the secondary procedure. CONCLUSIONS In selected cases, the superiorly based interpolated melolabial flap could represent a valuable choice for repairing of anteriorly located maxillary defects with oronasal fistulas.
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Gonzalez-Castro J, Petrisor D, Ballard D, Wax MK. The double-barreled radial forearm osteocutaneous free flap. Laryngoscope 2015; 126:340-4. [DOI: 10.1002/lary.25388] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/21/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Daniel Petrisor
- Department of Oral and Maxillofacial Surgery; Oregon Health and Science University; Portland Oregon U.S.A
| | | | - Mark K. Wax
- Department of Otolaryngology-Head and Neck Surgery
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Silverman DA, Przylecki WH, Arganbright JM, Shnayder Y, Kakarala K, Nazir N, Tsue TT, Girod DA, Andrews BT. Evaluation of bone length and number of osteotomies utilizing the osteocutaneous radial forearm free flap for mandible reconstruction: An 8-year review of complications and flap survival. Head Neck 2015; 38:434-8. [DOI: 10.1002/hed.23919] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dustin A. Silverman
- Department of Plastic Surgery; University of Kansas Medical Center; Kansas City Kansas
| | - Wojciech H. Przylecki
- Department of Plastic Surgery; University of Kansas Medical Center; Kansas City Kansas
| | - Jill M. Arganbright
- Department of Otolaryngology-Head and Neck Surgery; University of Kansas Medical Center; Kansas City Kansas
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery; University of Kansas Medical Center; Kansas City Kansas
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery; University of Kansas Medical Center; Kansas City Kansas
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health; Kansas City Kansas
| | - Terance T. Tsue
- Department of Otolaryngology-Head and Neck Surgery; University of Kansas Medical Center; Kansas City Kansas
| | - Douglas A. Girod
- Department of Otolaryngology-Head and Neck Surgery; University of Kansas Medical Center; Kansas City Kansas
| | - Brian T. Andrews
- Department of Plastic Surgery; University of Kansas Medical Center; Kansas City Kansas
- Department of Otolaryngology-Head and Neck Surgery; University of Kansas Medical Center; Kansas City Kansas
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Osteocutaneous free flaps for mandibular reconstruction: systematic review of their frequency of use and a preliminary quality of life comparison. The Journal of Laryngology & Otology 2014; 128:1034-43. [PMID: 25399527 DOI: 10.1017/s0022215114002278] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine whether the fibula free flap is the most frequently used osteocutaneous flap for mandible reconstruction, and whether it provides quality of life, depression and anxiety advantages. METHODS A systematic review of the public Medline database was conducted. Thirteen patients who underwent mandibular reconstruction at our hospital centre completed questionnaires to evaluate quality of life, depression and anxiety outcomes. RESULTS The most frequently used free flaps are those of the fibula (n = 982), radial forearm (n = 201), iliac crest (n = 113), subscapular system (n = 50) and rib-serratus (n = 7). In our patient population, there was a trend towards a better quality of life in those with a fibula free flap. However, patients in this group were significantly younger than patients with other flap types (p = 0.025). Patients with a subscapular system free flap were more depressed (p = 0.031); however, they had large through-and-through defects. CONCLUSION The flap used most frequently in the literature is the fibula free flap. Comparative quality of life data are lacking, and homogeneous populations should be used to reach significant conclusions.
