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Moest T, Kesting MR, Rohde M, Lang W, Meyer A, Weber M, Lutz R. A Treatment Approach for Carotid Blowout Syndrome and Soft Tissue Reconstruction after Radiotherapy in Patients with Oral Cancer: A Report of 2 Cases. J Clin Med 2023; 12:jcm12093221. [PMID: 37176661 PMCID: PMC10179401 DOI: 10.3390/jcm12093221] [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: 02/24/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND This retrospective case series study aims to demonstrate a salvage technique for the treatment of carotid blow-out syndrome (CBS) in irradiated head and neck cancer patients with a vessel-depleted neck. METHODS Between October 2017 and October 2021, two patients (N = 2) with CBS were treated at our institution in a multidisciplinary approach together with the Department of Vascular Surgery. Patients were characterized based on diagnoses, treatment procedures, and the subsequent postoperative course. RESULTS Surgical emergency intervention was performed in both cases. The transition zone from the common carotid artery (CCA) to the internal carotid artery (ICA) was resected and reconstructed with a xenogic (case 1) or autogenic (case 2) interposition (end-to-end anastomosis). To allow reconstruction of the vascular defect, an additional autologous vein graft was anastomosed to the interposition graft in an end-to-side technique, allowing arterial anastomosis for a free microvascular flap without re-clamping of the ICA. Because of the intraoperative ICA reconstruction, none of the patients suffered a neurological deficit. CONCLUSIONS The techniques presented in the form of two case reports allow for acute bleeding control, cerebral perfusion, and the creation of a vascular anastomosis option in the vessel-depleted neck.
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Affiliation(s)
- Tobias Moest
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054 Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054 Erlangen, Germany
| | - Maximilian Rohde
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054 Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054 Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054 Erlangen, Germany
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Bildstein AC, Fourdrain A, Prud'homme R, Salami A, Garmi R, Veyssière A, Bénateau H. Rerouting the internal thoracic vessels as recipient vessels in head and neck reconstruction: comparison of two anatomic approaches. J Plast Reconstr Aesthet Surg 2022; 75:3715-3721. [DOI: 10.1016/j.bjps.2022.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/01/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
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Shankhdhar VK, Mantri MR, Wagh S, Thiagarajan S, Chaukar D, Jaiswal D, Mathews S. Microvascular Flap Reconstruction for Head and Neck Cancers in Previously Operated and/or Radiated Neck: Is It Safe? Ann Plast Surg 2022; 88:63-67. [PMID: 34225312 DOI: 10.1097/sap.0000000000002951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microvascular reconstruction after oncologic resection with curative intent in recurrent or second primary cancer cases is challenging not only because of the complexity of the defect but also due to difficulty in finding suitable donor vessels in the neck that has already been subjected to surgery and subsequent adjuvant treatment. In our present study, we evaluated the success of free flaps, reexplorations, and factors associated with reexploration and with flap failures in previously operated and/or radiated neck. METHODS In this retrospective study, we analyzed patients who underwent microvascular reconstruction from January 2016 to December 2018 in patients with previous surgery and/or radiation, considered as "already treated neck" (ATN). These cases were reviewed to analyze variables that included age, sex, indication for surgery (recurrence, second primary, osteoradionecrosis, and secondary reconstruction), duration since previous surgery or radiation, free flap done, donor vessels used, the need to go to the contralateral neck or outside the neck, need for vein grafts, flap reexploration rate, flap survival rate, and hospital stay of the patients. We also tried to identify factors that predisposed for a reexploration after performing reconstruction with a free flap in ATN. RESULTS Of 1522 free flaps done, 371 patients were included in the study. Flap success rate was 90.8% in ATN, which was comparable to naive neck (94%; P = 0.108). The reexploration rate in ATN (16.2%) was significantly higher (P = 0.0003) than in naive neck (9.8%). The previous treatment (neck dissection) received [P = 0.001; odds ratio, 13.7 (1.87-101.6)] was the most significant predisposing factor, and patients undergoing osteocutaneous flaps were more prone to undergo reexplorations (P = 0.05). Side of anastomosis, vessel used for anastomosis, comorbidities, and time since previous treatment did not affect the reexploration rate significantly. CONCLUSIONS Microvascular reconstruction can be safely performed in ATN with good success rates, and it should not be a deterrent in whom free flap is required to achieve best functional outcome. However, it may be associated with increase in reexploration rates in the postoperative period. Patients having undergone a previous neck dissection are at more risk of undergoing this reexploration in comparison with radiotherapy (RT)/chemotherapy and radiotherapy (CTRT) alone.
