1
|
Escobar-Domingo MJ, Bustos VP, Akintayo R, Mahmoud AA, Fanning JE, Foppiani JA, Miller AS, Cauley RP, Lin SJ, Lee BT. The versatility of the scapular free flap: A workhorse flap? A systematic review and meta-analysis. Microsurgery 2024; 44:e31203. [PMID: 38887104 DOI: 10.1002/micr.31203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/03/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction. METHODS A comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection. RESULTS A total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%-4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2. CONCLUSION The SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions-both for vascularized bone and cutaneous skin-augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.
Collapse
Affiliation(s)
- Maria J Escobar-Domingo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Miami, Florida, United States
| | - Rachel Akintayo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir-Ala Mahmoud
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James E Fanning
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose A Foppiani
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amitai S Miller
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Cardín AA, Pereira A, Mendes A, Duarte J, Pereira A. Maxillary reconstruction with horizontally oriented scapular tip free flap: outcomes in orbital support and palate closure. J Plast Reconstr Aesthet Surg 2024; 95:221-230. [PMID: 38936333 DOI: 10.1016/j.bjps.2024.05.042] [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: 03/19/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Current indications of maxillary reconstruction with scapular tip free flap (STFF) are palatoalveolar defects associated with zygomaticomaxillary buttress and/or orbital floor defects. STFF can be placed either horizontally or vertically. Horizontal placement usually allows ideal palatal conformation, preventing oronasal communication, but has been argued to compromise orbital support and projection of the midface, whereas vertical placement is advocated for midface support but may be insufficient for the complete closure of the palate. The present study focuses on the horizontal placing of STFF to allow complete palate reconstruction and fistulae prevention while still obtaining optimal midface projection and orbital support. MATERIALS AND METHODS This study included 21 case complex maxillary reconstructions with this flap, in which the horizontally placed scapular tip component replaced the palate, a muscular flap component was included for midface volume restoration, and an alloplastic implant was utilized for supporting the orbital content when needed. RESULTS None of the patients presented palatal fistulas or alterations in the orbital support. CONCLUSION A multilevel approach was proposed according to the maxillectomy defect. This experience supported the horizontal insetting of STFF to allow palatal fistulae prevention while still obtaining an optimal midface projection and orbital support.
Collapse
Affiliation(s)
- Adrián A Cardín
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Donostia, San Sebastián, Spain.
| | - André Pereira
- Department of Stomatology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
| | - Ana Mendes
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
| | - José Duarte
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
| | - Alberto Pereira
- Department of Plastic and Reconstructive Surgery, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal; Department of Plastic and Reconstructive Surgery, Hospital da Luz Lisboa, Lisbon, Portugal.
| |
Collapse
|
3
|
Dhoot A, Mackenzie A, Rehman U, Adebayo O, Neves S, Sohaib Sarwar M, Brennan PA. Use of scapular tip flaps in the reconstruction of head and neck defects: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2024; 62:233-246. [PMID: 38431506 DOI: 10.1016/j.bjoms.2023.12.007] [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: 06/30/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
Scapular tip flaps (STF) may be used as an alternative to traditional methods of reconstruction of head and neck cancer (HNC) defects. This study aimed to establish the success and complication rates for STF in HNC reconstruction. A literature search was conducted on PubMed, BMJ Journals, DARE, EMBASE databases and Cochrane (CENTRAL) register. (Registry CRD42023428012). A total of 23 studies fulfilled the inclusion criteria with 474 patients who underwent reconstructive procedures using the STF. 100% of STF used were free flaps (STFFs). The most common reason for reconstruction was following malignancy (81.4%, n = 386). The pooled success rates in all studies using scapular tip flaps in head and neck reconstruction was 99% (95% CI, 97 to 100, p = 1.00; I2 = 0). Pooled total complication rates were 38% (95% CI, 25 to 51, p < 0.01; I2 = 90%). 19.6% required return to theatre with only 1.5% being for repeat flap coverage. The STF demonstrated an overall success rate of 99%. This is higher than other documented success rates with mainstay flaps for HNC defect reconstruction. Complication and re-operation rates were also like recorded rates. This review demonstrates the advantage of STF as a safe and versatile reconstructive option for HNC related defects. Evaluation of the literature is limited by poor-quality studies and comparability bias.
