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Vasques LF, Kwiatkowski FV, Kwiatkowski RV, Anjos ADS, Zanatta AS, Bonow DR, Franciosi BM. Versatility of the myocutaneous pectoralis major flap in oncology reconstruction: A literature review and practical application. J Surg Oncol 2024. [PMID: 39138935 DOI: 10.1002/jso.27724] [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: 04/01/2024] [Accepted: 05/12/2024] [Indexed: 08/15/2024]
Abstract
Pectoralis major muscle flaps are considered versatile and allow large reconstructions of anatomical defects within a single surgical procedure. Considered a "workhorse" due to these characteristics, the pectoralis major muscle is an excellent option for surgical reconstruction. Several uses of this flap are described in the literature, such as protection of the jugulocarotid system after cervical lymph node dissection, oral, cervical, breast, diaphragmatic, hypopharyngeal, pharyngeal, laryngeal, and esophageal reconstructions.
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Affiliation(s)
- Luana Ferreira Vasques
- Medicine Department of Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Filipe Vieira Kwiatkowski
- Surgical Oncology Department, Santa Casa de Misericórdia de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Rafael Vieira Kwiatkowski
- Surgical Oncology Department, Santa Casa de Misericórdia de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Amanda da Silva Anjos
- Internal Medicine Department, Santa Casa de Misericórdia de Curitiba, Curitiba, Parana, Brazil
| | | | - Danielle Rediess Bonow
- Medicine Department of Universidade Federal de Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
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Chen J, Liang N, Sun C, Zhang L, Yi T, Liao Q, Zhou S. Factors Influencing Postoperative Prognosis in Patients with Hypopharyngeal and Laryngeal Carcinoma. EAR, NOSE & THROAT JOURNAL 2023; 102:794-802. [PMID: 36427261 DOI: 10.1177/01455613221142120] [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] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Despite the increasingly modern surgical techniques in the oncology field, the factors that influence postoperative prognosis in patients with hypopharyngeal and laryngeal carcinoma (HLC) remain unclear. The study aimed to evaluate the factors influencing the prognosis of HLC patients with pathological diagnosis of squamous cell carcinoma, and the findings are intended to direct follow-up management strategies. METHODS A retrospective cohort study was performed. The study population included 407 postoperative patients with HLC from 2011 to 2015. Univariate and multivariate analyses were used to examine the prognostic factors identified. RESULTS Based on univariate analysis results, smoking and alcohol history, tumor differentiation, preoperative radiotherapy, primary tumor sites, flap reconstruction, lymph node invasion (LNI), and preoperative albumin levels (PAL) significantly affects the prognosis of HLC patients (P < .05). Meanwhile, multivariate analysis revealed that smoking pack-year (OR = 1.002, 95% CI = 1.001 ∼ 1.003), primary tumor sites (OR = 6.241, 95% CI = 1.715 ∼ 18.433), LNI (OR = 2.869, 95% CI = 1.095 ∼ 8.743), and PAL (OR = .020, 95% CI = .004 ∼ 0.104) were associated with complications. Tumor differentiation (OR = 0.650, 95% CI = .383 ∼ 0.855), primary tumor sites (OR = 12.392, 95% CI = 3.290 ∼ 26.679), LNI (OR = 16.323, 95% CI = 2.726 ∼ 47.729), preoperative radiotherapy (OR = 9.300, 95% CI = 3.182 ∼ 27.181), and PAL (OR = .321, 95% CI = .141 ∼ .732) were associated with overall survival rates. CONCLUSION Smoking and alcohol history, tumor differentiation, LNI, primary tumor sites, flap reconstruction, PAL, and preoperative radiotherapy are crucial factors that influence the postoperative prognosis of patients with HLC. In addition, a monogram of five factors was established to predict the survival rates of HLC patients.
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Affiliation(s)
- Jingjing Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Otorhinolaryngology-Head and Neck Surgery, Ningbo City Medical Treatment Center LiHuili Hospital, Ningbo, China
| | - Nan Liang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ningbo City Medical Treatment Center LiHuili Hospital, Ningbo, China
- Zhejiang Provincial Key Laboratory of Pathophysiology, Medical School of Ningbo University, Ningbo, China
| | - Chaochan Sun
- Department of General outpatient, Yinzhou District Baihe Street Community Health Service Center, Ningbo, China
| | - Luyi Zhang
- Zhejiang Provincial Key Laboratory of Pathophysiology, Medical School of Ningbo University, Ningbo, China
| | - Tianfei Yi
- Zhejiang Provincial Key Laboratory of Pathophysiology, Medical School of Ningbo University, Ningbo, China
| | - Qi Liao
- Zhejiang Provincial Key Laboratory of Pathophysiology, Medical School of Ningbo University, Ningbo, China
| | - Shuihong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Noothanapati NR, Akali NR, Buggaveeti R, Balasubramanian D, Mathew J, Iyer S, Thankappan K. Reconstruction in Salvage Surgery for Head and Neck Cancers. Craniomaxillofac Trauma Reconstr 2023; 16:211-221. [PMID: 37975025 PMCID: PMC10638975 DOI: 10.1177/19433875221109248] [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: 11/19/2023] Open
Abstract
Introduction Salvage surgery is the treatment option in recurrences and second primary tumors. This paper aimed to study the options and outcomes of reconstruction and the predictors of poor reconstructive outcomes in salvage surgery for head and neck cancers. Study Design This is a retrospective study of all patients who underwent reconstructive flap surgery as part of salvage surgery for head and neck cancers between the years 2004 and 2017. Methods The initial treatment may be single modality radiotherapy or surgery or multimodality with combinations of surgery, radiotherapy, and chemotherapy. Any pathology that required surgical salvage was included. Any procedures done purely as reconstructive surgery were excluded. Predictor variables included demographical, clinical, and treatment factors. The outcome parameter was the occurrence of any flap-related complication or not. The complications and morbidity related to the procedures are reported. Results Ninety-three patients underwent loco-regional flaps (LRF group), and 100 had free flaps (FF group). Pectoralis major flap was the commonest flap used in 68 patients (73.1%). Anterolateral thigh (ALT) flap was the commonest free flap and comprised 41% of the FF group. Any skin-related complication was seen in 35 patients (37.6%) and 41 (41%), respectively, in LRF and FF subsets. Any flap-related complication was seen in 16 patients (17.2%) and 29 patients (29%), respectively, in LRF and FF subsets. A summary measure "any one of the complications" was seen in 46 (49.5%) and 57 (57%), respectively, in LRF and FF subsets. Univariate and multivariate analysis for any flap-related complication identified no statistically significant predictor. Conclusions Soft tissue flaps were preferred in salvage reconstruction, though the defects had a bony component. In the microvascular free flap reconstruction era, pectoralis major flap has shifted its role from a "workhorse flap" to a "salvage flap." About half of the patients develop some complications. Flap-related complications are also common. In salvage surgery, it is important that an appropriate flap is selected, suitable for the setting, according to the indications, neck, and patient conditions.