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Hyodo I, Nakamura R, Okumura S, Kamei Y, Yasuda H, Suzuki H. Feasibility and Safety of Microvascular Anastomoses Within Previously-Dissected Neck Regions. J UOEH 2022; 44:331-339. [PMID: 36464307 DOI: 10.7888/juoeh.44.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The selection of appropriate recipient vessels is important for the success of head and neck reconstruction. Vessels located outside of previously-dissected neck regions tend to be more frequently selected due to relative ease of preparation. However, some advantages are offered regarding dead space filling and formation by using vascular anastomoses within regions previously dissected, or reusing former free flap pedicle due to their proximity to the defect. We analyzed microsurgical anastomoses in patients requiring oral reconstruction who had previously undergone neck dissection. Contralateral vascular anastomoses were preoperatively planned in 10 cases of which 9 could be successfully performed (achievement rate, 90%). Ipsilateral side anastomoses were planned in 28 cases, with 26 anastomosed as planned (achievement rate, 92.9%). There was no statistically significant difference between the two groups. Vascular anastomosis within the scar region can be performed safely, based on preoperative planning and intraoperative judgment.
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Affiliation(s)
- Ikuo Hyodo
- Department of Plastic and Reconstructive Surgery, University Hospital of Occupational and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8556, Japan
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Ryota Nakamura
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Seiko Okumura
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya 464-8681, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya 466-8560, Japan
| | - Hiroshi Yasuda
- Department of Plastic and Reconstructive Surgery, University Hospital of Occupational and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Hideaki Suzuki
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Occupational and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8556, Japan
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Transverse cervical vessels as a recipient site for microvascular reconstruction in vessel-depleted necks: a safe option. JPRAS Open 2021; 30:6-12. [PMID: 34337128 PMCID: PMC8318920 DOI: 10.1016/j.jpra.2021.06.003] [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: 04/17/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Free flap reconstruction is the gold standard in complex head and neck reconstruction. The branches of the external carotid vessels (ECVs) are considered the most suitable recipients, but they may be unavailable in patients presenting “frozen necks” or “vessel-depleted necks” due to previous treatments. We report our experience using the transverse cervical vessels (TCV) in these situations. Methods Retrospective chart review of microsurgical head and neck reconstructions from 2005 to 2017. We focused our analysis on secondary procedures and compared the complication rate according to whether the TCV or the ECVs were used. Results A total of 97 free flaps were performed for secondary procedures in 89 patients, mainly due to oncological recurrence and fistulae. TCV were used in 14 procedures when external carotid vessel branches were unavailable. The overall complication rate (all grade III Dindo-Clavien) was of 21% versus 35%, respectively, in the TCV and ECVs group. Grade IIIb Dindo-Clavien complications, i.e., microsurgical complications (10%) and flap loss (1%), were only recorded in the ECVs group. Other complications recorded were seroma (7% versus 1%) and hematoma (17% versus 6%) in the TCV and ECVs groups, respectively, and corresponded to grade IIIa Dindo-Claviens. Conclusions The use of TCV is a safe second-line recipient site for microsurgical head and neck reconstruction in vessel-depleted necks. Major advantages are their anatomical position outside the previous surgical and radiation zone, lower affinity for atherosclerotic damage, and similar diameter to the pedicles of the most used flaps.
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Kushida-Contreras BH, Manrique OJ, Gaxiola-García MA. Head and Neck Reconstruction of the Vessel-Depleted Neck: A Systematic Review of the Literature. Ann Surg Oncol 2021; 28:2882-2895. [PMID: 33550502 DOI: 10.1245/s10434-021-09590-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/28/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Damage of the vascular system secondary to radical neck dissection and/or radiotherapy or other treatments has a negative impact on microsurgical reconstruction. The search for adequate recipient vessels is hindered by the complexity of previous procedures. METHODS A systematic review of microsurgical head and neck reconstruction in the vessel-depleted neck was performed. The issues analyzed were indications for surgery, more frequently performed flaps, vascular systems used as recipient vessels, outcomes, and complications. RESULTS The eligibility criteria were fulfilled by 57 studies published between September 1993 and January 2020. In 8235 patients, 8694 flaps were performed, 925 of which were for a vessel-depleted neck. The most commonly used flap was the anterolateral thigh flap, used in 195 cases (30%), followed by the radial forearm free flap, used in 157 cases (24%). The potential recipient vessels were numerous for arteries (26 options) and veins (31 options). For the 712 flaps with an identifiable recipient artery, the superficial temporal artery was the most commonly used vessel (n = 142, 20%). The superficial temporal vein was the most commonly used vessel for 639 flaps with an identifiable recipient vein (n = 118, 18.5%). Complications amounted to 11%; 80 out of 716 flaps in papers that reported them. Flap losses were reported in 2% of cases. CONCLUSIONS Major microsurgical head and neck reconstruction for postoncologic defects depends on appropriate recipient vessels. Vein availability is paramount. Understanding the complexity of this problem is useful for preoperative planning, precise decision-making, and an accurate surgical approach.