Collapse
Affiliation(s)
- Amber Dhoot
- Final Year Medical Student, Imperial College London, London, United Kingdom.
| | - Alexandra Mackenzie
- Foundation Doctor, Department of Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Umar Rehman
- Core Surgical Trainee, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Oluwasemilore Adebayo
- Final Year Medical Student, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Salma Neves
- Final Year Medical Student, Imperial College London, London, United Kingdom.
| | - Mohammad Sohaib Sarwar
- Locum Clinical Fellow, Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Peter A Brennan
- Honorary Professor of Surgery, Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
| |
Collapse
|
4
|
Jelovac D, Micic M, Hajdarevic S, Kuzmanovic C, Cukic B, Stefanovic B, Zelic K, Bonfante E, Ewers R, Petrovic M. Immediate placement of extra-short implants in refined scapula tip microvascular free flaps: In house virtual planning and surgical technique - Proof of concept. Heliyon 2023; 9:e18021. [PMID: 37496908 PMCID: PMC10366439 DOI: 10.1016/j.heliyon.2023.e18021] [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: 03/01/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
Scapula tip flaps have been introduced in the literature as an ideal surgical treatment option for large defects in the horizontal plane of the maxilla. This article aims to present a unique step by step protocol for a near total maxillectomy with a pterygoid bone resection and consecutive microvascular reconstruction with a harvested scapula tip flap. The protocol includes immediate placement of extra-short implants in donor bone with the aid of Virtual Surgical Planning (VSP), and an in-house 3D printing of medical 3D models and surgical guides. So far, there has been no presented surgical technique combining immediate implant placement in the scapula region with simultaneous microvascular repair. This technique allows: tumour resection; flap harvesting; extra-short implant placements and reconstruction to be performed in one simultaneous procedure. The technique is presented with illustrations, VSP (presented on videos), radiographs, and surgical findings. We discovered that this refinement of the scapula tip surgery has enabled reconstructive procedures to be performed at the same time as implant placements, providing expedited functional and aesthetic outcomes in selected cases. Moreover, modification of the surgical technique could enhance the competence of the oropharyngeal edge. In conclusion, this new surgical protocol utilizing VSP, 3D models and simultaneous extra-short implant placement provides indispensable advantages for such a complicated surgical procedures, while significantly shortening the duration of surgery.
Collapse
Affiliation(s)
- Drago Jelovac
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Milutin Micic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Sanela Hajdarevic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Cedomir Kuzmanovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | | | | | - Ksenija Zelic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
- School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - E.A. Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo – Bauru School of Dentistry, Bauru, SP, Brazil
| | - Rolf Ewers
- University Hospital for Cranio Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria
| | - Milan Petrovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| |
Collapse
|
5
|
Grecchi F, D'Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med 2023; 12:jcm12113653. [PMID: 37297847 DOI: 10.3390/jcm12113653] [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: 04/26/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient presented complaints of asymptomatic enlarged swelling of 5-mm on the right hard hemi-palate. There was an oro-antral communication deriving from a previous local excision. Preoperative radiographs showed the involvement of the right maxilla, maxillary sinus, and nose with a suspect involvement of the maxillary division of the trigeminal nerve. Treatment was planned through a fully digital workflow. A partial maxillectomy was performed endoscopically, and maxilla was reconstructed using an anterolateral thigh free flap. Two zygomatic implants were inserted simultaneously. A provisional fix full-arch prosthesis was manufactured preoperatively through a fully digital workflow and was placed in the operating room. Following post-operative radiotherapy, the patient received a final hybrid prosthesis. During the follow-up period of two years, the patient reported good function, aesthetics, and significant enhancement in quality of life. According to the results of this case, the protocol represented can be a promising alternative for oral cancer patients with large defects, and can lead to an improved quality of life.