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Affiliation(s)
- Nageswara R. Noothanapati
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Nisha R. Akali
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rahul Buggaveeti
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Jimmy Mathew
- Department of Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Choudhury A, Laxmidhar MI, Ahirwar N. Has the Pectoralis Major flap Really Become Obsolete? Indian J Otolaryngol Head Neck Surg 2023; 75:2172-2176. [PMID: 37636713 PMCID: PMC10447656 DOI: 10.1007/s12070-023-03842-x] [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: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 08/29/2023] Open
Abstract
Aim To evaluate the current role of pectoralis major (PM) flap including the reasons for selecting it over free flaps. Materials and methods All patients who underwent PM flap at Apollo Hospitals Ahmedabad during the 3-year period from January 2020 to December 2022 were included. Patient demographics, tumour characteristics and complications were studied and reasons for selecting pectoralis major flap were analyzed. Data was entered in Microsoft excel spreadsheet and analyzed using online statistical calculators. The p value of < 0.05 was considered statistically significant. Results 57 patients underwent reconstruction with PM flap while 154 patients underwent free flap reconstruction. 54 were male and 3 were female. Median age was 51 years. PM flap was used for intraoral lining in 25 patients, and it was bilobed in 26 patients with full thickness cheek defect. Most common complication was wound infection seen in 10 patients. 5 patients developed marginal necrosis of the flap and 5 had donor site wound dehiscence. No complete flap loss was seen. During the same period, 15/154 (9.74%) patients with free flaps developed complete flap necrosis and this was statistically significant (p = 0.012). Reasons for choosing PM flap were also analyzed. 14 patients had major comorbidities, 18 had extensive disease, in 5 patients it was used for salvage post free flap failure, while 10 previously treated patients had unavailability of suitable vessels for anastomosis. 12 patients underwent PM flap due to financial constraints. Conclusion Thus, PM flap is not obsolete and continues to maintain its place in head and neck reconstruction.
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Affiliation(s)
- Arpan Choudhury
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
| | - Murtuza I Laxmidhar
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
| | - Neelam Ahirwar
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
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Lee ZH, Hanasono MM. Pharyngeaoesophageal Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00062-2. [PMID: 37221117 DOI: 10.1016/j.otc.2023.04.005] [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: 05/25/2023]
Abstract
Pharyngoesophageal reconstruction is one of the most challenging reconstructive dilemmas that demands extensive planning, meticulous surgical execution, and timely management of postoperative complications. The main goals of reconstruction are to protect critical blood vessels of the neck, to provide alimentary continuity, and to restore functions such as speech and swallowing. With the evolution of techniques, fasciocutaneous flaps have become the gold standard for most defects in this region. Major complications include anastomotic strictures and fistulae, but most patients can tolerate an oral diet and achieve fluent speech after rehabilitation with a tracheoesophageal puncture.
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Affiliation(s)
- Z-Hye Lee
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Matthew M Hanasono
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Taghizadeh F, Troob SH, Wax MK. The Role of Fluorescent Angiography in Free Flap Reconstruction of the Head and Neck. Laryngoscope 2022; 133:1388-1393. [PMID: 36239629 DOI: 10.1002/lary.30450] [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: 11/29/2021] [Revised: 08/13/2022] [Accepted: 09/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Highlight the use of fluorescent angiography in free flap reconstruction of the head and neck. Qualify how fluorescent angiography can be selectively added to management paradigms for head and neck free flap reconstruction. METHODS Retrospective chart review of 993 free flaps completed from the time the SPY Elite® system first became available at our institution between September 2013, until August 2020. Cases that used the SPY Elite® system were grouped into three broad categories: evaluation during initial flap harvest while still attached to the donor site, evaluation after anastomosis in the head and neck area, and evaluation post-operatively for questionable flap viability. RESULTS The SPY Elite® system was used in 64 cases. Forty flaps were evaluated intraoperatively during initial harvest and before anastomosis to the head and neck area. Of these, 20 had signs of poor perfusion of the entire skin paddle, 12 had large myogenous or skin flaps with questionable perfusion of the distal aspect, and 8 were evaluated for other reasons. In this group the use of SPY Elite® changed the management of the patient in 20 cases (50%). Ten flaps were evaluated intraoperatively after anastomosis to the head and neck to ascertain adequate flow to the entire flap. In this group management was changed in two (20%). Fourteen flaps were evaluated 3-5 days post operatively due to suspected failure of a component. In five cases (36%), the use of SPY Elite® determined management with either trimming or discarding the flap. CONCLUSION Assessment of flap perfusion via fluorescent angiography during initial flap harvest or when flap compromise is suspected post-operatively can guide decision making in free flap reconstruction of the head and neck and can be added to existing planning and management paradigms. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Farshid Taghizadeh
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Scott H Troob
- Department of Otolaryngology, Columbia University, New York, New York, U.S.A
| | - Mark K Wax
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, U.S.A
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Sharma AP, Malik J, Monga S, Alam S, Rasool S, Agarwal D, Bahadur S. Analysis of the efficacy of the pectoralis major myocutaneous flap in reconstructive head and neck surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:151-156. [DOI: 10.1016/j.otoeng.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022]
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Single Stage Reconstruction of Full Thickness Defects of Cheek with Pectoralis Major Myocutaneous Flap Using an Innovative Flap Technique. Indian J Surg Oncol 2021; 13:377-382. [DOI: 10.1007/s13193-021-01482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/23/2021] [Indexed: 10/19/2022] Open
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Bolletta A, Losco L, Lin J, Oh C, Di Taranto G, Trignano E, Cigna E, Chen HC. Partition of Pectoralis Major Musculocutaneous Flap as a Salvage Procedure for Simultaneous Coverage of the Exposed Carotid Artery and Reconstruction of Cervical Esophagus. Ann Plast Surg 2021; 87:435-439. [PMID: 34270475 DOI: 10.1097/sap.0000000000002895] [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: 11/26/2022]
Abstract
BACKGROUND In advanced pharyngoesophageal cancer patients, a critical event is represented by the failure of primary reconstruction with exposure of the carotid artery and partial or total defect of the cervical esophagus. For these high-risk patients, a partitioned pectoralis major musculocutaneous (PMMC) flap can prevent carotid blowout and provide skin for simultaneous esophageal reconstruction. METHODS Twenty-six patients needing pharyngoesophageal reconstruction together with coverage of carotid artery exposure were included in this retrospective case series. The patients were treated with a partitioned PMMC flap, based on the branching pattern of the pectoral branch of the thoracoacromial artery and the perforators of the pectoralis major muscle, to simultaneously reconstruct the defect and provide coverage for the carotid artery. RESULTS In 25 patients, the partitioned PMMC flap reconstructions resulted in complete wound healing without occurrence of carotid blowout syndrome or fistula formation. Minor complications as partial flap necrosis (7.7%) and strictures formation (7.7%) were recorded but did not compromise reconstruction. Twenty-two patients were able to adopt a semisolid diet, and 4 had recurrence of cancer. CONCLUSIONS The partitioned PMMC flap reconstruction represents a useful salvage solution to simultaneously restore the continuity of the alimentary tract and provide reliable coverage for the exposed carotid artery.