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Affiliation(s)
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, NY, USA
| | - Miguel Angel Gaxiola-García
- Plastic and Reconstructive Surgery Department, Mexico's Children Hospital (Hospital Infantil de México "Federico Gómez"), Mexico City, Mexico.
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Comparison of the surgical outcomes of free flap reconstruction for primary and recurrent head and neck cancers: a case-controlled propensity score-matched study of 1,791 free flap reconstructions. Sci Rep 2021; 11:2350. [PMID: 33504947 PMCID: PMC7840944 DOI: 10.1038/s41598-021-82034-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
This study was designed to compare the outcome and analyze the operation-related risk factors in free flap reconstruction for patients with primary and recurrent head and neck cancers. A 1:1 propensity score-matched analysis of the microsurgery registry database of the hospital. The primary outcome of the free flap reconstruction had a higher failure rate in the recurrent group than the primary group (5.1% vs. 3.1%, p = 0.037). Among the 345 pairs in the matched study population, there were no significant differences between the primary and recurrent groups regarding the rate of total flap loss (3.5% vs. 5.5%, p = 0.27) and secondary outcomes. This study revealed that free flap reconstruction had a higher failure rate in the recurrent group than the primary group, but such a difference may be attributed by the different patient characteristics.
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Surgical Techniques for Head and Neck Reconstruction in the Vessel-Depleted Neck. Facial Plast Surg 2020; 36:746-752. [PMID: 33368131 DOI: 10.1055/s-0040-1721108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The vessel-depleted neck presents a unique and challenging scenario for reconstructive surgery of the head and neck. Prior surgery and radiation often result in significant scarring and damage to the neck vasculature, making identification of suitable recipient vessels for microvascular free tissue transfer exceedingly difficult. Therefore, alternative reconstructive techniques and/or vessel options must be considered to obtain a successful reconstructive outcome for a patient. In this article, we discuss our experience and approach to the management of the vessel-depleted neck, emphasizing the importance of preoperative planning and having multiple backup options prior to surgery. The various preoperative imaging modalities and available options for recipient arteries and veins are presented in detail. Additionally, we discuss modifications of select free flaps to maximize their utility in successful reconstruction. Together with thoughtful preoperative planning, these techniques can help aid the reconstructive surgeon in addressing the complex decisions associated with the vessel-depleted neck.
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9
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Prince ADP, Broderick MT, Neal MEH, Spector ME. Head and Neck Reconstruction in the Vessel Depleted Neck. FRONTIERS OF ORAL AND MAXILLOFACIAL MEDICINE 2020; 2. [PMID: 33236000 DOI: 10.21037/fomm-20-38] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Microvascular free tissue transfer has revolutionized reconstruction and subsequently functional outcomes in the head and neck, but requires suitable recipient vessels for successful results. Recipient vessels can be significantly compromised by prior surgery, radiation therapy, or existing and/or underlying vascular disease in the neck. When further microvascular reconstruction is required in the vessel-depleted neck, identification of appropriate vessels for anastomosis can be difficult and can present complex decisions for the surgeon as well as the patient. In this article, we review the available literature on the vessel depleted neck and the possible vessel options. We present critical strategies for preoperative treatment planning and vessel selection in these patients. We also discuss the benefits and limitations of arterial and venous options while commenting on our unique institution's experiences. The external carotid branches as well as the available subclavian artery branches are presented in detail. The venous anatomy is also described, with particular focus on the accompanying veins and cephalic vein. We provide guidance on the selection and modification of free flaps to achieve the greatest function and cosmetic outcomes in the vessel depleted neck. Our collection of advanced management techniques will provide surgeons with more options to manage the complexity of the vessel depleted neck, and to further help patients understand the risk and benefits of these selections.
