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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Zhang C, Wang Q, Wu L, Wang J, Zhao S, Wang J. Continuous Interstitial Glucose Measurement for Flap Venous Occlusion Monitoring in a Diabetic Model. J Craniofac Surg 2022; 33:2698-2703. [PMID: 35761445 DOI: 10.1097/scs.0000000000008657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Glucose has been used in the monitoring of transplanted flaps. However, few studies have focused on the effect of diabetes on the decrease in flap glucose levels. The purpose of this study was to evaluate the application of continuous interstitial glucose monitoring to detect flap venous occlusion in a diabetic rat model. The flap interstitial glucose level was measured by transcutaneous sensors in the bilateral vertical rectus abdominis myocutaneous flaps of each rat. interstitial glucose values in the bilateral flaps were recorded every 5 minutes after the venous occlusion of 1 flap. Forty-one rats were divided into the control group (n = 13), diabetic group (n = 15, established by the intraperitoneal injection of streptozotocin), and insulin-treated diabetic group (n = 13, systemic glucose well controlled by insulin before surgery). Results indicated that flap interstitial glucose decreased to the lowest level in all flaps with venous occlusion. The time from venous occlusionto the lowest interstitial glucose level was significantlylongerinthe diabetic group than the control group (120.8 ± 5.7 minutes versus 56.5 ± 6.7 min-minutes, P < 0.001), but was similar in the insulin-treated diabetic and control groups (56.5 ± 6.7 minutes versus 56.0 ± 6.6 minutes, P = 0.876). The change in interstitial glucose in both the diabetic and insulin-treated diabetic groups began with a plateau period or a slow decline before decreasing for 49.0 ± 6.4 minutes and 24.4 ± 4.3 min-minutes, respectively. in a diabetic rat model, impaired glucose metabolism prolongs the required monitoring time and dulls the reaction of flap interstitial glucose to venous congestion. Insulin restores the prolonged monitoring time, but not the reaction of flap interstitial glucose. Therefore, care is needed during application of the technique in diabetic patients.
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Affiliation(s)
- Chang Zhang
- Head and Neck Plastic and Cosmetic Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Role of craniofacial surgery in oral and maxillofacial tumors involving the skull base: A retrospective analysis of 126 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:496-504. [PMID: 32682593 DOI: 10.1016/j.oooo.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/04/2020] [Accepted: 06/05/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Oral and maxillofacial tumors involving the skull base (SB) are rare and complex, making treatment difficult and controversial. The purpose of the present study was to evaluate the treatment efficacy of craniofacial surgery (CFS). STUDY DESIGN Patients who underwent CFS for these tumors between May 2000 and November 2017 were retrospectively analyzed. Clinicopathologic and treatment modality data were collected and follow-up was recorded. Kaplan-Meier and log-rank tests and Cox-regression model were used for survival analysis. RESULTS In total, 126 patients were enrolled (70 males and 56 females; 97 malignant tumors). Squamous cell carcinoma accounted for the majority of tumors. The lip-submandibular-neck approach was most frequently applied. Through-and-through SB bone or partial dura resection was performed in 42 cases. A pathologic positive margin was found in 18 cases. Of the included patients, 80 underwent simultaneous craniofacial reconstruction. The postoperative complications rate was 11.1%. Estimated 1-year, 3-year, and 5-year overall survival rates were 78.8%, 68.2%, and 54.4% respectively; and the 1-year, 3-year, and 5-year recurrence-free survival rates were 77.4%, 66.8%, and 63.8%, respectively. Multivariate analysis indicated postoperative complications, radiotherapy, recurrence, and metastasis status had a negative impact on survival (P < .05). CONCLUSIONS Although tumors involving the SB had various clinicopathologic characteristics, with interdisciplinary cooperation, CFS is an optimal option.
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Abstract
Palatomaxillary reconstruction presents a unique challenge for the reconstructive surgeon. The maxillofacial skeleton preserves critical aerodigestive functions-it provides a stable hard palate to support mastication and separate the nasal and oral cavities, and buttress support to provide adequate midface contour. Free tissue transfer has become a routine part of the reconstructive ladder in managing palatomaxillary defects. While there is a wide variety of options for bony reconstruction within the head and neck, the fibula and the scapula, and their variations, have become two of the most commonly used options for midface reconstruction. This review will discuss the advantages and disadvantages of both in specific regard to reconstruction of the palatomaxillary area.