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Thomas C, McMillan K, Jeynes P, Martin T, Parmar S. Use of a titanium cutting guide to assist raising the composite radial forearm free flap. Int J Oral Maxillofac Surg 2013; 42:1414-7. [DOI: 10.1016/j.ijom.2013.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 06/22/2013] [Accepted: 06/27/2013] [Indexed: 11/17/2022]
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Avery C, Bujtár P, Simonovics J, Dézsi T, Váradi K, Sándor GK, Pan J. A finite element analysis of bone plates available for prophylactic internal fixation of the radial osteocutaneous donor site using the sheep tibia model. Med Eng Phys 2013; 35:1421-30. [DOI: 10.1016/j.medengphy.2013.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 02/11/2013] [Accepted: 03/20/2013] [Indexed: 11/24/2022]
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Multidisciplinary Reconstruction of a Palatomaxillary Defect With Nonvascularized Fibula Bone Graft and Distraction Osteogenesis. J Craniofac Surg 2013; 24:e186-90. [DOI: 10.1097/scs.0b013e3182801eb0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wolff KD, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:829-35. [PMID: 23248713 DOI: 10.3238/arztebl.2012.0829] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/04/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND About 10,000 persons are diagnosed as having carcinoma of the oral cavity or the throat in Germany every year. Squamous-cell carcinoma accounts for 95% of cases. METHODS We systematically reviewed the pertinent literature on predefined key questions about these tumors (which were agreed upon by a consensus of the investigators), concerning imaging, the removal of cervical lymph nodes, and resection of the primary tumor. RESULTS 246 clinical trials were selected for review on the basis of 3014 abstracts. There was only one randomized, controlled trial (evidence level 1-); the remaining trials reached evidence levels 2++ to 3. Patients with mucosal changes of an unclear nature persisting for more than two weeks should be examined by a specialist without delay. The diagnosis is made by computed tomography or magnetic resonance imaging along with biopsy and a standardized histopathological examination. Occult metastases are present in 20% to 40% of cases. Advanced disease (stages T3 and T4) should be treated by surgery followed by radiotherapy, with or without chemotherapy. 20% of the patients overall go on to have a recurrence, usually within 2 to 3 years of the initial treatment. The 5-year survival rate is somewhat above 50%. Depending on the radicality of surgery and radiotherapy, there may be functional deficits, osteoradionecrosis, and xerostomia. The rate of loss of implants in irradiated bone is about 10% in 3 years. CONCLUSION The interdisciplinary planning and implementation of treatment, based on the patient's individual constellation of findings and personal wishes, are prerequisites for therapeutic success. Reconstructive measures, particularly microsurgical ones, have proven their usefulness and are an established component of surgical treatment.
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Affiliation(s)
- Klaus-Dietrich Wolff
- Clinic and Policlinic for Oro-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Bujtar P, Simonovics J, Váradi K, Sándor GKB, Pan J, Avery CME. Refinements in osteotomy design to improve structural integrity: a finite element analysis study. Br J Oral Maxillofac Surg 2012; 51:479-85. [PMID: 23084459 DOI: 10.1016/j.bjoms.2012.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Osteotomy cuts are typically made using a saw, and the meeting point acts as a focus for the concentration of stress and failure. We have studied the impact of different designs of osteotomy cut. Cadaver sheep tibias were scanned by computed tomography (CT) and transformed into a computer-aided design (CAD) model. A standard marginal resection defect was created and then modified, and a finite element analysis made. The relative stress concentrations at the intersection of osteotomy cuts were recorded using principal stresses S1, S3, and von Mises stress, von Mises under both 4-point bending and torsion testing. The osteotomy designs studied were: right-angled and bevelled osteotomy end cuts, overcutting, and a stop drill hole. Peak stress values for 4-point bending and torsion were 24-30% greater at the right-angled osteotomy than the bevelled end cut. Overcutting dramatically increased peak stress values caused by bending and torsion by 48% and 71%, respectively. Substantially lower concentrations of stress were noted with a stop hole using both a 90° (bending 38% and torsion 56%), and a tangential (bending 58% and torsion 60%) cut. A bevelled osteotomy has substantially lower concentrations of stress than a right-angled osteotomy. It is important to avoid creating an overcut as this causes an appreciable increase in the concentration of stress, while a stop drill hole substantially reduces the stress. The creation of a stop hole and the use of judicious bevelling techniques are modifications in the design of an osteotomy that are readily applicable to surgical practice.
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Affiliation(s)
- P Bujtar
- Department of Maxillofacial Surgery, University Hospitals of Leicester, Leicester, UK.
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Dean NR, McKinney SM, Wax MK, Louis PJ, Rosenthal EL. Free flap reconstruction of self-inflicted submental gunshot wounds. Craniomaxillofac Trauma Reconstr 2012; 4:25-34. [PMID: 22379504 DOI: 10.1055/s-0031-1272899] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In this study, we review outcomes for 15 patients with self-inflicted submental gunshot wounds requiring free flap reconstruction. Patients presented to two tertiary care centers over a 7-year period. Mean age was 46 years (range, 16 to 76 years), 67% (n = 10) had a psychiatric history, and four were known to abuse illicit substances. Patients with oromandibular involvement required on average a total of 2.8 procedures, and those with midface (3.7) or combined defects (6) required more total procedures (p = 0.21). Donor sites included osteocutaneous radial forearm (n = 8), fibula (n = 4), fasciocutaneous radial forearm (n = 5), and anterior lateral thigh (n = 1). Median length of hospitalization was 8 days. Overall complication rate was 33% (n = 5), and included hematoma (n = 1), fistula (n = 1), and mandibular malunion (n = 2). Most patients were able to tolerate a regular or soft diet (92%), maintain oral competency (58%), and demonstrate intelligible speech (92%) at a median time to follow-up of 12 months. Despite the devastating nature of this injury, free flap reconstruction of self-inflicted submental gunshot wounds results in acceptable functional results for the majority of patients.