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Affiliation(s)
- Alberto Bolletta
- From the Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Jason Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Christine Oh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Giuseppe Di Taranto
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Umberto I University Hospital, Rome, Italy
| | - Emilio Trignano
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Hung-Chi Chen
- From the Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
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Functional Shoulder Outcome and Quality of Life Following Modified Muscle-Sparing Pectoralis Major Flap Surgery. Healthcare (Basel) 2021; 9:healthcare9091158. [PMID: 34574932 PMCID: PMC8467859 DOI: 10.3390/healthcare9091158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The pedicled pectoralis major muscle flap (PMMF) is a well established flap for fistula prophylaxis after salvage laryngectomy. To reduce donor site morbidity, we established a modified muscle-sparing harvesting technique. We herein investigate postoperative shoulder function and health-related quality of life (HRQOL). METHODS A chart review of patients receiving the modified muscle-sparing pectoralis major muscle flap between 2013-2020 was performed. Nineteen patients (male = 18, female = 1) were potentially eligible and six male patients were ultimately enrolled. Postoperative shoulder function was assessed on both sides (flap side versus non-flap side) using the Constant Murley Score and the Bak criteria. Health-related quality of life was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in cancer patients (EORTC QLQ-C30) and head and neck cancer patients (EORTC H&N35). RESULTS No Constant Murley Score subscale was statistically significant (p ≥ 0.180). Bak criteria was overall rated "Good". Solely upper extremity adduction force was significantly altered on the flap side (p = 0.039). Median EORTC QLQ-C30 score was 82.2 (IQR 11.1) on the functional scale and 10.3 (IQR 2.6) on the symptomatic scale. Median quality of life score was 75.0 (IQR 33.3) and median EORTC QLQ-H&N35 was 20.6 (IQR 9.8). CONCLUSIONS Postoperative shoulder function after modified muscle-sparing pectoralis major muscle flap surgery is comparable to function of the healthy side with a significant deficiency in adduction force not compromising daily life in this small study cohort.
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Ahmadi A, Pahlavan PA, Goli MS. Simultaneous use of two pectoralis flaps after total laryngopharyngectomy and total glossectomy – A case report study. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Use of a sternocleidomastoid muscle flap to protect the carotid artery during laryngectomy. The Journal of Laryngology & Otology 2021; 135:547-550. [PMID: 33975660 DOI: 10.1017/s0022215121001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This paper describes a simple method of securing tissue coverage of the great vessels at the initial surgery by rotating the divided sternal heads of the sternocleidomastoid muscle, a routine step during laryngectomy, and approximating them to the prevertebral fascia. The paper presents an illustrated case example where this technique in a salvage laryngectomy repair resulted in a protected vascular axis following a salivary leak. RESULTS Since utilising this technique, there has been a marked reduction in the requirement of subsequent flap procedures to protect vessels, and no episodes of threatened or actual carotid blowout.
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Ooi ASH, Ng MJM, Sudirman SRB, Chang D. The chimeric medial sural artery perforator flap as the ideal for partial tongue reconstruction: A case series and technical refinements. J Plast Reconstr Aesthet Surg 2021; 74:2613-2621. [PMID: 33972203 DOI: 10.1016/j.bjps.2021.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/29/2021] [Accepted: 03/11/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The medial sural artery perforator free flap (MSAP) has gained increasing popularity in head and neck reconstruction. Its slightly bulkier nature than the radial forearm flap, combined with negligible donor site morbidity, makes it an ideal candidate for the reconstruction of partial glossectomy defects. The ability to harvest the MSAP as a chimeric flap with a portion of the medial gastrocnemius muscle gives it greater flexibility in soft tissue reconstruction. METHODS A retrospective study of patients with partial glossectomy defects reconstructed using the MSAP by a single surgeon was performed. Perioperative data, donor and recipient site characteristics, complications, and outcomes were analyzed. A video is included to show technical points for the harvest of the flap. RESULTS A total of 10 patients were included. The average age was 59.1 years, with a mean of 43.5% of the tongue resected. All flaps survived, with no major complications. At follow-up, the patients had regained an average of 86.5% of original speech, with none requiring NG feeding. The average MSAP skin flap thickness was 7.8 mm, with 6 flaps being harvested as chimeric fasciocutaneous muscle flaps. Five flaps incorporated 2 perforators. Two case examples are presented. CONCLUSION The chimeric MSAP perforator allows for more robust partial glossectomy reconstruction with improved postoperative functional outcomes. It should be considered as the workhorse flap for partial tongue reconstruction.
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Affiliation(s)
- Adrian S H Ooi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore; SingHealth Duke-NUS Head and Neck Center, SingHealth, Singapore; Polaris Plastic & Reconstructive Surgery, Singapore.
| | - Marcus J M Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - David Chang
- Section of Plastic Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, IL, USA
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Sharma AP, Malik J, Monga S, Alam S, Rasool S, Agarwal D, Bahadur S. Analysis of the efficacy of the pectoralis major myocutaneous flap in reconstructive head and neck surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30202-8. [PMID: 33485625 DOI: 10.1016/j.otorri.2020.11.007] [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] [Received: 06/19/2020] [Revised: 11/10/2020] [Accepted: 11/21/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Although free flaps have been used predominantly in past decades for the soft tissue reconstruction of head and neck malignancies, Pectoralis major myocutaneous flap (PMMF) is still a reliable workhorse for patients with co-existing co-morbidities or low economic status where free flaps are not feasible. PATIENTS AND METHODS It was a retrospective study done on 36 patients of head and neck malignancies over the period of 5 years in which PMMF was used as a method of reconstruction in our hospital. Patients were followed up for a period of one year and outcome of PMMF was evaluated. RESULTS Out of 36 patients 31 were of oral cancer and 5 were of carcinoma hypopharynx. Incidence of total flap necrosis was nil and partial flap necrosis was 16.6%. Orocutaneous fistula was found in 16.6%, wound dehiscence was in 19.4% and infection was found in 13.5% of patients. Non-flap related complications were found in 13.8% of patients. 35 out of 36 patients (97.2%) eventually achieved satisfactory surgical outcome of PMMF reconstruction. CONCLUSION PMMF is a reliable method of reconstruction for head and neck malignancies especially in basic healthcare settings. With minimal expertise and groundwork, it is still a cost-effective workhorse flap for head and neck reconstruction.
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Affiliation(s)
- Arun Parkash Sharma
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Junaid Malik
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Seema Monga
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India.
| | - Shamsheer Alam
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Shahid Rasool
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Deepti Agarwal
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Sudhir Bahadur
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
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Surgical Techniques for Head and Neck Reconstruction in the Vessel-Depleted Neck. Facial Plast Surg 2020; 36:746-752. [PMID: 33368131 DOI: 10.1055/s-0040-1721108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The vessel-depleted neck presents a unique and challenging scenario for reconstructive surgery of the head and neck. Prior surgery and radiation often result in significant scarring and damage to the neck vasculature, making identification of suitable recipient vessels for microvascular free tissue transfer exceedingly difficult. Therefore, alternative reconstructive techniques and/or vessel options must be considered to obtain a successful reconstructive outcome for a patient. In this article, we discuss our experience and approach to the management of the vessel-depleted neck, emphasizing the importance of preoperative planning and having multiple backup options prior to surgery. The various preoperative imaging modalities and available options for recipient arteries and veins are presented in detail. Additionally, we discuss modifications of select free flaps to maximize their utility in successful reconstruction. Together with thoughtful preoperative planning, these techniques can help aid the reconstructive surgeon in addressing the complex decisions associated with the vessel-depleted neck.