Collapse
Affiliation(s)
| | - Roberto Giuseppe D'Ambrogio
- Department of Surgical Specialties, Dental Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | | | - Fabrizio Grivetto
- Azienda Ospedaliero Universitaria Maggiore Della Carità Largo Bellini, 28100 Novara, Italy
| | - Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alberto Schreiber
- Department of Surgical Specialties, Ear, Nose and Throat Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | - Cesare Piazza
- Department of Surgical Specialties, Ear, Nose and Throat Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | - Stefano Salgarello
- Department of Surgical Specialties, Dental Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | - Camilla Dosio
- Azienda Ospedaliero Universitaria Maggiore Della Carità Largo Bellini, 28100 Novara, Italy
| | - Emma Grecchi
- Private Practice, Via Boccaccio 34, 20123 Milan, Italy
| |
Collapse
|
6
|
Russell J, Volker G, McGarvey D, Sharpe C, Breik O, Borgna SC, Pateman K, Batstone M. An objective analysis of composite free flap donor site morbidity in head and neck surgery: Prospective series. Head Neck 2023; 45:398-408. [PMID: 36437486 PMCID: PMC10098479 DOI: 10.1002/hed.27254] [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: 09/07/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A poor evidence basis exists regarding the objective donor site morbidity associated with osseous free flap harvest. This study prospectively assessed the objective donor site morbidity associated with osseous free flap harvest for the fibula, scapula, and iliac crest (DCIA) donor sites. METHODS A single-site, prospective cohort clinical research study was conducted. Sixty-four patients were recruited between 2017 and 2021. Patients were assessed using a donor site specific assessment tool pre-operatively, and again >12 months post-operatively. RESULTS There was a significant reduction post-operatively in assessment tool scores compared to the pre-operative period for the fibula, scapula and DCIA. Females were more likely to report a greater reduction in Harris Hip Score post-operatively compared to males. CONCLUSIONS The fibula, scapula, and DCIA donor sites are associated with reduced objective function post-operatively compared to patient's pre-operative baseline. The implications are least pronounced for the fibula.
Collapse
Affiliation(s)
- Joshua Russell
- Faculty of MedicineThe University of QueenslandHerstonQueenslandAustralia
| | - Glen Volker
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Declan McGarvey
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Catherine Sharpe
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Omar Breik
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Scott C. Borgna
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Kelsey Pateman
- The University of QueenslandSchool of DentistryHerstonQueenslandAustralia
| | - Martin Batstone
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| |
Collapse
|
7
|
Free Your Mind, Not Your Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4384. [PMID: 35720204 PMCID: PMC9200385 DOI: 10.1097/gox.0000000000004384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
The pedicled flap has been a mainstay of soft tissue reconstruction since the earliest days of plastic surgery. Advances in surgical technology and skill have led to an erosion in the use of pedicled flaps in favor of increasingly popular free tissue transfers. Still, regional flaps without microvascular anastomosis remain a valuable reconstructive tool. Although still requiring microsurgical skills, these flaps are of particular benefit in patients with few or poor quality recipient vessels, in those who cannot tolerate antiplatelet therapy, and in those who cannot tolerate the often-extended anesthesia time necessitated by microvascular anastomosis. Furthermore, pedicled flaps may significantly reduce total cost of a reconstruction procedure with similar outcomes. In this case series, we report challenging scenarios where microsurgical approaches may have been typical choices but were instead reconstructed by pedicled options with desired outcomes. Difficult soft tissue defects were successfully reconstructed with a variety of pedicled flaps. Soft tissue transfers to the abdomen, flank, shoulder, and back are presented. None of the reconstructions required microvascular anastomosis.
Collapse
|
8
|
Deganello A, Rampinelli V, Gualtieri T, Piazza C. Versatility of the subscapular system of flaps in head and neck oncologic reconstruction. Curr Opin Otolaryngol Head Neck Surg 2022; 30:161-167. [PMID: 34670257 PMCID: PMC9928565 DOI: 10.1097/moo.0000000000000771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review analyzes the different ways of applying the subscapular system of flaps (SSSF) as a convenient and versatile solution for a large variety of head and neck oncologic defects. RECENT FINDINGS The ventral approach permits safe and efficient harvest of various chimeric SSSF in a supine position, thus allowing simultaneous flap preparation and tumor ablation. Conformational studies have revealed how similar the tip of the scapula is to the hard palate in terms of dimensions, shape, and conformation. This has led to favor horizontal placement of the scapular tip for palate reconstruction in most instances, addressing the vertical extension of the postmaxillectomy defect using denuded bony grafts surrounded by well vascularized chimeric muscular components. SUMMARY The SSSF possesses an unparalleled versatility to efficiently address small-medium sized soft tissue defects up to vast and complex composite resections. The chimeric components of these flaps benefit from a considerable independency provided by the length of the named arteries arising from the thoracodorsal pedicle, offering a high degree of freedom to accomplish the required in-setting. This reconstructive option should be implemented in every head and neck surgical team and offered to suitable patients.
