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Vasudevan SS, Rogers B, Adilbay D, Olinde L, Pang J, Nathan CAO, Asarkar AA. Outcomes of internal mammary artery perforator flap in head and neck reconstruction: A systematic review. Head Neck 2024; 46:2076-2085. [PMID: 38769845 DOI: 10.1002/hed.27822] [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: 03/26/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024] Open
Abstract
This study aims to evaluate the functional and prognostic outcomes associated with the internal mammary artery perforator (IMAP) flap in various head and neck defect repairs, given the current lack of clarity on its effectiveness. We performed a systematic review of various databases: PubMed, Embase, Scopus, Web of Science, and ScienceDirect using keywords such as "Internal mammary artery perforator flap" and "IMAP." Screening and data extractions were performed by two individual reviewers. Articles were considered eligible if they included sufficient information on IMAP flap features, their applications in the head and neck, and outcomes. From 264 articles analyzed, 24 studies were included for qualitative analysis. Out of which, 125 patients who received internal mammary artery perforator flaps were included. Most of the patients, 103 (88%), received pedicled IMAP flaps, and 22 (12%) received IMAP free flaps. The second internal mammary artery (IMA) was favored as the single perforator (81.5%), with the combination of the first and second IMA being the primary choice for dual perforators (92.5%). IMAP flaps were predominantly single perforator flaps (65%), with 35% being dual perforator flaps. Among various applications, IMAP flaps are commonly employed in the reconstruction of neck defects (25.5%), pharyngocutaneous fistula repair (20.8%), and burn scar contracture restoration (8%). Only seven (5.6%) patients had flap complications, including venous congestion (1.6%), partial necrosis (1.6%), complete necrosis (1.6%), and incision dehiscence (0.8%). Donor sites were predominantly closed by the primary closure (92%). 3.2% of donor sites had minor complications. The average follow-up was 12.6 (IQR: 6-18) months. This systematic review highlights the effectiveness and safety of IMAP flaps in head and neck reconstruction, with positive outcomes and minimal complications.
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Affiliation(s)
- Srivatsa Surya Vasudevan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Brianna Rogers
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Dauren Adilbay
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Lindsay Olinde
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - John Pang
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Ameya A Asarkar
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
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2
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Sharbel D, Lin C, Topf MC, Mannion K. The internal mammary artery perforator flap in pharyngoesophageal, cervical tracheal, and cutaneous neck reconstruction. Head Neck 2024; 46:1835-1840. [PMID: 38711230 DOI: 10.1002/hed.27769] [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: 01/22/2024] [Revised: 03/04/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
The internal mammary artery perforator (IMAP) flap is an evolution of the deltopectoral flap that is harvested based upon a single perforator from the internal mammary artery. Its favorable characteristics include pliability as a fasciocutaneous flap, ease of harvest, and minimal donor site morbidity. In this paper, we report our harvest technique and the versatility of the IMAP flap for pharyngoesophageal, cervical tracheal, and cutaneous neck defects. We seek to highlight the IMAP as a useful regional reconstructive option in both the primary and salvage reconstructive setting. As such, this flap is an important option in the head and neck reconstructive surgeon's armamentarium.
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Affiliation(s)
- Daniel Sharbel
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Chen Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Scarabosio A, Tel A, Contessi Negrini F, Albanese R, Robiony M, Parodi P. The shark flap: a modified internal mammary artery perforator flap for composite defects in head and neck reconstruction. Case Reports Plast Surg Hand Surg 2023; 10:2178924. [PMID: 36818191 PMCID: PMC9937011 DOI: 10.1080/23320885.2023.2178924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This report describes a multi-vector variant of IMAP flap which allows to reconstruct composite head and neck defects. It was named the 'shark flap' because of its shape: a main body (the regular IMAP) and a superior 'fin' based on a randomic vascular pathway.