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Ng MJM, Goh CSL, Tan NC, Song DH, Ooi ASH. A Head-to-Head Comparison of the Medial Sural Artery Perforator versus Radial Forearm Flap for Tongue Reconstruction. J Reconstr Microsurg 2020; 37:445-452. [PMID: 33032358 DOI: 10.1055/s-0040-1718551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND For tongue reconstruction, the radial forearm flap (RFF) is commonly used. In the last decade, the medial sural artery perforator (MSAP) flap has been successfully used with reportedly superior donor-site outcomes. Our study is the first to compare the RFF and MSAP for reconstruction of partial glossectomy defects (<50% of tongue). METHODS We conducted a retrospective review of 20 patients with partial glossectomy defects reconstructed at a tertiary referral center. Patient demographics, perioperative data, and postoperative complications were analyzed. Objective measures of speech, swallowing, and subjective patient satisfaction with their donor site were recorded. RESULTS Ten RFF and MSAP were each used, with a mean partial glossectomy defect size of 40.5 and 43.5%, respectively. The MSAP was significantly thicker (7.8 vs. 4.3 mm, p < 0.05) with a longer harvest time (122.5 vs. 75.0 minutes, p < 0.05). There were no cases of free flap failure. Donor-site healing times were comparable, but the MSAP group experienced significantly less donor-site complications (n = 1 vs. n = 7, p < 0.05). Functional outcomes were comparable with 13 patients achieving normal speech and diet after 3 months (MSAP = 6 vs. RFF = 7, p = 1.00). All patients were satisfied with their donor-site outcome with the MSAP group having a marginally higher score. CONCLUSION Both flaps are good options for partial glossectomy reconstruction. Though more challenging to harvest, the MSAP gives comparable functional results and has become our first reconstructive option given its superior donor-site outcomes.
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Affiliation(s)
- Marcus J M Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cindy S L Goh
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Ngian Chye Tan
- SingHealth Duke-NUS Head and Neck Center, SingHealth, Singapore
| | - David H Song
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Adrian S H Ooi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.,SingHealth Duke-NUS Head and Neck Center, SingHealth, Singapore
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17
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Lakshminarayana G, Venkitachalam S, Mani CS. Choice of Regional Flaps for Oral Cancer Defects: Relevance in Current Era. J Maxillofac Oral Surg 2019; 20:246-251. [PMID: 33927493 DOI: 10.1007/s12663-019-01305-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Microvascular free flaps (MVFF) are the current standard of care for reconstruction of oral ablative defects; however, pedicled myocutaneous flaps (PMCF) are still used widely in India. The rationale behind the preference for selecting PMCF in the present era is not well understood. The associated complications and swallowing outcomes are variable. Methods We retrospectively analysed the records of patients who underwent reconstructive surgery for oral cancer ablative defects over a 3-year period. Results Ninety-seven pedicled myocutaneous flaps [89 pectoralis major myocutaneous (PMMC) flaps, eight lower trapezius island myocutaneous (TMC) flaps] and 113 MVFFs were performed. The reasons for selecting PMCF were financial constraints 38.7%, MVFF salvage 22.5%, medically compromised 10.7%, vessel-depleted neck 6.4%, old age with PS2 + 5.3%, early recurrence 5.3%, borderline resectable 4.3%, palliative resection 2.1%. Overall complication rate was 20.4%. Of patients, 50.7% and 34.7% were on regular and semisolid diet, respectively; 66.6% had acceptable swallowing-related social well-being. Conclusion PMCFs have an important role in developing countries with patients having financial constraints. The other potential reasons driven by patient factors were discussed. The swallowing outcomes are good, with majority of the people having socially acceptable swallowing function.
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Affiliation(s)
- G Lakshminarayana
- Cancer Research and Relief Trust, C/o Kumaran Hospital, No. 214, EVR Periyar Salai, Kilpauk, Chennai, Tamil Nadu 600010 India
| | - Shruti Venkitachalam
- Cancer Research and Relief Trust, C/o Kumaran Hospital, No. 214, EVR Periyar Salai, Kilpauk, Chennai, Tamil Nadu 600010 India
| | - C S Mani
- Cancer Research and Relief Trust, C/o Kumaran Hospital, No. 214, EVR Periyar Salai, Kilpauk, Chennai, Tamil Nadu 600010 India
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18
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Rauchenwald T, Dejaco D, Morandi EM, Djedovic G, Wolfram D, Riechelmann H, Pierer G. The Pectoralis Major Island Flap: Short Scar Modified Muscle-Sparing Harvesting Technique Improves Aesthetic Outcome in Reconstructive Head and Neck Surgery. ORL J Otorhinolaryngol Relat Spec 2019; 81:327-337. [PMID: 31698360 DOI: 10.1159/000503008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pectoralis major flap reconstruction is often associated with large unappealing scars in head-neck surgery. We recently established an alternative harvesting technique that improves aesthetic outcome. OBJECTIVES The objective of this study was to demonstrate a modified surgical technique that harvests the pectoralis major muscle as an island flap and focuses on minimizing incision lines and applying a muscle-sparing approach. METHODS A retrospective analysis covering the period 2008-2018 was conducted. Patients who underwent pectoralis major island flap reconstruction for fistula prophylaxis after salvage laryngectomy at the Medical University of Innsbruck were included. Flap harvesting was performed subcutaneously using two small incision lines, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle. RESULTS Twenty-three patients with squamous cell carcinoma of the larynx (n = 19) or pharynx (n = 4) underwent salvage laryngectomy and consecutive reconstruction using a pectoralis major island flap and our muscle-sparing technique. Mean overall operation time was 147 ± 48.6 min. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity as compared to traditional harvesting techniques. Six (26%) patients had major complications that required surgical revision. Three (13%) cases were complicated with fistulas. CONCLUSION The pectoralis major island flap is shown to be reliable in otolaryngeal surgery. This surgical technique minimizes scarring and preserves thoracic wall architecture by taking a less invasive approach, thereby improving aesthetic outcome and reducing overall patient morbidity.