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Affiliation(s)
- Arvind K. Badhey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohemmed N. Khan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
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Olsson AB, Dillon J, Kolokythas A, Schlott BJ. Reconstructive Surgery. J Oral Maxillofac Surg 2019; 75:e264-e301. [PMID: 28728733 DOI: 10.1016/j.joms.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Song D, Li Z, Zhou X, Zhang Y, Peng X, Zhou B, Lü C, Peng C, Peng W, Ou Y. [Effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect after oral cancer ablation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:607-611. [PMID: 29806351 DOI: 10.7507/1002-1892.201708110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect following oral cancer ablation. Methods Between January 2008 and December 2016,42 patients with oral cancer were treated. There were 31 males and 11 females with an average age of 44.5 years (range, 31-68 years). There were 28 cases of buccal mucosa carcinoma, 10 cases of basal cell carcinoma of buccal skin, 3 cases of gingiva carcinoma, and 1 case of recurrent parotidduct carcinoma. The disease duration ranged from 1 to 24 months (mean, 13.5 months). The size of through-and-through maxillofacial defect ranged from 6.0 cm×4.5 cm to 9.0 cm×7.0 cm. All defects were repaired with the bipaddled anterolateral thigh perforator flap. The paddles were adjusted to repair the buccal area. And the size of flap ranged from 7 cm×5 cm to 10 cm×8 cm. The donor sites were closed directly. Results The operation time was 4.5-7.5 hours (mean, 5.5 hours). All flaps healed and the wounds of recipient and donor sites healed by first intention. All patients were followed up 9-60 months (mean, 22 months). All patients were satisfied with their facial appearance and the speech function. The range of mouth opening was 3-5 cm. Three patients died of recurrence during the follow-up period and the other patients were alive. Conclusion The bipaddled anterolateral thigh perforator flap is flexible and reliable for the through-and-through maxillofacial defect reconstruction following oral cancer ablation.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008,
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000, P.R.China
| | - Xiaowei Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
| | - Cuie Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
| | - Wen Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
| | - Yan Ou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China
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Wilkman T, Husso A, Lassus P. Clinical Comparison of Scapular, Fibular, and Iliac Crest Osseal Free Flaps in Maxillofacial Reconstructions. Scand J Surg 2018; 108:76-82. [DOI: 10.1177/1457496918772365] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: This study compared the three most used composite flaps in maxillofacial reconstructions in our institute. Patients and Methods: Between 2000 and 2012, a total of 163 patients with mandibular, maxillary, and orbital defects received either scapular, fibular, or iliac crest osseal reconstructions in Helsinki University Hospital, Departments of Plastic Surgery and Maxillofacial Surgery. Data regarding the patient demographics, complications, and outcomes were analyzed. Results: There were 92 deep circumflex iliac artery flaps (56%), followed by 42 scapular (26%) and 29 fibular flaps (18%). The rate of flap loss was the highest in the deep circumflex iliac artery group (p = 0.001). Reconstructions using fibula were fastest (p = 0.001) and had lowest perioperative blood loss (p = 0.013). There were no significant differences in the number of early or late complications between the flaps, but donor site complications were more severe in deep circumflex iliac artery. Osteotomies as well as dental implants were safely performed in all flaps with equal results. Conclusion: All three flaps of this study can be performed with awareness of the deep circumflex iliac artery flap being the least reliable alternative. The knowledge of the advantages and disadvantages of several osseal-free flap alternatives is beneficial in selecting the best suitable method for each individual patient requiring maxillofacial osseal reconstruction.