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Affiliation(s)
- Anna Scarabosio
- Plastic Surgery Resident at Santa Maria della Misericordia Hospital, Udine, Italy,CONTACT Anna Scarabosio Plastic Surgery Resident at Santa Maria della Misericordia Hospital, Udine, Italy
| | - Alessandro Tel
- Maxillo-Facial Surgery Resident at Santa Maria della Misericordia Hospital, Udine, Italy
| | | | - Roberta Albanese
- Plastic Surgery Consultant at Santa Maria della Misericordia Hospital, Udine, Italy
| | - Massimo Robiony
- Maxillo-Facial Surgery Resident at Santa Maria della Misericordia Hospital, Udine, Italy
| | - Piercamillo Parodi
- Plastic Surgery Resident at Santa Maria della Misericordia Hospital, Udine, Italy
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Zhao J, Xie K, Qin S, He R, Jiang S, Qi X, Wen B. Impact of internal mammary artery perforator propeller flaps combined with radiotherapy in the treatment of large chest keloids: Our experience. Front Surg 2023; 10:1136496. [PMID: 37082362 PMCID: PMC10110891 DOI: 10.3389/fsurg.2023.1136496] [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: 01/03/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
Background Keloids are benign skin hyperplasias but have a tumor-like appearance. Clinical management of keloids remains challenging. Aims We retrospectively evaluated the safety and efficacy of internal mammary artery perforator propeller flaps combined with timely radiotherapy in the treatment of large chest keloids. Methods From June 2017 to May 2020, 25 patients with large chest keloids (average size 4.82 cm ± 2.53 cm × 9.04 cm ± 4.86 cm) who received both radiotherapy and internal mammary artery perforator flaps transplantation in our department were included. After surgical removal of the keloids, various propeller flaps based on the unilateral internal mammary artery were designed and applied to repair the defects. Timely and full-dose radiotherapy was performed for these patients after the operation. Results After keloid resection, the dimensions of the defect area were 3 cm-15 cm × 4 cm-25 cm, and the sizes of the flaps were 3 cm-16 cm × 4 cm-27 cm. For all 25 patients, the flaps survived, and the incisions healed in one stage. During the follow-up (median 18 months), no local recurrence was observed, and the itching and pain symptoms in the scar area were significantly relieved. Both physicians and patients were satisfied with the results. Conclusions The application of internal mammary artery perforator propeller flaps combined with radiotherapy in the treatment of chest keloids can effectively reduce the recurrence of keloids and relieve the related symptoms. It also has advantages including minimized donor site damage, short operation time and speedy postoperative recovery, suggesting its great clinical value.
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Affiliation(s)
- Jianfang Zhao
- Department of Plastic and Burn Surgery, Peking University First Hospital, Beijing, China
| | - Kun Xie
- Department of Plastic and Burn Surgery, Peking University First Hospital, Beijing, China
| | - Shangbin Qin
- Department of Radiotherapy, Peking University First Hospital, Beijing, China
| | - Rui He
- Department of Plastic and Burn Surgery, Peking University First Hospital, Beijing, China
| | - Shan Jiang
- Department of Plastic and Burn Surgery, Peking University First Hospital, Beijing, China
| | - Xin Qi
- Department of Plastic and Burn Surgery, Peking University First Hospital, Beijing, China
| | - Bing Wen
- Department of Plastic and Burn Surgery, Peking University First Hospital, Beijing, China
- Correspondence: Bing Wen
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5
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De Virgilio A, Costantino A, Festa BM, Russo E, Malvezzi L, Pellini R, Colombo G, Spriano G, Mercante G, Ferreli F. Surgical prevention of pharyngocutaneous fistula in salvage total laryngectomy: a systematic review and network meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5839-5849. [PMID: 35731297 DOI: 10.1007/s00405-022-07490-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the efficacy of different reconstructive techniques in preventing pharyngocutaneous fistula (PCF) after salvage total laryngectomy (STL). METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model according to the PRISMA-NMA guidelines. RESULTS A total of 1694 patients with a median age of 64 years (n = 1569, 95% CI: 62-66 years) were included. If compared to primary pharyngeal closure alone, only a pedicled flap onlay (PFO) showed a statistically significant reduction in PCF rate (OR: 0.35, CI: 0.20-0.61). PFO seemed to perform better than other treatments according to the rank probabilities test (39.9% chance of ranking first). CONCLUSIONS A pedicled flap placed with an overlay technique might be preferred over a patch reconstruction to prevent PCF after STL.