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Affiliation(s)
- Tina Rauchenwald
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria,
| | - Evi M Morandi
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Djedovic
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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19
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Chen WL, Wang Y, Zhou B, Liao JK, Chen R. Comparison of the reconstruction of through-and-through cheek defects involving the labial commissure following tumor resection using four types of local and pedicle flaps. Head Face Med 2019; 15:12. [PMID: 31097002 PMCID: PMC6521464 DOI: 10.1186/s13005-019-0196-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/06/2019] [Indexed: 11/21/2022] Open
Abstract
Background The reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge. Methods This study evaluated 35 patients with buccal squamous cell carcinoma (SCC) involving the labial commissure who underwent Abbe–Estlander (A-EF), folded extended supraclavicular fasciocutaneous island (SFIF), folded pectoralis major muscle (PMMF), or folded extended vertical lower trapezius island myocutaneous (TIMF) flap reconstruction of through-and-through cheek defects involving the labial commissure following radical resection. Results The A-EF and SFIF groups differed significantly (P < 0.05) from the PMMF and TIMF groups in terms of tumor clinical stage and type of treatment. The inner PMMF (median 6.3 × 4.5) and TIMF (median 9.8 × 6.7) skin paddle dimensions were larger than those of the A-EF (median 1.8 × 2.2) and SFIF (median 5.5 × 4.3) groups (P < 0.05). The outer PMMF (median 6.3 × 6.6) and TIMF (median 9.8 × 13.2) dimensions were larger than those of the A-EF (median 1.8 × 3.8) and SFIF (median 5.5 × 4.6) groups (P < 0.05). The esthetic results, orbicularis oris function, and speech function were significantly (P < 0.05) better in the A-EF group than in the SFIF, PMMF, and TIMF groups. The patients were followed for 6–38 months (median 26.8, 25.0, 22.1, and 20.8 months in the A-EF, SFIF, PMMF, and TIMF groups, respectively). At the final follow-up, 4 (80.0%) patients in the A-EF, 7 (87.5%) in the SFIF, 5 (55.6%) in the PMMF, and 5 (38.4%) in the TIMF groups were alive with no disease; 1 (20.0%), 1 (22.2%), 2 (22.2%), and 4 (30.8%) patients, respectively, were alive with disease; and 2 (22.2%) patients in the PMMF and 4 (30.8%) in the TIMF group had died of local recurrence or distant metastases at between 9 and 38 months. There was a significant survival difference in the A-EF and SFIF groups compared with the PMMF and TIMF groups (P < 0.05). Conclusions The A-EF is suitable for reconstructing defects of clinical stage II disease; the SFIF for clinical stage II or III disease; the PMMF for clinical stage III or IV; and the TIMF for clinical stage rCS III or rCS IV disease.
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Affiliation(s)
- Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120, China.
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120, China
| | - Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120, China
| | - Juan-Kun Liao
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120, China
| | - Rui Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120, China
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20
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Anehosur V, Dikhit PS, Nagraj N, Jayade B, Kumar N. PMMC Flap Revisited and its Clinical Outcome in 150 Patients. J Maxillofac Oral Surg 2019; 19:26-31. [PMID: 31988559 DOI: 10.1007/s12663-019-01228-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022] Open
Abstract
Introduction Pectoralis myocutaneous flap remains the workhorse for the reconstruction of large defects in the head and neck region despite free flaps gaining popularity; because of its drawbacks such as long operating hours, high cost and special skill techniques, it is not used in most of the institutions. Even in our institution, free tissue transfers are carried out on a regular basis, but there is a definite scope and role for PMMC flap in reconstruction. We present our experience with pectoralis major myocutaneous flap in terms of postoperative complications, donor site morbidity, flap survival and long-term healing of the flap. Materials and methods In this study, 150 patients who underwent pectoralis myocutaneous flap reconstruction from 2008 to 2016 were analysed for postoperative complications like donor site morbidity, flap survival and long-term healing of the flap. Results On analysis of our data, it was found that the most common complication was wound dehiscence, which was seen in 25 patients(16%), followed by orocutaneous fistula in 15 (10%), wound infection and partial skin margin necrosis, which was seen in a maximum of 12 each(8%), hematoma in 5 (3%), and donor site wound dehiscence in 5 (3%), and there was no case of total flap failure or carotid blowout. Discussion We conclude that PMMC flap along with its modifications is the most cost-effective and associated with least complications.
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Affiliation(s)
- Venkatesh Anehosur
- 1Department of Oral and Maxillofacial Surgery, SDM Craniofacial Research Centre, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka 580009 India
| | - Punit S Dikhit
- 2AIIMS, Bhubaneshwar, India.,3Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Nikhil Nagraj
- 1Department of Oral and Maxillofacial Surgery, SDM Craniofacial Research Centre, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka 580009 India
| | - Bhushan Jayade
- 1Department of Oral and Maxillofacial Surgery, SDM Craniofacial Research Centre, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka 580009 India
| | - Niranjan Kumar
- 4Department of Plastic and Reconstructive Surgery, SDM Craniofacial Research Centre, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka 580009 India
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21
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Haidar YM, Kuan EC, Verma SP, Goddard JA, Armstrong WB, Tjoa T. Free Flap Versus Pedicled Flap Reconstruction of Laryngopharyngeal Defects: A 10-Year National Surgical Quality Improvement Program Analysis. Laryngoscope 2018; 129:105-112. [PMID: 30151829 DOI: 10.1002/lary.27455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/03/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Large defects after total laryngectomy (TL) and total laryngopharyngectomy (TLP) often benefit from free flap (FF) or pedicled flap (PF) reconstruction to maintain continuity of the aerodigestive tract, protect great vessels, or reinforce pharyngeal closure. Although both techniques are commonly used, no consensus exists as to which results in fewer complications. The goal of this study was to determine if 30-day morbidity/mortality outcomes differ between PF and FF reconstruction in patients undergoing TL/TLP. STUDY DESIGN Retrospective cohort study. METHODS Patients were analyzed who underwent TL/TLP with reconstruction using records from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2015). RESULTS A total of 347 patients were included; 204 received FF reconstruction, whereas 143 received PF reconstruction. FF reconstruction was more commonly used with TLP defects (P = .001). The total operative time in the FF (590 ± 140 minutes) was longer than the PF (441 ± 125 minutes) group (P < .0001). There was a higher rate of postoperative transfusions in those undergoing FF reconstruction (P = .022). There was no significant difference in complication rates among TLP patients. Among TL patients only, FF reconstruction had a higher association with wound infections than PFs (P = .040). On multivariate analysis, low hematocrit was associated with complications (P = .031). Age (P = .031) and congestive heart failure exacerbation (P < .001) were associated with increased hospital stay. Overall, there were no differences in readmissions, reoperations, or deaths between the groups. CONCLUSIONS Reported complication rates after TL/TLP remain high, despite widespread usage of vascularized flaps in reconstruction. This comparison reveals no significant difference in postoperative complications between patients who received PF and FF laryngopharyngeal reconstruction. LEVEL OF EVIDENCE 4 Laryngoscope, 129:105-112, 2019.
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Affiliation(s)
- Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Julie A Goddard
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Colorado, Denver, Colorado, U.S.A
| | - William B Armstrong
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
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22
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Sen S, Gajagowni JG, Pandey JK, Dasgupta P, Sahni A, Gupta S, Mp S, Ravi B. Effectiveness of pectoralis major myocutaneous flap in the surgical management of oral cancer: A retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:21-27. [PMID: 30125737 DOI: 10.1016/j.jormas.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Over 80,000 oral cancer cases get diagnosed each year in India, majority undergoing extensive resections owing to their late presentation. Pectoralis major myocutaneous (PMMC) flap is a pedicled axial pattern flap which is based on thoracoacromical artery. It is readily available as a viable alternative to free flap reconstruction, especially for the economically poor and malnourished patients. Its proximity to head and neck structures gives added advantage to reconstruct complex and large volume oral and maxillofacial defects. It provides a relatively good possibility of functional and aesthetic restoration providing both mucosal lining and skin cover. MATERIALS AND METHODS This was a prospective observational study of 29 PMMC flap reconstructions, conducted between 2013-2016. The reconstruction outcomes assessed in this study were divided into two categories namely "success" and "failure" based on certain functional parameters observed during follow-up of 1 year. The complications were broadly classified as major/minor and flap related/non-flap related. We assessed the feasibility of using a PMMC flap for reconstructing various subsites of oral cavity cancer. Further, the association of patient variables with complication rates and outcome of reconstruction were analysed. RESULTS Out of 29 patients overall complications were noted in 15 (51.7%) cases with a female preponderance. Flap-related complications were noted in 9 whereas non-flap-related complications were seen in 6 patients. Major and minor complications were noted in 2 (both flap related) and 13 cases respectively. Complete full thickness flap necrosis was not encountered in any patient. Patients with flap skin paddle size ≤ 36 cm2 (n = 12) had significantly increased overall complication rates. Despite complications a high success rate (93.1%, n = 27) was achieved with this mode of reconstruction. CONCLUSION The PMMC flap reconstruction is a versatile, reliable and an affordable single staged procedure with a high success rate in terms of achieving treatment goals. Although it has moderately high complication rates, but PMMC flap proved to be a workhorse in locally advanced cases of head and neck cancer at the end of 1 year follow-up.