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Affiliation(s)
| | | | - Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
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10
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Scaglioni MF, Meroni M, Fritsche E, Rajan G. Internal mammary artery perforators as recipient vessels for free tissue transfer in head and neck reconstruction: A case report and literature review. Microsurgery 2020; 41:355-360. [PMID: 33159486 DOI: 10.1002/micr.30680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/29/2020] [Accepted: 10/23/2020] [Indexed: 11/12/2022]
Abstract
Head and neck defect reconstruction is a common challenge for plastic surgeons. Microsurgical free tissue transfer is a frequently used solution but its success strictly depends on the quality of recipient vessels. A particularly demanding situation occurs when there are no nearby available vessels because of previous extensive neck dissection and radiotherapy. In similar cases, it is necessary to resort to other and farther vessels. Common alternatives might be the thoraco-acromial vessels, the transverse cervical vessels, and the internal mammary vessel. Recently, the perforator vessels of the internal mammary artery and vein were shown to be safe alternatives as recipient vessels for autologous breast reconstruction, causing less morbidity and allowing adequate perfusion of rather large flaps. Here we present a floor of the mouth reconstruction after cancer relapse resection. In this case, we employed a chimeric anterolateral thigh (ALT) free flap anastomosed to the internal mammary perforator vessels in end-to-end fashion. A 46-years-old male patient presented a defect in the floor of the mouth and base of the tongue after cancer removal. No nearby vessels were available because of extensive fibrosis and damages due to previous surgeries and radiotherapy. Therefore, on the basis of our experience in autologous breast reconstruction, we chose the internal mammary perforator vessels in the recipient side and we harvested a chimeric ALT-based skin island then split into two parts for mouth reconstruction and monitoring. We performed the anastomosis resorting to internal mammary perforator vessels and we obtained a satisfactory result from both the functional and aesthetic point of view. Postoperative course was uneventful and at 6 months follow up the reconstructive result was good with no functional issue. We believe that this might be a valid and modern evolution of the use of internal mammary vessels as recipient vessels and that it is a worthy addition in the field of perforator-anastomosed flaps, extending its application also to head and neck reconstructions. Moreover, a brief literature review about alternative recipient vessels for depleted neck is also provided.
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Affiliation(s)
- Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Elmar Fritsche
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gunesh Rajan
- Department of Otolaryngology, Head & Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.,Otolaryngology, Head & Neck Surgery, Medical School, University of Western Australia, Perth, Australia
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11
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Wolff KD, Ritschl LM, von Bomhard A, Braun C, Wolff C, Fichter AM. In vivo perfusion of free skin flaps using extracorporeal membrane oxygenation. J Craniomaxillofac Surg 2019; 48:90-97. [PMID: 31874806 DOI: 10.1016/j.jcms.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/18/2019] [Accepted: 12/02/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The vessel-depleted, irradiated, and frozen neck, as well as severe atherosclerosis of recipient vessels represent challenging problems in free flap transfer. Extracorporeal free flap perfusion theoretically allows free flap reconstructions in the absence of local donor vessels, but is associated with a number of technical issues. In this study, a novel technique is presented using a commercially available system for extracorporeal membrane oxygenation (ECMO), modified for small blood volumes. METHODS After preclinical testing, an ECMO system certified for lung support was used to establish blood flow through the flap's artery with oxygenation, decarboxylation and warming of diluted packed blood cells. Venous blood was allowed to flow passively into a separate container. Perfusion was performed for 15 min at intervals of 4 h over 4-6 days. RESULTS Five patients with soft tissue defects requiring free flap reconstruction were included. Either primarily thinned anterolateral thigh (ALT) flaps (n = 3) or radial forearm flaps (n = 2) were used. We observed infection of the perfusate, with consequent subtotal flap loss, in one patient, complete epithelial loss in two patients, venous congestion in one case, and almost uneventful healing in the fifth patient. With conservative wound care and a split thickness skin graft in one case, stable wound coverage was achieved in all patients except one, who had secondary healing. None of the patients required a second flap for sufficient coverage. CONCLUSIONS The technique described is associated with the risks of infection, flap congestion, nutritive hypoperfusion, and consequent tissue loss. Nevertheless, stable defect closure seems to be achievable even in patients with depleted recipient vessels.
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Affiliation(s)
- Klaus-Dietrich Wolff
- Technical University of Munich, School of Medicine, Department of Oral and Maxillofacial Surgery, Ismaninger Str. 22, Munich, 81675, Germany.
| | - Lucas M Ritschl
- Technical University of Munich, School of Medicine, Department of Oral and Maxillofacial Surgery, Ismaninger Str. 22, Munich, 81675, Germany
| | - Achim von Bomhard
- Technical University of Munich, School of Medicine, Department of Oral and Maxillofacial Surgery, Ismaninger Str. 22, Munich, 81675, Germany
| | - Christian Braun
- University of Munich, School of Medicine, Institute of Legal Medicine, Nußbaumstraße 26, Munich, 80336, Germany
| | - Constantin Wolff
- Technical University of Munich, School of Medicine, Department of Oral and Maxillofacial Surgery, Ismaninger Str. 22, Munich, 81675, Germany
| | - Andreas M Fichter
- Technical University of Munich, School of Medicine, Department of Oral and Maxillofacial Surgery, Ismaninger Str. 22, Munich, 81675, Germany.