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy. .,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Giovanni Colombo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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6
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Yue S, Ju M, Su Z. Analysis of risk factors for complications of perforator propeller flaps used for soft tissue reconstruction after malignant tumor resection: A systematic review and meta-analysis. Microsurgery 2022; 42:512-519. [PMID: 35043463 DOI: 10.1002/micr.30862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/29/2021] [Accepted: 11/29/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Perforator propeller flaps (PPFs) have been widely used due to their numerous advantages; however, they were also associated with various complications. Herein, we analyzed the risk factors for complications of PPFs used for soft tissue reconstruction after malignant tumor resection. METHODS We searched databases for articles on soft tissue reconstruction using PPFs after malignant tumor resection published between January 1991 and April 2021. Studies were selected according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Fixed effects models and relative risks were used for data analysis. Funnel plots and Begg's test were used to evaluate publication bias. RESULTS Twenty-six articles met the inclusion criteria. Complications were found in 24.7% of all patients. The four significant risk factors were age equal or older than 60 years (pooled relative risk, 1.83; p = .04), smoking (pooled relative risk, 2.32; p = .03), diabetes (pooled relative risk, 2.59; p = .01) and radiotherapy (pooled relative risk, 2.09; p = .01). Hypertension, defects located in the extremities, flap size equal or greater than 100 cm2 , and pedicle rotation equal or greater than 120 degrees were not significant risk factors for complications. No publication bias was found in the included articles. CONCLUSION Age equal or older than 60 years, smoking, diabetes and radiotherapy are four risk factors for complications when PPFs are used to reconstruct soft tissue defects resulting from malignant tumor resection.
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Affiliation(s)
- Shuai Yue
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengran Ju
- Department of Plastic and Reconstructive Surgery, Chengdu Badachu Medical Aesthetics Hospital, Chengdu, China
| | - Zhe Su
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
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7
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Visconti G, Bianchi A, Hayashi A, Salgarello M. Designing Anterolateral Thigh Flap Using Ultrasound. J Reconstr Microsurg 2021; 38:206-216. [PMID: 34921373 DOI: 10.1055/s-0041-1740126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preoperative knowledge of themicrovascular anatomy of a patientmay improve safetyand efficacy and reduce morbidity. Today, with the advancement in technology, ultrasound can provide minute details of the structures within the body, which makes this technology very helpful in preoperative evaluation of the traditional perforator flaps as well as thin, superthin, and pure skin perforator flaps. METHODS In this article, we will describe the design of one of the most popular perforator flaps, the anterolateral thigh (ALT) flap, using high-frequency and ultrahigh-frequency ultrasound technology. RESULTS Ultrasound technology allows to study preoperatively the ALT donor-site and its microvascular anatomy by using different US modalities in order to provide a virtual surgical plan to the operating surgeon. CONCLUSION Ultrasound technology allow to expand preoperative knowledge of flap microvascular anatomy and its course within the subcutaneous tissue up to and within the dermis, allowing to select the best perforator for the given reconstruction and the plane of elevation for thin, superthin and pure skin perforator flap.
