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Ruffin W, Gal TJ. Impact of Flap Size and Comorbidities on Supraclavicular Artery Island Flap Outcomes. OTO Open 2024; 8:e175. [PMID: 39050363 PMCID: PMC11267172 DOI: 10.1002/oto2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/18/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024] Open
Abstract
Objective Use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction has increased in recent years. Limited but improving experience among reconstructive surgeons with the procedure have exposed numerous issues associated with flap success. The objective of this study is to examine the role of flap size on viability. Study Design Retrospective case series. Setting Tertiary Academic Medical Center. Methods Review of patients undergoing SCAIF reconstruction between January 2014 and March 2022 was performed. Flap failure was defined as >50% skin paddle loss. The total flap surface area was examined. Multivariable analysis was performed to evaluate the association of other variables associated with flap failure. Results Eighty-nine supraclavicular island flaps were reviewed. Mean patient age was 63.2 ± 11.4 years. Fifty-five (61.2%) were male. Forty-five flaps (50.6%) were used for the reconstruction of defects of the skin of the neck/face. Twenty-nine flaps (32.6%) were utilized for defects of the pharynx/oropharynx, and 15 (16.9%) were utilized for oral cavity defects. Flap success rate was 94% (73/89). Flap site was not associated with flap failure (P = .46). Flaps >25 cm2 were 75% more likely to be successful. Multivariable logistic regression to assess the association of flap size in the context of other co-morbidities indicated flaps >25 cm2 were 3.6 times more likely to succeed regardless of co-morbidities, and patients with chronic obstructive pulmonary disease (COPD) have a 7-fold risk of flap failure (odds ratio: 7.3, 1.72-30.98, P = .007). Conclusion An association with improved flap outcomes and larger skin paddles was observed in this series. The applicability of these observations to smaller flaps and larger series with more surgeons requires further study. Co-morbidities, particularly, COPD, continue to impact flap outcomes.
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Affiliation(s)
- William Ruffin
- Department of Otolaryngology–Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Thomas J. Gal
- Department of Otolaryngology–Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
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Patel NN, Gulati A, Zebolsky AL, Park AM, Seth R, Knott PD. Through a New Lens: Skin-Grafted Free Flaps and Objective Facial Skin Color Matching. Facial Plast Surg Aesthet Med 2024; 26:28-33. [PMID: 37036812 DOI: 10.1089/fpsam.2022.0327] [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: 04/11/2023] Open
Abstract
Background: Head and neck ablative surgery can impose aesthetic disfigurement, particularly when severe color mismatch exists between native and reconstructed facial skin. To date, the accuracy, objectivity, and modifiability of facial skin color matching remains poorly understood. Objective: To measure skin color match outcomes after head and neck reconstruction using handheld colorimetry. Methods: Patients undergoing complex head and neck reconstruction involving facial skin were included. A variety of skin paddle donor sites were studied, including split-thickness skin graft (STSG) placement over myocutaneous or adipofasciocutaneous free flaps after de-epithelization. Skin color match (deltaE) was measured during follow-up using a handheld colorimeter. Results: Forty-seven patients were included, with median age 69. The most common flap type was the anterolateral thigh (n = 31, 66%). Twenty patients underwent STSG to the skin paddle. DeltaE measurements among the patients with STSGs demonstrated better color match (lowest deltaE), compared with patients with unaltered skin paddles (3.4 ± 1.0 vs. 6.5 ± 2.5, p < 0.0001). Conclusion: We found the use of STSGs over de-epithelialized myogenous or adipofasciocutaneous flaps improves color match, as measured by handheld colorimetry.
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Affiliation(s)
- Neil N Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Arushi Gulati
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Aaron Lee Zebolsky
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Andrea M Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
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Seebauer CT, Völkl M, Kunkel J, Künzel J, Kühnel T, Hofmann HS, Bohr C. Tracheoesophageal Fistula Closure in a Pediatric Patient Using a Supraclavicular Artery Island Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5250. [PMID: 37744771 PMCID: PMC10513133 DOI: 10.1097/gox.0000000000005250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023]
Abstract
Acquired tracheoesophageal fistulas can lead to large defects with fatal complications. Surgical management is challenging but necessary to prevent respiratory infections and poor weight gain. Therefore, a reliable and pliable flap like the pedicled supraclavicular artery island flap with its wide arc of rotation and robust vascularization is needed for reconstruction. We highlight the surgical technique and postoperative measures in managing a tracheoesophageal fistula due to button battery ingestion in a 9-month-old boy with the supraclavicular artery island flap. In summary, the supraclavicular artery island flap is a safe and successful tool for closure of large acquired tracheoesophageal fistulas in pediatric patients.