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Affiliation(s)
- T. Wilkman
- Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A. Husso
- Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - P. Lassus
- Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Ebrahimi A, Nejadsarvari N, Ebrahimi A. Reconstructions of Small Scalp Defects with Step Flap. J Cutan Aesthet Surg 2017; 10:106-108. [PMID: 28852298 PMCID: PMC5561705 DOI: 10.4103/jcas.jcas_138_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Defects of the scalp arise from several aetiologies including trauma, burn, injury, infection, radiation and surgical excision of tumours. Multiple options for reconstruction of scalp defects exist that included primary closure, skin grafts, local flaps, regional and distal free flaps. Patients and Methods: This was a prospective case-series study, which was carried out in the Department of Plastic Surgery of our Hospital. Step flap was used for small (2.5 cm × 2.5 cm) scalp skin defects reconstructions after skin tumour ablations. In this 2 years study, 15 patients (7 female , 8 male), ranging from 40 to 72 years (mean, 53 years), underwent an operation with local step flap for reconstruction of scalp defects caused by basal cell carcinoma or squamous cell carcinoma excision. Results: The patients who present with small scalp malignant tumours need complete resection and perfect reconstruction. This study showed that step flap with sufficient releasing was an effective method for reconstruction of small scalp defects due to skin malignancies. We had no case of flap complications such as ischaemia or necrosis. Conclusion: We recommend this local flap (z-flap) as a new approach for small scalp defect reconstruction in all areas of hair-bearing scalp.
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Affiliation(s)
- Ali Ebrahimi
- Department of Plastic Surgery, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nasrin Nejadsarvari
- Department of Medical Ethics, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Ebrahimi
- Medical Student, Tehran University of Medical Sciences, Tehran, Iran
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Paprottka FJ, Krezdorn N, Ipaktchi R, Radtke C, Vogt PM. Plastic reconstructive surgery techniques for defect coverage of extended skull base defects. J Plast Reconstr Aesthet Surg 2016; 69:1266-74. [PMID: 27436756 DOI: 10.1016/j.bjps.2016.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/03/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Large skull base defects are extremely difficult to treat and have a severe impact on patients' physical appearance and functional aspects. These extensive defect zones are mainly caused by trauma, surgical interventions, or wide tumor excision. High-level microsurgical techniques are necessary to provide sufficient treatment. The aim of this study is to describe successful reconstructive strategies for surgical treatment. METHODS Nine patients with skull base defects were treated in our department from 2008 to 2014 (n = 9). Plastic surgical reconstruction was performed with latissimus dorsi (LD;) (n = 4), LD-scapula flaps (n = 2), vertical rectus abdominis myocutaneous (VRAM) flaps (n = 2), and a greater omentum flap (n = 1). The mean follow-up period was 2.3 ± 2.2 years (0.5-4.5 years). Oncologic diseases (8 patients) and iatrogenic damage (1 patient) caused the massive skull base defects. RESULTS In all cases, we achieved the final surgical treatment of large skull base defects by free flaps with permanent wound closure. The mean operating time was 5:53 h (range 4:45-7:52 h). The primary outcome measures were survival and sufficient defect coverage. Flap survival rate was 100%, and none of the patients deceased during the follow-up period. Furthermore, we demonstrated the surgical key points of LD-scapula flap closure in detail. CONCLUSION Plastic surgical defect coverage by well-perfused tissue flaps of large skull base defects provides an efficient and effective treatment option. Complex skin, soft tissue, and dural defects can be successfully covered with these preformed free flaps. The choice of flap is based on the individual case.
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Affiliation(s)
- Felix J Paprottka
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Straße 17, 27356 Rotenburg (Wümme), Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany
| | - Ramin Ipaktchi
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany
| | - Christine Radtke
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany.
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Pink R, Molitor M, Tvrdy P, Michl P, Pazdera J, Zboril V, Zalesak B. Reconstructive procedures in maxillofacial oncosurgery. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 160:153-7. [PMID: 25482734 DOI: 10.5507/bp.2014.055] [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: 04/11/2014] [Accepted: 10/15/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Oropharyngeal cancers are a biologically heterogenous group of tumors with diverse risk factors including tobacco, alcohol, HPV, inherited disorders, the acquired immunodeficiency of Karposi's Sarcoma and non Hodgkin's lymphoma. In the Czech Republic, oropharyngeal cancers represent around 2% of all cancers. The treatment of these tumors is long and complex. Reconstructive procedures in maxillofacial oncosurgery demand good interdisciplinary collaboration and great professional preparedness of the surgical and nursing team. Patient age and stage of disease, including the presence of metastases are of key importance. A prerequisite for the success of surgical treatment is removal of the tumor with a sufficient safety margin. Reconstructive procedures then follow. AIM To highlight the importance of radical tumor resection and describe reconstruction of the defect in a group of our patients. METHODS AND RESULTS From 2008 to 2013, 23 patients with oropharyngeal carcinoma underwent radical surgical removal of tumor, followed by reconstruction of postoperative defects using distant and free flaps. The histopathology showed predominantly squamous cell carcinomas and one of Merkel cell carcinoma. 16 patients had malignant disease detected in III-IV. In only 7 cases was treatment initiated in the first and second stages of the disease. In these patients, the tumors were removed with a safety margin of healthy tissue and in none, did the basic cancer recur . The postoperative course in terms of flap engraftment and overall condition of the patient was uneventful. All of these patients still enjoy a good life quality with a current mean survival in range 5 - 76 months. Radical surgical removal of a malignant tumor in the early stages of the disease is associated with fewer postoperative complications and longer survival. CONCLUSION To avoid the risk of local and/or systemic postoperative complications, appropriate patient selection is important. Overall, the traditional, classic reconstructive procedures with the use of prostheses, in many cases is still the best option in our experience.