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12
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Kubota A, Murai Y, Umezawa H, Ishisaka E, Tsukiyama A, Nakagawa S, Matano F, Ogawa R, Morita A. Second Free Flap Surgery for Skull Base Tumors: Case Report and Literature Review. J NIPPON MED SCH 2019; 86:248-253. [PMID: 31484881 DOI: 10.1272/jnms.jnms.2019_86-406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.
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Affiliation(s)
- Asami Kubota
- Department of Neurological Surgery, Nippon Medical School
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School
| | - Hiroki Umezawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
| | | | | | | | | | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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13
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Patel SY, Meram AT, Kim DD. Soft Tissue Reconstruction for Head and Neck Ablative Defects. Oral Maxillofac Surg Clin North Am 2019; 31:39-68. [PMID: 30449526 DOI: 10.1016/j.coms.2018.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Soft tissue reconstruction of head and neck ablative defects is a broad, challenging, and subjective topic. The authors outline goals to keep in mind when deciding on a primary reconstructive option for defects created by oncologic resection. Factors considered in local, regional, and distant flap selection are discussed. Based on the goals of reconstruction and factors involved in flap selection, a defect-based reconstructive algorithm is developed to help choose the ideal reconstructive option. The authors also discuss indications, pearls, pitfalls, and challenges in the harvest and inset of commonly used soft tissue flaps for head and neck reconstructive surgery.
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Affiliation(s)
- Stavan Y Patel
- Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Andrew T Meram
- Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Dongsoo D Kim
- Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71103, USA
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Decaudaveine S, Bachelet JT, Vacher C, Combes F, Mojallal A, Benichou L. Letter responds to comment on published paper: "Using the internal mammary artery as recipient artery in cervicofacial reconstruction by fibular flap". J Plast Reconstr Aesthet Surg 2018; 71:1816-1834. [PMID: 30196024 DOI: 10.1016/j.bjps.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S Decaudaveine
- Service de Chirurgie Maxillo-Faciale, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, Paris, France
| | - J T Bachelet
- Service de Chirurgie Maxillo-Faciale, Hôpital de la Croix Rousse CHU de Lyon, 103 Grande Rue de la Croix Rousse, Lyon, France; INSERM, UMR 1052, Groupe de Radiobiologie, 28 rue Laennec, Lyon, France.
| | - C Vacher
- Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon - APHP, 100 Boulevard du Général Leclerc Clichy, France
| | - F Combes
- Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon - APHP, 100 Boulevard du Général Leclerc Clichy, France
| | - A Mojallal
- Service de Chirurgie Plastique Reconstructrice et Esthétique, Hôpital de la Croix Rousse CHU de Lyon, 103 Grande Rue de la Croix Rousse, Lyon, France
| | - L Benichou
- Service de Chirurgie Maxillo-Faciale, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, Paris, France
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15
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Frohwitter G, Rau A, Kesting MR, Fichter A. Microvascular reconstruction in the vessel depleted neck – A systematic review. J Craniomaxillofac Surg 2018; 46:1652-1658. [DOI: 10.1016/j.jcms.2018.05.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/25/2018] [Accepted: 05/29/2018] [Indexed: 11/24/2022] Open
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16
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Decaudaveine S, Bachelet JT, Vacher C, Combes F, Mojallal A, Benichou L. Using the internal mammary artery as recipient artery in cervicofacial reconstruction by fibular flap. J Plast Reconstr Aesthet Surg 2018; 71:923-925. [PMID: 29398608 DOI: 10.1016/j.bjps.2018.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/03/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Suzanne Decaudaveine
- Service de Chirurgie Maxillo-Faciale, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, Paris, France
| | - Jean-Thomas Bachelet
- Service de Chirurgie Maxillo-Faciale, Hôpital de la Croix Rousse CHU de Lyon, 103 Grande Rue de la Croix Rousse, Lyon, France; INSERM, UMR 1052, Groupe de Radiobiologie, 28 rue Laennec, Lyon, France.