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Affiliation(s)
- Caroline T. Seebauer
- From the Department of Otorhinolaryngology, University Medical Center Regensburg, Regensburg, Germany
| | - Melanie Völkl
- Department of Pediatrics, University Medical Center Regensburg, Regensburg, Germany
| | - Jürgen Kunkel
- Department of Pediatrics, University Medical Center Regensburg, Regensburg, Germany
| | - Julian Künzel
- From the Department of Otorhinolaryngology, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Kühnel
- From the Department of Otorhinolaryngology, University Medical Center Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christopher Bohr
- From the Department of Otorhinolaryngology, University Medical Center Regensburg, Regensburg, Germany
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4
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Chang BA, Asarkar AA, Horwich PM, Nathan CAO, Hayden RE. Regional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten. Laryngoscope Investig Otolaryngol 2023; 8:63-75. [PMID: 36846409 PMCID: PMC9948595 DOI: 10.1002/lio2.983] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/06/2022] [Accepted: 11/08/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives The objective of this article is to review options for regional pedicled reconstruction for large head and neck defects in a salvage setting. Methods Relevant regional pedicled flaps were identified and reviewed. Expert opinion and supporting literature were used to summarize and describe the available options. Results Specific regional pedicled flap options are presented including the pectoralis major flap, deltopectoral flap, supraclavicular flap, submental flap, latissimus flap, and trapezius flap. Conclusions Regional pedicled flaps are useful options in a salvage setting even for large defects and should be in the armamentarium of any reconstructive head and neck surgeon. Each flap option carries specific characteristics and considerations.
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Affiliation(s)
- Brent A. Chang
- Department of Otolaryngology – Head & Neck SurgeryMayo Clinic ArizonaPhoenixArizonaUSA
| | - Ameya A. Asarkar
- Department of Otolaryngology/Head and Neck SurgeryLouisiana State University Health Sciences Center & Feist‐Weiller Cancer CenterShreveportLouisianaUSA
- Department of SurgeryOverton Brooks Veterans Affairs Medical Center (OBVAMC)ShreveportLouisianaUSA
| | - Peter M. Horwich
- Head and Neck Specialists, HCA South Atlantic, Sarah Cannon Cancer InstituteCharlestonSouth CarolinaUSA
| | - Cherie Ann O. Nathan
- Department of Otolaryngology/Head and Neck SurgeryLouisiana State University Health Sciences Center & Feist‐Weiller Cancer CenterShreveportLouisianaUSA
- Department of SurgeryOverton Brooks Veterans Affairs Medical Center (OBVAMC)ShreveportLouisianaUSA
| | - Richard E. Hayden
- Department of Otolaryngology – Head & Neck SurgeryMayo Clinic ArizonaPhoenixArizonaUSA
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5
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Dong C, Yu Z, Ma X. The transverse cervical artery cervical cutaneous branch flap: An anatomy-based nomenclature. Front Surg 2023; 9:1029065. [PMID: 36684245 PMCID: PMC9856184 DOI: 10.3389/fsurg.2022.1029065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/26/2022] [Indexed: 01/09/2023] Open
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6
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Hamidian Jahromi A, Horen SR, Miller EJ, Konofaos P. A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction. Ann Plast Surg 2022; 88:e20-e32. [PMID: 35502968 DOI: 10.1097/sap.0000000000003098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The supraclavicular artery flap (SCF) is a highly vascularized fasciocutaneous flap overlying the shoulder. The flap was first described in 1979 by Lamberty but did not gain popularity until much later due to lack of a reliable technique. The main advantages of using the SCF include avoiding microsurgical techniques, requiring only a single-stage operation, shorter operative time compared with alternative options, and a wider patient population including those with comorbidities who may be excluded from more extensive operations including free flaps surgeries. The SCF has been successfully performed on individuals with advanced age, poor nutrition, cachexia, obesity, diabetes, tobacco use, severe chronic obstructive pulmonary disease, hypertension, coronary artery disease, peripheral vascular disease, supraventricular tachycardia, atrial fibrillation, heart failure, asthma, and steroid use. The largest disadvantages of the SCF include the possibility of distal tip necrosis, size limitation without pre-expansion, and a moderately visible donor site scar. The following review and meta-analysis of the SCF details its use historically as both an island and a pedicle flap, and its application in head and neck reconstruction.