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Affiliation(s)
- Richard Pink
- Department of Oral and Maxillofacial Surgery, University Hospital Olomouc, Czech Republic
| | - Martin Molitor
- Department of Plastic and Aesthetic Surgery, University Hospital Olomouc, Czech Republic
| | - Peter Tvrdy
- Department of Oral and Maxillofacial Surgery, University Hospital Olomouc, Czech Republic
| | - Petr Michl
- Department of Oral and Maxillofacial Surgery, University Hospital Olomouc, Czech Republic
| | - Jindrich Pazdera
- Department of Oral and Maxillofacial Surgery, University Hospital Olomouc, Czech Republic
| | - Vitezslav Zboril
- Department of Oral and Maxillofacial Surgery, University Hospital Olomouc, Czech Republic
| | - Bohumil Zalesak
- Department of Plastic and Aesthetic Surgery, University Hospital Olomouc, Czech Republic
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Beck-Broichsitter BE, Garling A, Koehne T, Barvencik F, Smeets R, Mehl C, Jeschke A, Wiltfang J, Becker ST. 3D-tracking the regenerative potential of the mandible with micro-CTs. Oral Maxillofac Surg 2014; 19:29-35. [PMID: 24577628 DOI: 10.1007/s10006-014-0443-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 02/11/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE The treatment of large bone defects is a challenging problem especially when the mandible is affected. Bone healing is dependent on the defect size and the integrity of periosteum. So far, these both aspects have not been investigated separately. The aim of this study was to evaluate the healing potential of the mandibular bone with the help of three-dimensional micro-computed tomography (CT). METHODS The angle of the mandible was exposed in 15 Wistar rats. A 3-mm core of bone was removed with a trephine. The local periosteum next to the defect was excised. Animals were randomized in five groups, which were ended 5, 10, 15, 28 and 56 days after operation. The mandible was excised and underwent micro-CT. For statistical evaluation, t-test statistics and regression analysis were applied. RESULTS Characteristics of the defects began to change on the tenth postoperative day. Fifteen days until 4 weeks after intervention new mineralization processes could be observed. New bone grew from the borders into the defect. In the 2D study, bone apposition changed significantly from the beginning to week 8 (0.08 to 0.74 mm) as well as the 3D bone gain (0.05 % to 29.67 %) in t-test statistical evaluation. For development of the bone volume inside the defect linear as well as exponential regression analysis revealed a statistically significant connection. CONCLUSIONS This study quantified the amount of newly grown bone during osseous regeneration. We could show that the mandible itself provides regenerative capacity without any intact periosteum.
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Affiliation(s)
- Benedicta Elisabeth Beck-Broichsitter
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Campus Forschung, Gebäude N27, 20246, Hamburg, Germany,
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Biosynthetic porcine collagen dressings as an adjunct or definitive tool for the closure of scalp defects without periosteum. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:887-96. [PMID: 23149053 DOI: 10.1016/j.adengl.2012.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/01/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. OBJECTIVE To evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. MATERIALS AND METHODS We performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. RESULTS The most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. CONCLUSIONS The use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.