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Kolb CM, Pierce LM, Roofe SB. Biocompatibility comparison of novel soft tissue implants vs commonly used biomaterials in a pig model. Otolaryngol Head Neck Surg 2012; 147:456-61. [PMID: 22687327 DOI: 10.1177/0194599812450855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a model to evaluate biocompatibility, integration, and substrate independence of novel porous bioscaffolds for maxillofacial and plastic reconstruction using sphere-templated angiogenic regeneration technology compared with currently available synthetic and biologic soft tissue implants. STUDY DESIGN A prospective pilot study using animals. SETTING Military medical center. SUBJECTS AND METHODS Five pigs underwent dorsal subcutaneous implantation of a polypropylene-based material coated with precision pore silicone granules (sphere-templated scaffold), expanded polytetrafluoroethylene, human dermis, and porcine dermis. Sham and undissected sites were also used as controls. Specimens were harvested 7, 21, 90, and 180 days after surgery and evaluated histologically for inflammation, neovascularization, and collagen deposition. RESULTS All materials and sham sites induced a mild to moderate inflammation that decreased over time, except for human dermis, which elicited a moderate to severe inflammatory response. The responses were varied and measurable using subjective scoring methods. The sphere-templated scaffold demonstrated numerous foreign body giant cells adjacent to the silicone granules, which were not seen in any of the other specimens. CONCLUSION Subjective scoring of pathology slides and measurement of capsule thickness appeared to show differences between the materials, but these differences require a larger number of subjects and proper statistical analysis to assess. The robust foreign body reaction elicited by the polypropylene/silicone-based scaffold argues against the use of this material in future studies. The authors advocate using inert biodegradable substances for future bioscaffold constructs.
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Affiliation(s)
- Caroline M Kolb
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA.
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Hoffman GR, Islam S, Eisenberg RL. Microvascular Reconstruction of the Mouth, Jaws, and Face: Experience of an Australian Oral and Maxillofacial Surgery Unit. J Oral Maxillofac Surg 2012; 70:e371-7. [DOI: 10.1016/j.joms.2012.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/12/2012] [Accepted: 01/15/2012] [Indexed: 11/26/2022]
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Dean NR, Wax MK, Virgin FW, Magnuson JS, Carroll WR, Rosenthal EL. Free flap reconstruction of lateral mandibular defects: indications and outcomes. Otolaryngol Head Neck Surg 2011; 146:547-52. [PMID: 22166963 DOI: 10.1177/0194599811430897] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare outcomes following osteocutaneous radial forearm and fibula free flap reconstruction of lateral mandibular defects. STUDY DESIGN Retrospective case-controlled study. SETTING Historical cohort study. SUBJECTS AND METHODS All patients who underwent free flap reconstruction of lateral mandibular defects from 1999 to 2010 were included in this study. Patients were classified into 2 groups based on type of reconstruction: (1) osteocutaneous radial forearm (n = 73) and (2) fibula free flap reconstruction (n = 51). Patient characteristics, length of hospital stay, recipient and donor site complications, and long-term outcomes including postoperative diet were evaluated. RESULTS Most patients were male (68%) and presented with advanced T-stage (71%) squamous cell carcinoma (94%) involving the alveolus (21%), retromolar trigone (23%), or oral tongue (21%). Median length of hospital stay was 8 days (range, 4-22 days). The recipient site complication rate approached 27% and included infection (n = 11), mandibular malunion (n = 9), exposed bone or mandibular plates (n = 9), and flap failure (n = 5). Most patients demonstrated little to no trismus following reconstruction (94%) and were able to resume a regular or edentulous diet (73%). No difference in complication rates or postoperative outcomes was seen between osteocutaneous radial forearm and fibula free flap groups (P > .05). One patient underwent dental implantation following osteocutaneous radial forearm free flap reconstruction. No patients from the fibula free flap group underwent dental implantation. CONCLUSION The osteocutaneous radial forearm and fibula free flap provide equivalent wound healing and functional outcomes in patients undergoing lateral mandibular defect reconstruction.