Collapse
Affiliation(s)
- Alberto Deganello
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| |
Collapse
|
9
|
Deane EC, Liu AQ, Nguyen S, Anderson DW, Durham JS, Prisman E. Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction. Head Neck 2021; 44:760-769. [PMID: 34936161 DOI: 10.1002/hed.26963] [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: 10/06/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The scapula free flap is a versatile option in head and neck reconstruction but is less amenable to simultaneous harvest and ablation. METHODS Retrospective series (2015-2021) of consecutive scapula flaps. Cases categorized as simultaneous versus sequential, compared for operative time, oncological and patient-reported outcomes. RESULTS Seventy consecutive scapula free flaps were performed (n = 21 simultaneous, n = 49 sequential). Mandible reconstruction was performed in 51.0% and 61.9% of sequential and simultaneous cases, respectively; 49.0% and 38.1% addressed bony maxillary defects. Simultaneous surgery reduced operative time by 37.9% (151 min, p < 0.00001) and there were fewer tracheostomies performed (p < 0.005). Rates of positive margins and free flap compromise were equivalent (n = 1, 4.8% vs. n = 2, 4.1%). There was no difference in patient-reported outcomes. CONCLUSIONS This series demonstrates feasibility, efficacy, and outcomes of bony scapula reconstruction of maxillofacial defects comparing simultaneous and sequential approaches. Benefits of the two-team approach are highlighted including decreased operative time.
Collapse
Affiliation(s)
- Emily C Deane
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Q Liu
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sally Nguyen
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald W Anderson
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Scott Durham
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Scapular osseous free flap in head and neck reconstruction: An assessment of the postoperative function of the donor site. J Plast Reconstr Aesthet Surg 2021; 75:753-760. [PMID: 34810144 DOI: 10.1016/j.bjps.2021.09.065] [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: 11/20/2020] [Revised: 06/20/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The scapular osseous free flap (SOFF) has become an important reconstructive option for complex head and neck defects. Postoperative donor site function is, however, an important consideration. The objective of this study was to prospectively investigate SOFF donor site morbidity and to relate the findings to hand dominance and neck dissection. METHODS Objective assessment included bilateral measurement of shoulder, elbow, and hand range of motion (ROM), hand strength, and distal nerve function in consecutive patients with head and neck cancer SOFF reconstruction at a tertiary referral center in Sweden between 2016 and 2019. The subjective function was assessed by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS Sixteen of 20 consecutive patients were evaluated (median follow-up 10 months [range 3-17]). Significant side differences in shoulder range of motion (ROM) (flexion, abduction, external and internal rotation) were observed for patients where the SOFF had been harvested from the same side as their dominant hand (n = 9; Ps ≤ 0.04). For patients where the SOFF was harvested from the non-dominant hand side, no significant shoulder ROM side differences were observed (n = 7; Ps ≥ 0.08). There were significant side differences in shoulder ROM for patients who underwent neck dissections (n = 12; Ps ≤ 0.03), not for the other four patients. Patients reported low but varying DASH scores (median 2.5, range 0-57). CONCLUSION Postoperative donor site morbidity seems to be quite acceptable after SOFF surgery. The results indicate possible benefits of choosing the non-dominant hand side for the SOFF and that a neck dissection affects postoperative shoulder outcome. Further studies are however needed.
Collapse
|
11
|
Fullerton H, Dawood A, Kalavrezos N, Sinha D. Contemporary management of advanced midface malignancy in the age of Instagram - a parallel surgical and patient's perspective. Br Dent J 2021; 231:233-238. [PMID: 34446894 PMCID: PMC8390028 DOI: 10.1038/s41415-021-3320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022]
Abstract
The internet and social media give our patients extraordinary access to information; in these unprecedented times of the COVID-19 pandemic, where so much of life takes place online, patients and professionals alike look to the internet more and more for information and (self-)diagnosis. This article details the treatment journey for a patient with a high-grade chondroblastic osteosarcoma of the right maxilla, paranasal area and zygoma, from misdiagnosis through to resection and full rehabilitation with free flap surgery and implant reconstruction. Uniquely, the article details the patient's treatment, in parallel with her own perception of the treatment, as shared on social media. Alerts the reader to the power of social media as a tool to inform and educate the patient and the dental team. Informs the reader of the power of social media as a means for the patient to describe and share their experiences - both positive and negative. Describes contemporary management of an advanced oral malignancy, from the patient's and the surgeon's perspective.