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Beck-Broichsitter BE, Christofzik DW, Daschner F, Knöchel R, Smeets R, Warnke P, Wiltfang J, Becker ST. Endocultivation: Metabolism During Heterotopic Osteoinduction In Vivo—Monitoring with Fiber Optic Detection Devices. Tissue Eng Part C Methods 2012; 18:740-6. [DOI: 10.1089/ten.tec.2011.0641] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - David W. Christofzik
- Department of Conservative Dentistry, Christian Albrechts University, Kiel, Germany
| | - Frank Daschner
- Microwave Laboratory, Faculty of Engineering, Christian Albrechts University, Kiel, Germany
| | - Reinhard Knöchel
- Microwave Laboratory, Faculty of Engineering, Christian Albrechts University, Kiel, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, Hamburg University, Hamburg, Germany
| | - Patrick Warnke
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany
| | - Stephan T. Becker
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany
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Chen YW, Chen CY, Chiang SC, Lui MT, Kao SY, Yang MH. Predictors and impact of microsurgical complications in patients with locally advanced oral squamous cell carcinoma. Cancer Sci 2012; 103:1672-8. [PMID: 22632121 DOI: 10.1111/j.1349-7006.2012.02345.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/03/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022] Open
Abstract
Microvascular free flap transfer for post-oncologic reconstructive surgery in oral cancer is considered to be a challenge due to the complexity of the anatomy and function of the region. We sought to identify possible factors associated with microsurgical complications and to assess the impact of these complications in relation to patient survival. Following the inclusion and exclusion protocol, 142 patients with stage III and IV oral squamous cell carcinoma (OSCC) who underwent immediate free flap reconstruction after tumor ablation were included in the study. Clinical and surgical procedural-related factors were retrieved from a database and analyzed retrospectively; survival data were evaluated using the Kaplan-Meier method. Major complications that required re-anastomosis of the flap vessels occurred in 23 patients (16.2%); total necrosis of the flaps, regardless of salvage treatment, occurred in seven cases, with 95.1% of full flap survival. The American Society of Anesthesiologists classification, types of neck dissection, and number of flaps were regarded as strong predictors for surgical complications. Patients with these complications appeared to have a shortened survival (5-year cancer-specific survival of approximately 60%, both in stage III and IV OSCC). However, the impact of surgical complications on survival was significant only in stage III OSCC (P = 0.037). Strategies to minimize surgical complications should be used to ensure better prognoses for these patients.
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Affiliation(s)
- Ya-Wei Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taiwan
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Martorell-Calatayud A, Sanz-Motilva V, Nagore E, Serra-Guillén C, Sanmartín O, Echeverría B, Guillén-Barona C. Biosynthetic Porcine Collagen Dressings as an Adjunct or Definitive Tool for the Closure of Scalp Defects Without Periosteum. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:887-896. [PMID: 22770502 DOI: 10.1016/j.ad.2012.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/24/2012] [Accepted: 04/01/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND: Aggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. OBJECTIVE: To evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. MATERIALS AND METHODS: We performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. RESULTS: The most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. CONCLUSIONS: The use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.
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Liu SC, Chiu WK, Chen SY, Lee TP, Wang HW, Chen SG. Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance. J Craniomaxillofac Surg 2011; 39:633-8. [DOI: 10.1016/j.jcms.2011.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 01/04/2011] [Accepted: 01/04/2011] [Indexed: 11/28/2022] Open
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Decreased cognitive functioning in patients with advanced oral squamous cell carcinoma. Oral Oncol 2011; 47:993-7. [DOI: 10.1016/j.oraloncology.2011.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 08/14/2011] [Accepted: 08/16/2011] [Indexed: 11/17/2022]
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Functional outcome in patients with advanced head and neck cancer: surgery and reconstruction with free flaps versus primary radiochemotherapy. Eur Arch Otorhinolaryngol 2011; 269:629-38. [PMID: 21643935 DOI: 10.1007/s00405-011-1642-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
Abstract
The objective was to compare functional outcome in patients with advanced head and neck cancer (HNC) treated with (a) surgical resection and reconstruction with microvascular free flaps (MVFF) followed by radiochemotherapy versus (b) primary radiochemotherapy (RCT) on the basis of the International Classification of Functioning, Disability and Health (ICF) from WHO. This was a cross-sectional, multi-institutional study. The outcome measures included ICF Core Sets for HNC, the EORTC-QLQ, modules c30 + hn35 and the University of Washington-Quality of life Questionnaire (UW-QOL). Analyses included descriptive statistics, ranking exercises, and regression analyses in a cumulative logit model; 27 patients were treated with MVFF and 22 with RCT. Global Quality of life scores suggested a slightly better functional outcome for the surgical approach. The majority of ICF categories (81/93, 87%) did not show a difference in functional outcome between the two treatment approaches. In the remaining 12 ICF categories, n = 3 body structures were more affected in the MVFF group, while n = 3 body functions, and n = 6 activities/participations were more problematic in the RCT group. This included oral swallowing and weight maintenance functions as well as social relationships, acquiring a job, and economic self-sufficiency. In addition, nine contextual environmental factors were more relevant to the RCT group. Both treatment approaches seemed appropriate to advanced HNC from the perspective of functional outcome. The influence of treatment modalities on the social and economic lives of cancer survivors needs to be explored further. In order to guide rehabilitation according to patients' needs, the ICF offers a multidimensional view comprising body structures, body functions, and activities and participation in life.