| | - Christian Vacher
- Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon - APHP, 100 Boulevard du Général Leclerc Clichy, France
| | - Floriane Combes
- Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon - APHP, 100 Boulevard du Général Leclerc Clichy, France
| | - Ali Mojallal
- Service de Chirurgie Plastique Reconstructrice et Esthétique, Hôpital de la Croix Rousse CHU de Lyon, 103 Grande Rue de la Croix Rousse, Lyon, France
| | - Ludovic Benichou
- Service de Chirurgie Maxillo-Faciale, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, Paris, France
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Morel F, Crampon F, Adnot J, Litzler PY, Duparc F, Trost O. Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study. Surg Radiol Anat 2018; 40:911-916. [PMID: 29289988 DOI: 10.1007/s00276-017-1965-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions. METHODS We performed a descriptive single centre anatomical study on 20 formalin-embalmed cadavers. The ITP was harvested on both sides from the emergence of the artery under the brachiocephalic vein to its terminal division. The level reached by the ITP in the cervicofacial area was described. Distal arterial and venous diameters, pedicle length and other parameters were measured. RESULTS In at least 85% of the cases, the ITP reached the mandibular angle. The mean diameter at the distal extremity for the ITA was 2.36 ± 0.15, and 2.48 ± 0.19 mm for the committing vein. The mean length of the ITP was 177.3 mm. CONCLUSION Rerouting the ITP towards the cervicofacial area could provide a reliable pedicle for free-flap reconstructions in patients with a vessel-depleted neck but it should be limited to selected patients. This novel solution for situations where current techniques are unfeasible warrants further clinical research.
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Affiliation(s)
- François Morel
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen, France
| | - Frédéric Crampon
- Laboratory of Anatomy, Rouen Faculty of Medicine, 22, Boulevard Léon-Gambetta, 76000, Rouen, France
| | - Jérôme Adnot
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen, France
| | - Pierre-Yves Litzler
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, Rouen, France.,French National Institute for Health (INSERM), U-1096, Rouen, France
| | - Fabrice Duparc
- Laboratory of Anatomy, Rouen Faculty of Medicine, 22, Boulevard Léon-Gambetta, 76000, Rouen, France
| | - Olivier Trost
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen, France. .,Laboratory of Anatomy, Rouen Faculty of Medicine, 22, Boulevard Léon-Gambetta, 76000, Rouen, France. .,French National Institute for Health (INSERM), LIMICS UMR-1142, Rouen, France.
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Ciudad P, Agko M, Date S, Chang WL, Manrique OJ, Huang TCT, Lo Torto F, Trignano E, Chen HC. The radial forearm free flap as a "vascular bridge" for secondary microsurgical head and neck reconstruction in a vessel-depleted neck. Microsurgery 2017; 38:651-658. [PMID: 29105820 DOI: 10.1002/micr.30259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 08/13/2017] [Accepted: 10/03/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND In a vessel-depleted neck, distant recipient sites may be the only option for secondary free flap reconstruction. While interposition vein grafts and arteriovenous loops can bridge the gap between the recipient and donor pedicle, they are not without risks. In these scenarios, we examinate the reliablity of a radial forearm free flap (RFFF) as an alternative vascular conduit. PATIENTS AND METHODS A retrospective review of cases between March 2005 and May 2016 was performed. Demographic data, prior surgical history, intraoperative details and outcomes were recorded. A total of ten patients, eight male and two female, with a mean age of 54.2 years (range, 39-74) were identified. The RFFF was initially anastomosed to either the thoracoacromial (n = 6) or internal mammary vessels (n = 4) and subsequently served as the recipient pedicle for the second "main" flap, an anterolateral thigh (n = 4), jejunum (n = 3) or fibula flap (n = 3). RESULTS The average RFFF dimensions were 13.8 cm by 5.8 cm. All twenty flaps, ten RFFF and ten "main' flaps survived completely with only one case of minimal epidermal loss. One patient with esophageal reconstruction with jejunum developed a fistula that required closure with a local falp. At a mean follow-up of 18.4 months (range 8-29), the reconstructive goals had been achieved in all cases. CONCLUSIONS The RFFF serves as a reliable "vascular bridge" that extends the reach of distant recipient sites to free flaps in secondary head and neck reconstruction.
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Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Mouchammed Agko
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shivprasad Date
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Ling Chang
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Oscar J Manrique
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tony C T Huang
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Federico Lo Torto
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Emilio Trignano
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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A New Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap (PIMOC) for Salvage Head and Neck Reconstruction: Anatomic Study and Clinical Application. Sci Rep 2017; 7:12960. [PMID: 29021615 PMCID: PMC5636798 DOI: 10.1038/s41598-017-13428-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/25/2017] [Indexed: 11/08/2022] Open
Abstract
Well-vascularized composite tissue offers improved outcomes for complex head and neck reconstruction. Patients with vessel-depleted necks and failed reconstructions require alternative reconstructive options. We describe a pedicled internal mammary artery osteomyocutaneous chimeric flap (PIMOC) for salvage head and neck reconstruction. Bilateral dissections of 35 fresh cadavers were performed to study individual tissue components and vascular pedicles to develop the PIMOC technique. The flap was then utilized in a series of patients with vessel-depleted neck anatomy. The PIMOC was dissected bilaterally in all cadavers and there were no statistical differences in vascular pedicle caliber or length with regards to laterality or gender. Five patients subsequently underwent this procedure. The flaps included a vertical rectus abdominis myocutaneous component and a 6th or 7th rib with adjacent muscle and skin to restore bone defects, internal lining, and external coverage. All donor sites were closed primarily. There were no flap losses and all patients gained improvements in facial contour, speech and swallow. Although technically complex, the PIMOC is reproducible and provides a safe and reliable option for salvage head and neck reconstruction. The harvest of the 6th or 7th rib and rectus abdominis muscle renders an acceptable donor site.