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Affiliation(s)
- S Sen
- Unit III, Department of Surgical Oncology, Chittaranjan National Cancer Institute, 700026 Kolkata, West Bengal, India.
| | - J G Gajagowni
- Department of Surgical Oncology and Robotic Surgery, Yashoda Hospitals, Secunderabad, India
| | - J K Pandey
- Department of Surgical oncology, AIIMS, Patna, Bihar, India
| | | | - A Sahni
- Max Superspeciality Hospitals, New Delhi, India
| | - S Gupta
- SSKM Hospital, Kolkata, India
| | - S Mp
- Mangalore, Karnataka, India
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23
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Chen WL, Zhang DM, Huang ZQ, Wang Y, Zhou B, Wang YY. Comparison of outcomes with extensive segmental pectoralis major myocutaneous flap via the anterior axillary line and the conventional technique in oral and oropharyngeal cancer. Head Neck 2017; 40:349-354. [PMID: 28963817 DOI: 10.1002/hed.24959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study compared the outcomes of an extensive segmental pectoralis major myocutaneous flap (esPMMF) and a conventional pectoralis major myocutaneous flap (PMMF). METHODS The study enrolled 91 patients with primary oral and oropharyngeal squamous cell carcinoma (SCC) who underwent radical resection followed by reconstruction of the defect using either an esPMMF via the anterior axillary line or a PMMF. The pedicle lengths of the esPMMF and PMMF were 22-28 and 18-22 cm, respectively. The esPMMF and PMMF had skin paddle dimensions of 5 × 8 to 7 × 14 cm and 6 × 7 to 8 × 17 cm, respectively. RESULTS The esPMMF pedicle was longer than that of the PMMF. The range of shoulder abduction was significantly greater in the esPMMF group and the donor-site aesthetic results were better. CONCLUSION The esPMMF has a longer pedicle flap, enables a greater range of shoulder abduction, and has a better aesthetic result than the conventional technique.
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Affiliation(s)
- Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Da-Ming Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Quan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - You-Yuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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24
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Franz A, Klaas J, Schumann M, Frankewitsch T, Filler TJ, Behringer M. Anatomical versus functional motor points of selected upper body muscles. Muscle Nerve 2017; 57:460-465. [PMID: 28719731 DOI: 10.1002/mus.25748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/03/2017] [Accepted: 07/14/2017] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In this study we aimed to identify nerve entry points (NEPs) of superficial skeletal muscles obtained by dissection of 20 human cadavers and compared them with motor points (MP) obtained previously by electrical stimulation. METHODS The biceps brachii (BB), trapezius (TZ), latissimus dorsi (LD), pectoralis major (Pmaj), and pectoralis minor (Pmin) muscles were dissected from human cadavers. NEP data (mean ± standard deviation) from each muscle were calculated. F-tests with Bonferroni corrections were used to compare NEPs and MPs. RESULTS The number of NEPs was 2 in BB, 1 in Pmin, 4 in TZ, and 3 in LD, whereas the total number in Pmaj varied from 3 to 5. NEPs and MPs were statistically equal only in Pmin and in the descending part of TZ. DISCUSSION The findings show crucial differences between NEPs and MPs, possibly impacting the effectiveness of several medical treatment strategies. Muscle Nerve 57: 460-465, 2018.
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Affiliation(s)
- Alexander Franz
- Institute of Anatomy I, Heinrich Heine University, Universitätsstrasse 1, 40225, Düsseldorf, Germany.,Department of Orthopedics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Joschua Klaas
- Institute of Anatomy I, Heinrich Heine University, Universitätsstrasse 1, 40225, Düsseldorf, Germany
| | - Moritz Schumann
- Exercise, Health, and Technology Center, Shanghai Jiao Tong University, Shanghai, China.,Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Thomas Frankewitsch
- Institute of Anatomy I, Heinrich Heine University, Universitätsstrasse 1, 40225, Düsseldorf, Germany
| | - Timm J Filler
- Institute of Anatomy I, Heinrich Heine University, Universitätsstrasse 1, 40225, Düsseldorf, Germany
| | - Michael Behringer
- Faculty of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
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25
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Liu M, Liu W, Yang X, Guo H, Peng H. Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications. Sci Rep 2017; 7:46256. [PMID: 28387356 PMCID: PMC5384233 DOI: 10.1038/srep46256] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/10/2017] [Indexed: 02/05/2023] Open
Abstract
The role of the pectoralis major myocutaneous flap (PMMF) in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. This study was designed to evaluate the indications and reliability of using a PMMF in the current free flap era based on a single center experience. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps.
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Affiliation(s)
- Muyuan Liu
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
| | - Weiwei Liu
- Department of Head and Neck Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Xihong Yang
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
| | - Haipeng Guo
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
| | - Hanwei Peng
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, 515031, P. R. China
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26
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Li W, Zhang P, Li R, Liu Y, Kan Q. Radial free forearm flap versus pectoralis major pedicled flap for reconstruction in patients with tongue cancer: Assessment of quality of life. Med Oral Patol Oral Cir Bucal 2016; 21:e737-e742. [PMID: 27694786 PMCID: PMC5116116 DOI: 10.4317/medoral.21274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background This study investigated the quality of life of Chinese patients with tongue cancer who had undergone immediate flap reconstruction surgery. In addition, we compared 2 groups of patients: those who had received radial forearm free flap (RFFF) surgery and others who had received pectoralis major myocutaneous flap (PMMF) surgery. Material and Methods Patients who received RFFF or PMMF reconstruction after primary tongue cancer treated with total and subtotal tongue resection were eligible for the current study. The patients’ demographic data, medical history, and quality of life scores (14-item Oral Health Impact Profile (OHIP-14) and the University of Washington Quality of Life (UW-QOL) questionnaires) were collected. Results A total of 41 of 63 questionnaires were returned (65.08%). There were significant differences between the 2 groups in the gender (p< .05). Patients reconstructed with RFFF performed better in the shoulder domains, in addition to worse appearance domains. Conclusions Using either RFFF or PMMF for reconstruction of defects after tongue cancer resection significantly influences a patient’s quality of life. Data from this study provide useful information for physicians and patients during their discussion of reconstruction modalities for tongue cancers. Key words:Quality of life, radial forearm free flaps, pectoralis major myocutaneous flap, tongue cancer, oral function.