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Jeon BJ, Mun GH. Perspectives on reconstructive microsurgery in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.6.604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Byung-Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee S, Thiele C. Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in preirradiated soft tissue. J Oral Maxillofac Surg 2010; 68:2169-78. [PMID: 20605307 DOI: 10.1016/j.joms.2009.08.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 08/24/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Several factors are associated with free flap complications in head and neck reconstruction after radiotherapy. The present study aimed to identify the correlation between irradiation and the healing of wounds after microvascular free flap transfer and to clarify the molecular mechanisms for the differences in healing between irradiated and nonirradiated patients. PATIENTS AND METHODS A retrospective study of 81 cases of microvascular free flap transfer was conducted. Tissue samples were obtained from 3 different regions of the patients (nonirradiated oral mucosa, irradiated skin, and nonirradiated skin). Expression of transforming growth factor-beta(1) was monitored by immunohistochemistry and immunoblot analysis. The levels of matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 were investigated qualitatively and quantitatively. RESULTS Multivariate analysis revealed that only preoperative irradiation was a significant predictor of free flap complications (P = .006), with a 4 times greater risk (odds ratio 4.141). It was also shown that patients with an advanced tumor stage and those who had received chemotherapy after radiotherapy were twice as likely to develop free flap complications. Transforming growth factor-beta(1) was overexpressed in free flaps for as long as 6 months after radiotherapy. It was remarkably observed in the granulation tissue in the preirradiated skin. Moreover, extracellular matrix remodeling regulated by transforming growth factor-beta(1) was detected with decreased matrix metalloproteinase-1 and increased TIMP-1 expression in the irradiated skin. CONCLUSION The healing of surgical wounds created by microvascular free flap transfer correlated negatively with preoperative radiotherapy. Extracellular matrix remodeling was also detectable in the free flap for up to 6 months after radiotherapy completion.
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Affiliation(s)
- Sooyeon Lee
- Department of Oral and Craniomaxillofacial Surgery/Plastic Surgery, University of Jena, Jena, Thueringen, Germany.
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Draenert FG, Gosau M, Al Nawas B. Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations. Head Face Med 2010; 6:8. [PMID: 20529277 PMCID: PMC2894781 DOI: 10.1186/1746-160x-6-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 06/07/2010] [Indexed: 11/10/2022] Open
Abstract
Background Mandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy. Venous failure still represents the most common complication in free flap surgery. We present the injection of heparine into the arterial pedicle as modification of the revising both anastomoses in these cases and illustrate the application with a clinical case example. Methods Methods consist of immediate revision surgery with clot removal, heparin perfusion by direct injection in the arterial vessel of the pedicle, subsequent high dose low-molecular weight heparin therapy, and leeches. After 6 hours postoperatively, images of early flap recovery show first sings of recovery by fading livid skin color. Results The application of this technique in a patient with venous thrombosis resulted in the complete recovery of the flap 60 hours postoperatively. Other cases achieved similar success without additional lysis Therapy or revision of the arterial anastomosis. Conclusion Rescue of fibular flaps is possible even in patients with massive thrombosis if surgical revision is done quickly.
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Affiliation(s)
- Florian G Draenert
- Clinic for Maxillofacial Surgery, University of Mainz, Augustusplatz 2, 55131 Mainz, Germany.
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Bell RB, Gregoire C. Reconstruction of Mandibular Continuity Defects Using Recombinant Human Bone Morphogenetic Protein 2: A Note of Caution in an Atmosphere of Exuberance. J Oral Maxillofac Surg 2009; 67:2673-8. [DOI: 10.1016/j.joms.2009.07.085] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 07/27/2009] [Indexed: 11/28/2022]
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