Collapse
Affiliation(s)
- Hannah Fullerton
- Dawood & Tanner Dental Practice, 45 Wimpole Street, London, W1G 8SB, UK; Head and Neck Surgery, London Sarcoma Service, University College London Hospital, London, NW1 2PG, UK
| | - Andrew Dawood
- Dawood & Tanner Dental Practice, 45 Wimpole Street, London, W1G 8SB, UK; Head and Neck Surgery, London Sarcoma Service, University College London Hospital, London, NW1 2PG, UK.
| | - Nicholas Kalavrezos
- Head and Neck Surgery, London Sarcoma Service, University College London Hospital, London, NW1 2PG, UK
| | - Deepti Sinha
- Head and Neck Surgery, London Sarcoma Service, University College London Hospital, London, NW1 2PG, UK
| |
Collapse
|
12
|
Russell J, Pateman K, Batstone M. Donor site morbidity of composite free flaps in head and neck surgery: a systematic review of the prospective literature. Int J Oral Maxillofac Surg 2021; 50:1147-1155. [PMID: 33531270 DOI: 10.1016/j.ijom.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
Composite free flaps represent the cornerstone for the repair of osseous defects in the head and neck. For many patients, there are often multiple defect-suitable donor sites that may be utilised as part of the reconstructive process. Therefore, to optimise patient outcomes, an evidence-based approach to donor site selection is required to maximise quality of life and long-term functionality. A systematic review of the literature was conducted in accordance with PRISMA guidelines to evaluate the evidence for donor site selection based on minimising the associated donor site morbidity and optimising patient functionality postoperative. The fibula is associated with the greatest potential risk for wound healing complications. Fibula and scapula harvest has the potential to have a significant impact on physical performance. The iliac crest is most favourable in terms of aesthetic scar healing outcomes. Overall, however, the quality and quantity of evidence for all donor sites is limited. Each site is associated with specific complications and morbidity, of which the surgeon and patient must both be aware. Whilst a cross-sectional informed opinion of the likely advantages/disadvantages of one donor site over another can thus be made, there are few head-to-head studies available that directly compare donor sites.
Collapse
Affiliation(s)
- J Russell
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - K Pateman
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - M Batstone
- Maxillofacial Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| |
Collapse
|
13
|
A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2267. [PMID: 31942327 PMCID: PMC6952141 DOI: 10.1097/gox.0000000000002267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
Although many algorithms exist to classify oral cavity defects, they are limited by either considering a single subsite or failing to provide a concise reconstructive algorithm for the breadth of defects. Based upon our experience as a tertiary referral center, a unifying algorithm is presented that guides free flap selection in this heterogenous population.
Collapse
|
14
|
Deganello A, Ferrari M, Paderno A, Turri-Zanoni M, Schreiber A, Mattavelli D, Vural A, Rampinelli V, Arosio AD, Ioppi A, Cherubino M, Castelnuovo P, Nicolai P, Battaglia P. Endoscopic-assisted maxillectomy: Operative technique and control of surgical margins. Oral Oncol 2019; 93:29-38. [PMID: 31109693 DOI: 10.1016/j.oraloncology.2019.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/23/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND When amenable to radical excision, cancer involving the maxilla is typically treated with maxillectomy followed by adjuvant therapy. Posterior tumor extension beyond the maxillary box leads to the invasion of complex areas, where achieving clear margins may be challenging. METHODS Patients undergoing endoscopic-assisted maxillectomy for nasoethmoidal, maxillary, or hard palate cancer between 2007 and 2017 were included in the study. Surgical technique, margin status, and recurrences were analyzed. Extension of posterior resection was classified in 3 types (type 1: resection of the pterygopalatine fossa; type 2: resection of the pterygoid plates and related muscles; type 3: resection of the upper parapharyngeal space). The analysis of putative risk factors for involvement of margins and local recurrence was performed with special focus on the posterior and medial margin. RESULTS The study included 79 patients (75 with available follow-up; mean: 20.6 months, range: 6-101 months), 37 (46.8%) of whom underwent type 1 resection, 34 (43.0%) type 2, and 8 (10.1%) type 3. According to pT category, 57 (72.2%) tumors were classified as T4a/T4b. Posterior and medial clear margins were achieved in 76/79 (96.2%) and 75/79 (94.9%) patients, respectively. T4b category, extension to the ethmoid, sphenoid sinus, pterygoid process, orbital cavity, and premaxillary tissues were significantly associated with a higher rate of margin involvement. None of the factors was significantly associated with medial margin involvement. CONCLUSION Endoscopic-assisted maxillectomy combines several refinements including the facilitated detachment of the maxilla from the skull base and precise delineation of the posterior and medial margins of resection.
Collapse
Affiliation(s)
- Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alperen Vural
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Department of Otorhinolaryngology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Daniele Arosio
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Microsurgery and Lymphatic Surgery Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Battaglia
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
15
|
Eskander A, Kang SY, Teknos TN, Old MO. Advances in midface reconstruction: beyond the reconstructive ladder. Curr Opin Otolaryngol Head Neck Surg 2017; 25:422-430. [DOI: 10.1097/moo.0000000000000396] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
|