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Affiliation(s)
- W Li
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052,China,
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Yang Y, Li F, Li W. Factors that affect the quality of life of patients with oral cancer who have had their defects reconstructed immediately after excision of the tumour. Br J Oral Maxillofac Surg 2016; 54:410-4. [DOI: 10.1016/j.bjoms.2015.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/05/2015] [Indexed: 11/17/2022]
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Dagnino U. B, Cifuentes O. I, Salisbury D. C. RECONSTRUCCIÓN DE CABEZA Y CUELLO. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Okoturo E. Regional Myocutaneous Flaps for Head and Neck Reconstruction: Experience of a Head and Neck Cancer Unit. Niger J Surg 2015; 21:85-90. [PMID: 26425058 PMCID: PMC4566327 DOI: 10.4103/1117-6806.162568] [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] [Indexed: 12/01/2022] Open
Abstract
Background: Pectoralis major myocutaneous pedicle flap and other regional myocutaneous pedicle flaps (RMF), despite the superiority shown by free flaps, have remained relevant in the reconstruction of major head and neck oncologic defects. It has continued to find relevance as the preferred reconstruction of choice in some general head and neck reconstructive applications. While its role has been defined in developed environment, the same cannot be said for developing environment. The aim thus, was to review our experiences with RMFs in head and neck reconstructions, with a view to evaluating the indications and outcomes in a limited opportunity environment with some free flaps expertise. Materials and Methods: This was a retrospective cohort study from records of RMF cases performed for head and neck reconstruction, at the study institution. Eligibility for study inclusion comprised case cohorts with advanced head and neck diseases requiring ablative surgery and reconstruction with pectoralis major flaps and other RMFs. Results: A total of 17 cases were treated with RMFs. 10 were pectoralis major flaps while 7 were other RMFs. The main indications were failed free flaps and financial constraints. No regional pedicle flap failure was recorded; however, complication rate was 35.5% (6/17). Conclusion: Pectoralis major flaps and other RMFs were very reliable option for head and neck reconstruction. Free flap failure and financial constraints were the main indications for RMF reconstruction indications in head and neck reconstruction in a developing environment with some free flap expertise.
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Affiliation(s)
- Eyituoyo Okoturo
- Department of Oral and Maxillofacial Surgery, Regional Head and Neck Cancer Division, LASUCOM/LASUTH, Lagos, Nigeria
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Zhang YX, Li Z, Grassetti L, Lazzeri D, Nicoli F, Zenn MR, Zhou X, Spinelli G, Yu P. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope 2015; 126:1315-20. [PMID: 26394236 DOI: 10.1002/lary.25675] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The reconstruction of hypopharyngeal defects should focus on minimizing morbidity in a high-risk population while achieving adequate functional results with regard to the restoration of speech, swallowing, and airway control. We introduce the clinical application of the thoracoacromial artery perforator (TAAP) flap as a new reconstructive option for hypopharyngeal defects. METHODS This method was used to restore oncologic hypopharyngeal defects in nine patients: three who had previous irradiation and surgery, one who had previous surgery only, and another who had previous radiotherapy only. RESULTS All of the TAAP flaps of our series were transferred successfully and survived entirely. The donor sites were closed primarily in all cases. No fistulas, stenosis/strictures, dehiscence, or swelling occurred. Pectoralis major muscle function was completely preserved in all patients. CONCLUSIONS The use of TAAP flap to reconstruct hypopharyngeal defect is a simple and effective method that does not require microsurgical skills. The flap is thin and pliable, with a reliable blood supply. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1315-1320, 2016.
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Affiliation(s)
- Yi Xin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Zan Li
- Division of Head and Neck Surgery, Department of Surgery, Hunan Provincial Tumor Hospital, Xiangya Medical School of Central South University, Changsha, Hunan, China
| | - Luca Grassetti
- Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome
| | - Fabio Nicoli
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome
| | - Michael R Zenn
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina
| | - Xiao Zhou
- Division of Head and Neck Surgery, Department of Surgery, Hunan Provincial Tumor Hospital, Xiangya Medical School of Central South University, Changsha, Hunan, China
| | | | - Peirong Yu
- MD Anderson Cancer Center, Houston, Texas, U.S.A
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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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Chen WL, Wang YY, Zhang DM, Fan S, Lin ZY. Extended vertical lower trapezius island myocutaneous flap versus pectoralis major myocutaneous flap for reconstruction in recurrent oral and oropharyngeal cancer. Head Neck 2014; 38 Suppl 1:E159-64. [PMID: 25535024 DOI: 10.1002/hed.23960] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the use of an extended vertical lower trapezius island myocutaneous flap (TIMF) and a pectoralis major myocutaneous flap (PMMF). METHODS A total of 39 patients with advanced recurrent oral and oropharyngeal squamous cell carcinoma (SCC) underwent salvage surgery followed by placement of either an extended lower vertical TIMF or PMMF for reconstruction. Twenty-one patients received extended lower vertical TIMFs, whereas 18 received PMMFs. RESULTS The pedicle length of the TIMF was longer than that of the PMMF, and the skin paddle of the TIMF was both wider and longer than the PMMF. No major complication developed in any of the patients. The TIMF group experienced a lower rate of minor flap failure than did the PMMF group. CONCLUSION Use of an extended vertical lower TIMF, which has a longer pedicle flap and a larger skin paddle than a PMMF, is optimal for reconstruction of major defects. © 2015 Wiley Periodicals, Inc. Head Neck 38: E159-E164, 2016.
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Affiliation(s)
- Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - You-Yuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Da-Ming Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Song Fan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhao-Yu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Wang CH, Wong YK, Wang CP, Wang CC, Jiang RS, Lai CS, Liu SA. Risk factors of recipient site infection in head and neck cancer patients undergoing pectoralis major myocutaneous flap reconstruction. Eur Arch Otorhinolaryngol 2014; 272:3475-82. [DOI: 10.1007/s00405-014-3372-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/22/2014] [Indexed: 11/24/2022]
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Corbitt C, Skoracki RJ, Yu P, Hanasono MM. Free flap failure in head and neck reconstruction. Head Neck 2014; 36:1440-5. [DOI: 10.1002/hed.23471] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 05/31/2013] [Accepted: 08/14/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christian Corbitt
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Roman J. Skoracki
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Peirong Yu
- 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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Twieg M, Reich W, Dempf R, Eckert AW. [Renaissance of pedicled flaps in oral and maxillofacial surgery]. Chirurg 2014; 85:529-36. [PMID: 24449079 DOI: 10.1007/s00104-013-2638-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A retrospective analysis in the period 2007 to 2011 included 71 surgically treated patients for carcinoma of the head and neck region and subsequent reconstruction with 36 pedicled distant flaps and 47 free flaps. Patient specific parameters of data collection with SPSS 17.0 were age and sex distribution, TNM stage and treatment. The specific type of flap reconstruction, duration of surgery, complications, intensive care and inpatient treatment were recorded. The results showed that the healing process was uneventful in 26 (72.2 %) pedicled flaps, 14 (38.9 %) pedicled flaps were transplanted in a preoperatively irradiated area of the head and neck region and in 86.0 % with a positive healing process. Tumor stage, general physical condition of the patient and type of therapy are the key parameters for the choice of reconstruction.