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Affiliation(s)
- Nichole R Dean
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0012, USA
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Chen YC, Valerio IL, Chien CY, Jeng SF. Pedicled mandible myo-osseous flaps combined with free skin flaps for reconstruction of complex lateral mandibular defects. Head Neck 2011; 34:384-92. [PMID: 21584895 DOI: 10.1002/hed.21740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 12/10/2010] [Accepted: 01/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study presents an alternative in reconstruction, using free skin flaps in combination with pedicled mandible bone flaps for complex lateral mandibular defects. METHODS In all, 13 patients were included in this prospective study. Pedicled mandible myo-osseous flaps were used for reconstruction of bone defects of the lateral mandible in combination with free skin flaps, including radial forearm flaps (n = 3), anterolateral thigh (ALT) flaps (n = 9), and local tongue flap (n = 1). Postoperatively, a (99m)Tc-methyl diphosphonate bone scan was performed to assess bone flap viability. RESULTS All patients had acceptably contoured mandibles. The major complications consisted of 1 failed ALT flap and 2 nonviable bone flaps. The bone scan confirmed viable bone flaps in 11 cases. Ten patients (77%) were able to resume soft to full diets. CONCLUSIONS For complex lateral mandibular defects (≤6 cm), a combination of the pedicled mandible myo-osseous flaps and free skin flaps is an alternative in reconstruction.
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Affiliation(s)
- Yen-Chou Chen
- Department of Plastic and Reconstructive Surgery, and Department of Otolaryngology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Avery C, Skidmore M, Peden A, Pan J. Biomechanical study of a unilocking T-plate system for prophylactic internal fixation of the radial osteocutaneous donor site using the sheep tibia model. Oral Oncol 2011; 47:268-73. [DOI: 10.1016/j.oraloncology.2011.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 01/22/2011] [Accepted: 02/03/2011] [Indexed: 11/30/2022]
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Abstract
Reconstruction of a midfacial defect can represent a formidable challenge for the reconstructive surgeon. Attesting to both the variety and the complexity of midfacial defects, numerous different classification schemes have been proposed, and are reviewed in this article. The approach to reconstruction can be simplified, however, by classifying maxillectomy defects into four types. Understanding the complex three-dimensional anatomy of the maxilla and its relationship to contiguous structures is the first step in approaching reconstruction of the midface. Achieving basic functional and aesthetic goals of maxillary reconstruction can be achieved using free flap reconstruction with good reliability and predictability in the majority of patients. A specific approach to each defect type is outlined.
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Ya'ish F, Waton A, B'Durga H, Nanu A. Osteocutaneous radial forearm free flaps: prophylactic fixation of donor site using locking plate augmented with mineral cement. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2011; 16:215-222. [PMID: 21548165 DOI: 10.1142/s0218810411005400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 02/08/2011] [Indexed: 05/30/2023]
Abstract
Prophylactic plating of donor site in osteocutaneous radial forearm free flaps have demonstrated improvement in fracture rates. Previous series used conventional plating systems which rely on plate-bone friction forces to generate stability and can result in iatrogenic fractures if not accurately contoured. Locking plates have superior stability and do not require contouring. This retrospective series reports our experience using locking plate fixation augmented with calcium phosphate mineral cement. Twenty patients' records were reviewed; 13 were alive and reviewed clinically. Mean radiological follow-up was 28.2 months. Two deceased patients had donor site fractures diagnosed on the first postoperative radiograph. These fractures were related to technical fixation errors and failure to apply correct locking fixation principles. None of the other patients with proper locking fixation had fractures or metalwork related complications. We believe that locking fixation augmented with mineral cement can provide more biological stability and enhance restoration of bone structural strength.
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Affiliation(s)
- F Ya'ish
- Orthopaedic Department, Sunderland Royal Hospital Sunderland, SR4 7TP, UK.
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Avery C, Parmar S, Martin T. The use of a T-shaped contoured unilocking titanium radial plate for prophylactic internal fixation of the radial osteocutaneous donor site. Br J Oral Maxillofac Surg 2010; 48:648-50. [DOI: 10.1016/j.bjoms.2010.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/26/2010] [Indexed: 11/26/2022]
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The Temporoparietal Fascial Flap Is an Alternative to Free Flaps for Orbitomaxillary Reconstruction. Plast Reconstr Surg 2010; 126:880-888. [DOI: 10.1097/prs.0b013e3181e3b6f0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Avery C. Review of the radial free flap: still evolving or facing extinction? Part two: osteocutaneous radial free flap. Br J Oral Maxillofac Surg 2010; 48:253-60. [DOI: 10.1016/j.bjoms.2009.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 09/30/2009] [Indexed: 10/19/2022]
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