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Multiple Free Flap Reconstructions of Head and Neck Defects Due to Oral Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1337. [PMID: 28740764 PMCID: PMC5505825 DOI: 10.1097/gox.0000000000001337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
Objective: We studied complications following multiple free flap reconstructions in the head and neck. Methods: In this cohort, 26 patients (14 men and 12 women) who underwent multiple microvascular free flap reconstructions were included in the study. The reasons for secondary reconstruction were recurrence of tumor (12 cases), necrosis of transferred skin and/or bone (6 cases), reconstruction plate fracture or exposure (4 cases), and others (4 cases). A third reconstruction in 4 cases and a fourth reconstruction in 1 case were performed. Results: No flap necrosis occurred. Postsurgical infections occurred at only secondary reconstructions in 7 patients. Although 4 cases with a history of external radiation therapy were anastomosed at contralateral side, those 4 cases suffered from severe pre-and postsurgical infection of the ipsilateral side. Postsurgical infection occurred in 2 cases with anastomoses at the ipsilateral side of the neck and required drainage after secondary surgery. Conclusions: A history of external radiation therapy and the existence of severe preoperative infection affected complications after multiple reconstructions.
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Buck PM, Wax MK, Petrisor DI. Internal Mammary Vessels: Alternate Recipient Vessels in Microvascular Head and Neck Reconstruction. J Oral Maxillofac Surg 2016; 74:1896.e1-6. [DOI: 10.1016/j.joms.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 02/19/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
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Wolff KD, Mücke T, von Bomhard A, Ritschl LM, Schneider J, Humbs M, Fichter AM. Free flap transplantation using an extracorporeal perfusion device: First three cases. J Craniomaxillofac Surg 2016; 44:148-54. [DOI: 10.1016/j.jcms.2015.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
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Garg RK, Poore SO, Wieland AM, Sanchez R, Baskaya MK, Hartig GK. Recipient vessel selection in the difficult neck: Outcomes of external carotid artery transposition and end-to-end microvascular anastomosis. Microsurgery 2015; 37:96-100. [PMID: 26186688 DOI: 10.1002/micr.22448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/02/2015] [Accepted: 06/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Selection of recipient vessels for head and neck microvascular surgery may be limited in the previously dissected or irradiated neck. When distal branches of the external carotid artery (ECA) are unavailable, additional options for arterial inflow are needed. Here we propose high ligation of the ECA and transposition toward the lower neck as an alternative. METHODS After obtaining institutional approval, patients who underwent head and neck tumor resection and simultaneous free flap reconstruction were identified over a 5-year period. Patients whose recipient artery was listed in the operative report were included. Chart review was performed to identify patient demographics, operative details, and patient and flap complications. In cases where the ECA was used, the artery was traced distally with care taken to protect the hypoglossal nerve. The ECA was then divided and transposed toward the lower neck where an end-to-end microvascular anastomosis was performed. RESULTS The recipient artery used for head and neck microsurgery was available for 176 flaps, and the facial (n = 127, 72.2%) and external carotid (n = 19, 10.8%) arteries were most commonly used. There were 0 flap thromboses in the ECA group compared to 3 flap thromboses that occurred with other recipient arteries (P = 1.00). No cases of first bite syndrome or hypoglossal nerve injury were identified. CONCLUSIONS The ECA may be transposed toward the lower neck and used for end-to-end microvascular anastomosis without complication of hypoglossal nerve injury or first bite syndrome. This method may be considered an alternative in patients with limited recipient vessel options for head and neck microsurgery. © 2015 Wiley Periodicals, Inc. Microsurgery 37:96-100, 2017.