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Affiliation(s)
- M Twieg
- Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland,
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Avery C. A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. Avery
- University Hospitals of Leicester; Leicester UK
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Llorente JL, López F, Suárez V, Fueyo Á, Carnero S, Martín C, López V, Camporro D, Suárez C. Free Flap Reconstruction in the Head and Neck. Indications, Technical Aspects and Outcomes. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Llorente JL, López F, Suárez V, Fueyo Á, Carnero S, Martín C, López V, Camporro D, Suárez C. Reconstrucción de cabeza y cuello mediante colgajos libres microvascularizados. Indicaciones, aspectos técnicos y resultados. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 65:33-42. [DOI: 10.1016/j.otorri.2013.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/07/2013] [Indexed: 10/25/2022]
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Cordova A, D'Arpa S, Di Lorenzo S, Toia F, Campisi G, Moschella F. Prophylactic chimera anterolateral thigh/vastus lateralis flap: preventing complications in high-risk head and neck reconstruction. J Oral Maxillofac Surg 2013; 72:1013-22. [PMID: 24534160 DOI: 10.1016/j.joms.2013.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE In high-risk head and neck cases treated with tumor resection and associated radical neck dissection, orocutaneous fistulas and wound breakdowns in the neck are relatively frequent and can have serious consequences, such as carotid blowout syndrome (CBS), the need for salvage reoperations, and prolonged recovery time. The authors present the application of a prophylactic chimeric anterolateral thigh (ALT) and vastus lateralis (VL) flap to prevent complications. MATERIALS AND METHODS A retrospective review was performed of a historical group (96 patients) of patients with head and neck cancer treated with tumor resection, radical neck dissection, and microsurgical reconstruction of the tumor site only and a prospective cohort (21 patients) in which a chimeric ALT-VL flap was used to simultaneously reconstruct the tumor site and sternocleidomastoid muscle to fill dead space and protect the carotid artery. RESULTS The rate of complications was higher in the historical group: CBS occurred in 4.1% and orocutaneous fistulas in 11.5% of patients; 5.2% of patients required major salvage surgery for a wound complication. In the cohort group, no CBS or orocutaneous fistula occurred and no major salvage surgical procedure was needed. CONCLUSIONS Prophylactic ALT-VL flaps in high-risk head and neck cancers provide adequate and long-lasting soft tissue coverage for the carotid artery, with minimal additional morbidity, and could be beneficial in preventing serious and life-threatening wound complications and the need for reoperation.
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Affiliation(s)
- Adriana Cordova
- Full Professor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Salvatore D'Arpa
- Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Sara Di Lorenzo
- Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesca Toia
- Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppina Campisi
- Full Professor, Section of Oral Medicine "V. Margiotta", Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Moschella
- Full Professor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
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Sayles M, Grant DG. Preventing pharyngo-cutaneous fistula in total laryngectomy: A systematic review and meta-analysis. Laryngoscope 2013; 124:1150-63. [DOI: 10.1002/lary.24448] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 09/02/2013] [Accepted: 09/23/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Mark Sayles
- Department of Otolaryngology-Head and Neck Surgery; Queen's Medical Centre; Nottingham University Hospitals' NHS Trust; Nottingham United Kingdom
| | - David G. Grant
- Department of Otolaryngology-Head and Neck Surgery; Queen's Medical Centre; Nottingham University Hospitals' NHS Trust; Nottingham United Kingdom
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Avery CME, Gandhi N, Peel D, Neal CP. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit. Int J Oral Maxillofac Surg 2013; 43:546-54. [PMID: 24220666 DOI: 10.1016/j.ijom.2013.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/04/2013] [Accepted: 10/09/2013] [Indexed: 11/26/2022]
Abstract
There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P=0.028), diabetes mellitus (P=0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P=0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P=0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005-2012) of the study period (22.2% vs. 79.8%, P=0.002, and 0% vs. 55.7%, P=0.064, respectively). There were also declines in recurrent disease (P=0.008), MRSA (P<0.001), and duration of admission (P=0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.
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Affiliation(s)
- C M E Avery
- Department of Maxillofacial Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
| | - N Gandhi
- University of Birmingham, Birmingham, UK
| | - D Peel
- Department of Clinical Oncology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - C P Neal
- Department of Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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Xiao Y, Zhu J, Cai X, Wang J, Liu F, Wang H. Comparison between anterolateral thigh perforator free flaps and pectoralis major pedicled flap for reconstruction in oral cancer patients--a quality of life analysis. Med Oral Patol Oral Cir Bucal 2013; 18:e856-61. [PMID: 24121914 PMCID: PMC3854077 DOI: 10.4317/medoral.19276] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/23/2013] [Indexed: 11/05/2022] Open
Abstract
UNLABELLED The aim of this study was to compare the differences between anterolateral thigh perforator free flaps (ALTFF) and pectoralis major myocutaneous flap (PMMF) for reconstruction in oral cancer patients. Method Patients: who received free flap or PMMF reconstruction after ablation surgeries were eligible for the current study. The patients' demographic data, medical history, and quality of life scores(Medical Outcomes Study-Short Form-36 (MOS SF-36) and the University of Washington Quality of Life (UW-QOL) questionnaires were collected. RESULTS 81 of 118 questionnaires were returned (68.64%). There was significant differences between two groups in the gender (P<0.005). Patients reconstructed with ALTFF had better appearance domains and better shoulders domains, in addition to better role emotion domains. CONCLUSION Using either PMMF or ALTFF for reconstruction of oral defects after cancer resection significantly influences a patient's quality of life. Data from this study provide useful information for physicians and patients during their discussion of reconstruction modalities for oral cancers.
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Affiliation(s)
- Yan Xiao
- Department of Stomatolagy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China,
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Green JM, Thomas S, Sabino J, Howard R, Basile P, Dryden S, Crecelius C, Valerio I. Use of Intraoperative Fluorescent Angiography to Assess and Optimize Free Tissue Transfer in Head and Neck Reconstruction. J Oral Maxillofac Surg 2013; 71:1439-49. [DOI: 10.1016/j.joms.2013.01.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/14/2012] [Accepted: 01/21/2013] [Indexed: 11/27/2022]
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Liu ZM, Wu D, Liu XK, Liu WW, Li H, Li Q, Zhang XR, Zeng ZY, Guo ZM. Reconstruction of Through-and-Through Cheek Defects With Folded Free Anterolateral Thigh Flaps. J Oral Maxillofac Surg 2013; 71:960-4. [DOI: 10.1016/j.joms.2012.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/15/2012] [Accepted: 10/20/2012] [Indexed: 11/25/2022]
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46
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Frank S, Flusberg M, Friedman S, Swinburne N, Sternschein M, Wolf E, Stein M. CT appearance of common cosmetic and reconstructive surgical procedures and their complications. Clin Radiol 2013; 68:e72-8. [DOI: 10.1016/j.crad.2012.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/10/2012] [Accepted: 10/09/2012] [Indexed: 11/29/2022]
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Saito A, Minakawa H, Saito N, Nagahashi T. Indications and Outcomes for Pedicled Pectoralis Major Myocutaneous Flaps at a Primary Microvascular Head and Neck Reconstructive Center. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/mps.2012.24025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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