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Affiliation(s)
- Giuseppe Visconti
- UOC Chirurgia Plastica, Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del "Sacro Cuore," Fondazione Policlinico Universitario "Agostino Gemelli" IRCSS, Rome, Italy
| | - Alessandro Bianchi
- UOC Chirurgia Plastica, Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del "Sacro Cuore," Fondazione Policlinico Universitario "Agostino Gemelli" IRCSS, Rome, Italy
| | - Akitatsu Hayashi
- Department of Breast Center, Kameda Medical Center Chiba, Chiba, Japan
| | - Marzia Salgarello
- UOC Chirurgia Plastica, Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del "Sacro Cuore," Fondazione Policlinico Universitario "Agostino Gemelli" IRCSS, Rome, Italy
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8
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Han B, Han Z, Wu J, Fang J. Regional pedicled flaps in prevention and repair of pharyngocutaneous fistulas. Am J Otolaryngol 2021; 42:103119. [PMID: 34175692 DOI: 10.1016/j.amjoto.2021.103119] [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: 04/05/2021] [Revised: 05/31/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pharyngocutaneous fistula (PCF) is a common complication after laryngopharyngeal surgery. It presents incredible difficulties to both doctors and patients and can lead to prolonged hospitalization. OBJECTIVE To analyze the pros and cons of the pedicled skin flap in the prevention and repair of PCF and put forward the authors' views and experience about the selection and application of flaps for the treatment of PCF. METHODS A literature review of pedicled flap application in PCF was carried out. RESULTS Based on the analysis of the characteristics of the pedicled flap in PCF treatment, the advantages and disadvantages are compared. RESULTS In the literature, the pectoralis major myocutaneous flap is the most widely used regional pedicled flap for PCF. Many other flaps can be used to prevent and treat PCF. Each kind of pedicled flap has advantages and limitations. This plays a role in the individualized selection and design of PCF to maximize the benefits of patients. CONCLUSIONS Taking unity of function, aesthetics, and proficiency of operators into account, choosing the appropriate flap to repair PCF can reduce the occurrence rate of PCF and improve the patient's quality of life.
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Affiliation(s)
- Bo Han
- Department of General Surgery, Beijing TongRen Hospital, Capital Medical University, No.1 Dong Jiao MinXiang Street, Dongcheng District, Beijing City 100730, China; Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, No.1 Dong Jiao MinXiang Street, Dongcheng District, Beijing City 100730, China; Department of Head and Neck Surgery, BaoTou Cancer Hospital, 18th,Tuanjie Street, Qingshan District, BaoTou, Inner Mongolia 014000, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Jixiang Wu
- Department of General Surgery, Beijing TongRen Hospital, Capital Medical University, No.1 Dong Jiao MinXiang Street, Dongcheng District, Beijing City 100730, China.
| | - Jugao Fang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, No.1 Dong Jiao MinXiang Street, Dongcheng District, Beijing City 100730, China
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9
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Almadori G, De Corso E, Settimi S, Di Cintio G, Mele DA, Brigato F, Paludetti G, Salgarello M. When is a surgical multidisciplinary approach required in the management of head and neck non-melanoma skin cancer and in advanced head and neck pathologies involving skin? ACTA ACUST UNITED AC 2021; 41:S145-S157. [PMID: 34060530 PMCID: PMC8172116 DOI: 10.14639/0392-100x-suppl.1-41-2021-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
Non-melanoma Skin cancer, including cutaneous squamous cell carcinoma and basal cell carcinoma, is the most common form of malignancy in the Caucasian population, and the skin of the head and neck is the site most involved. They should not be underestimated; in particular, high-risk lesions and advanced skin cancers require accurate diagnostic work up, aggressive surgical treatment and should be managed by the head and neck surgeon, the dermatologist and the plastic surgeon. Cutaneous head-neck malignancies are often overlooked or not routinely treated with a multidisciplinary surgical approach. Similarly, for primary head and neck cancers with involvement of surrounding skin, the involvement of the dermatologist and the plastic surgeon could better define an adequate diagnosis and treatment planning. The management of these patients presents both therapeutic and ethical problems, because the poor prognosis is burdened by facial disfigurement, open malodorous wounds and intractable pain. Therefore, in patients with advanced disease that is not candidate to radical surgery, palliative surgery with flap reconstruction could take place and could be proposed to improve quality of life.