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Affiliation(s)
- Ravi K Garg
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Samuel O Poore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Aaron M Wieland
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Ruston Sanchez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin, Madison, WI
| | - Gregory K Hartig
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI
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Xu ZF, Duan WY, Zhang EJ, Bai S, Tian Y, Tan XX, Liu FY, Sun CF. Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy. World J Surg Oncol 2015; 13:183. [PMID: 25966959 PMCID: PMC4485336 DOI: 10.1186/s12957-015-0576-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/06/2015] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy. Methods Between January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient. Results All of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up. Conclusions In patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.
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Affiliation(s)
- Zhong-fei Xu
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Wei-yi Duan
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
| | - En-jiao Zhang
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Shuang Bai
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Yu Tian
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Xue-xin Tan
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Fa-yu Liu
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Chang-fu Sun
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
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Pierrel C, Bodin F, Schultz P, Dupret-Bories A. Semi-free forearm flap for pharyngeal-esophageal reconstruction after radiation therapy. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 132:101-3. [PMID: 25482241 DOI: 10.1016/j.anorl.2014.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
Reconstruction of the pharynx and upper esophagus uses various procedures, including pedicled or free flap. Pharyngoplasty with free forearm flap provides excellent functional results. In radiation-related pharyngeal stenosis, recipient vascularization is often poor, especially in the venous system. The authors describe pharyngeal reconstruction with semi-free forearm flap, pedicled on the cephalic vein, to minimize the risk of venous thrombosis, which is the main factor of free forearm flap necrosis. Taking the case of a laryngectomy with complete pharyngeal stenosis after radiation therapy and iterative neck surgery, the technique of pharyngeal-esophageal reconstruction by semi-free forearm flap is described in a context of impaired vascularization.
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Affiliation(s)
- C Pierrel
- Service d'ORL et de Chirurgie Cervico-Faciale, CHU de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - F Bodin
- Service de Chirurgie Plastique, Esthétique et Reconstructrice, CHU de Strasbourg, Hôpital Civil, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - P Schultz
- Service d'ORL et de Chirurgie Cervico-Faciale, CHU de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - A Dupret-Bories
- Service d'ORL et de Chirurgie Cervico-Faciale, CHU de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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An effective method to access recipient vessels outside the zone of injury in free flap reconstruction of the lower extremity. Ann Plast Surg 2014; 73 Suppl 2:S136-8. [PMID: 25046668 DOI: 10.1097/sap.0000000000000202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A principle of microvascular surgery in lower extremity reconstruction is to identify recipient vessels and perform the anastomosis outside the zone of injury. Microsurgeons will often create an incision that extends from the wound several centimeters proximally to access the recipient vessels through healthy tissue. This iatrogenic wound, however, traverses the zone of injury and is susceptible to delayed healing and wound breakdown. These complications can be avoided by creating a unique incision proximal to the zone of injury through which the recipient vessels are dissected and the anastomosis performed. METHODS In 13 consecutive patients with lower extremity wounds requiring free flap reconstruction, a remote incision was made in healthy tissue proximal to the defect to access the recipient vessels outside the zone of injury. The pedicle was tunneled in the subcutaneous plane from the wound to this site, and the anastomosis was performed. The flap was inset in the standard fashion, and the remote incision was closed in layers. RESULTS There were 3 female and 10 male patients, and the median age was 65 years (18-85 years). Etiology of the wounds was traumatic (3 acute, 7 chronic), oncologic (2), and ischemic (1). Defects varied in size and were primarily located on the distal third of the extremity. Free flaps included radial forearm (4), anterolateral thigh (4), gracilis (2), vastus (1), latissimus dorsi (1), and parascapular (1). Postoperatively, there were no major complications related to the flap or any flap losses. There was 1 donor site hematoma requiring operative evacuation. There were no complications associated with the anastomotic incision. CONCLUSIONS Accessing the recipient vessels via a separate proximal incision in lower extremity free flap reconstruction allows excellent exposure outside the zone of injury, avoids wound healing problems, and protects the pedicle from injury in the setting of multiple-staged procedures.
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Kubota Y, Mitsukawa N, Akita S, Hasegawa M, Satoh K. Postoperative patency of the retrograde internal mammary vein anastomosis in free flap transfer. J Plast Reconstr Aesthet Surg 2014; 67:205-11. [DOI: 10.1016/j.bjps.2013.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 09/02/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022]
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Ridha H, Clarke PM, Wood SH. Re: "Long-term oral intake through a salivary bypass tube with chronic pharyngocutaneous fistula". Am J Otolaryngol 2013; 34:615-6. [PMID: 23602699 DOI: 10.1016/j.amjoto.2013.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/07/2013] [Accepted: 03/13/2013] [Indexed: 12/14/2022]
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Current World Literature. Curr Opin Oncol 2013; 25:325-30. [DOI: 10.1097/cco.0b013e328360f591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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