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Affiliation(s)
- Giovanni Almadori
- Cervico-Facial Oncological Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Eugenio De Corso
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Settimi
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Di Cintio
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Antonio Mele
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Brigato
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marzia Salgarello
- Plastic and Reconstructive Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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10
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Crosetti E, Arrigoni G, Sprio AE, Succo G. "Fistula Zero" Project After Total Laryngectomy: The Candiolo Cancer Institute Experience. Front Oncol 2021; 11:690703. [PMID: 34239804 PMCID: PMC8258249 DOI: 10.3389/fonc.2021.690703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Pharyngocutaneous fistula (PCF) is a troublesome complication after total laryngectomy. The “Fistula zero” project aims to reduce the number of PCF by following a detailed protocol based on three fundamental key points. Materials and Methods The Fistula zero project included 77 patients who underwent total laryngectomy in the period from January 2019 to December 2020. The protocol consisted of three main aspects: the systematic placement of a Har-El salivary bypass tube, the continuous horizontal watertight pharyngeal suture using a barbed suture, onlay insetting of a pedicled flap in pre-treated patients. Results One case of PCF (1.3%) and three small blind fistulas (3.9%) were observed in this series. The mean length of hospitalization was 18 days. Conclusion Pharyngocutaneous fistula (PCF) prolongs hospitalization and delays adjuvant treatments. Thanks to a strict adherence to the protocol, it was possible to reduce PCF rates, avoiding lengthy hospitalization and additional surgical procedures.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia - IRCCS (FPO-IRCCS), Candiolo, Italy
| | - Giulia Arrigoni
- Head and Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia - IRCCS (FPO-IRCCS), Candiolo, Italy
| | - Andrea Elio Sprio
- Department of Biomedical and Clinic Sciences, University of Turin, Orbassano, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia - IRCCS (FPO-IRCCS), Candiolo, Italy.,Department of Oncology, University of Turin, Orbassano, Italy
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11
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Correia C, Wang W, Vincent AG, Chan D, Ducic Y. Regional Salvage Flap Options in Head and Neck Reconstruction. Semin Plast Surg 2020; 34:293-298. [PMID: 33380916 DOI: 10.1055/s-0040-1721767] [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: 12/28/2022]
Abstract
Microvascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.
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Affiliation(s)
- Camil Correia
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Chicago, Illinois
| | - Weitao Wang
- Otolaryngology and Facial Plastic Associates, Fort Worth, Texas
| | | | - David Chan
- Section of Otolaryngology - Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Associates, Fort Worth, Texas
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12
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The usefulness of the IMAP propeller flap for trachea and tracheostome reconstruction after resection of parastomal recurrence of squamous cell carcinoma following salvage total laryngectomy. Eur Arch Otorhinolaryngol 2020; 278:499-507. [PMID: 32613354 DOI: 10.1007/s00405-020-06168-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Parastomal recurrence of squamous cell carcinoma (SCC) with tracheal involvement following salvage total laryngectomy after prior concurrent chemoradiotherapy is one of the most insidious challenges in head and neck surgery because a complex reconstruction is often required for covering a large area of skin loss, filling the dead space beneath, tracheal reconstruction and suspension, and tracheostome resurfacing. The aim is to describe our experience with the internal mammary artery perforator (IMAP) propeller flap for tracheal and tracheostome reconstruction and neck resurfacing after parastomal and cervical trachea resection, especially for suspension and anchoring the stump of the residual distal trachea to the island flap itself. METHODS We describe IMAP flap reconstruction after resection of parastomal recurrence of SCC requiring cervical trachea resection in five patients between January 1, 2005 and August 30, 2019. RESULTS IMAP propeller flap was successfully used for reconstruction after complex resection of parastomal recurrence of SCC with cervical trachea involvement in all cases. The mean length and width were, respectively, 16.8 cm (range 13-23) and 6.9 cm (range 5.5-8). We did not report complications of both the donor and the recipient site. Pharyngo-cutaneous or tracheoesophageal fistulas and wound dehiscence were not observed. CONCLUSIONS to the best of our knowledge, this is the first report about the use of the IMAP propeller flap in this more complex clinical setting and we provide the message that this surgical procedure is worthy of consideration.
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