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Affiliation(s)
- Alireza Hamidian Jahromi
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Sydney R Horen
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Emily J Miller
- Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN
| | - Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN
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7
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Use of Serial Flap Transfer Technique in En Bloc Reconstruction of Extensive Soft Tissue Defects in the Head and Neck. J Craniofac Surg 2022; 33:809-813. [DOI: 10.1097/scs.0000000000007682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Wang L, Ma CY, Shen Y, Fang J, Haugen TW, Guo B, Sun J. Transverse cervical artery anterior perforator flap for head and neck oncological reconstruction: Preliminary study. Head Neck 2021; 43:3598-3607. [PMID: 34510610 DOI: 10.1002/hed.26873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 08/22/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To describe the indications, technique, and our experience in the application of the transverse cervical artery anterior perforator flap (ap-TCAF) for reconstruction of head and neck oncological defects. METHODS From September 2016 to September 2019, 11 patients underwent surgical treatment for head neck squamous cell carcinoma and were subsequently reconstructed with ap-TCAFs. The clinical details were recorded, and the postoperative appearance and function were analyzed. RESULTS The ap-TCAF was used to reconstruct intraoral defects in eight patients and to repair an oropharyngeal defect in one patient. In two remaining patients, the ap-TCAF was divided into two to restore defects with both an intraoral and extraoral component. The flap size ranged from 6 × 4 cm to 15 × 9 cm. All flaps healed uneventfully. There was no delayed wound healing or dysfunction at the donor site. CONCLUSIONS The ap-TCAF is reliable with characteristics making it useful for head and neck oncological reconstruction, especially in male patients.
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Affiliation(s)
- Liang Wang
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chun-Yue Ma
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yi Shen
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jin Fang
- Department of Stomatology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Thorsen W Haugen
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bing Guo
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jian Sun
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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9
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A 3D visualization layered anatomy for acromial arterial rete and flap design. Surg Radiol Anat 2021; 43:1559-1567. [PMID: 34156508 DOI: 10.1007/s00276-021-02781-y] [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: 10/30/2020] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The acromial arterial rete (AAR) is the junction between the skin blood supply of the cervical side and that of the upper arm, and it is the only site crossed by the trans-regional blood supply of the cervico-humeral flap (CHF). The aim of this study was to explore the structures of AAR to optimizing flap design. METHODS A body arteriography and spiral CT scan were performed on 33 whole adult corpses. The 3D reconstruction was used to perform continuous digital layered anatomy of the shoulder and upper chest; the acromion and acromioclavicular joint were used as the center to observe the source, route and distribution characteristics of a perforating branch and their anastomosis. RESULTS The perforating branches were separated from an acromial branch of the transverse cervical artery (97%), posterior humeral circumflex artery (95%), a deltoid branch of the thoracoacromial artery (95%), and the acromial branch of the thoracoacromial artery (93%). The diameter of the acromial branch of the transverse cervical artery at its initial location was 1.18 ± 0.37 mm; the trunk length was 12.53 ± 3.83 cm, and it was anastomosed with other blood vessels in three forms. CONCLUSION Deep fascia should be included in the flap design. Three kinds of pedicled transfer flaps can be designed with the acromial branch of transverse carotid artery as the vascular pedicle. Free flaps can be designed with the acromial branch of thoracoacromial artery as the vascular pedicle.
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10
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Haroun F, Benmoussa N, Bouhir S, Alkashnam H, Honart JF. A twostep supraclavicular flap method in head and neck reconstruction for refractory osteoradionecrosis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:218-221. [PMID: 34098167 DOI: 10.1016/j.jormas.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/22/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022]
Abstract
Techniques of reconstructive surgery of the head and neck region have existed since Antiquity, with the pedicled forehead flap of Susruta as a reference. These methods are constantly evolving, with the introduction of free flaps in the 1980s, and more recently new technologies such as CAD-CAM. However, the surgical management of patients treated by radiotherapy for upper airway cancers remains a challenge in terms of functional and aesthetic results. Indeed, cervical irradiation, which alters the quality of skin and vascular tissue, jeopardizes good healing after head and neck reconstructive surgery. In this article, the authors proposed to revisit the standard technique of the pedicled supraclavicular flap. Flap design inspired from the known and described technique of the two-stage forehead flap, for the management of a fragile patient with refractory mandibular osteoradionecrosis.
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Affiliation(s)
- Fabienne Haroun
- Gustave Roussy, Paris-Saclay University, Department of Head and Neck Oncology, Villejuif, F-94805, France
| | - Nadia Benmoussa
- Gustave Roussy, Paris-Saclay University, Department of Head and Neck Oncology, Villejuif, F-94805, France.
| | - Samia Bouhir
- Gustave Roussy, Paris-Saclay University, Department of Head and Neck Oncology, Villejuif, F-94805, France
| | - Heba Alkashnam
- Gustave Roussy, Paris-Saclay University, Department of Plastic Surgery, Villejuif, F-94805, France
| | - Jean-François Honart
- Gustave Roussy, Paris-Saclay University, Department of Plastic Surgery, Villejuif, F-94805, France
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11
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Dargan D, Kazzazi D, Limnatitou D, Cochrane E, Stubbington Y, Shokrollahi K, Ralston D. Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature. Ann Plast Surg 2021; 86:517-531. [PMID: 33675628 DOI: 10.1097/sap.0000000000002755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. RESULTS An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. DISCUSSION The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. CONCLUSIONS More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.
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Affiliation(s)
| | - Diana Kazzazi
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Elliott Cochrane
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Kayvan Shokrollahi
- Mersey Regional Burns Centre, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Merseyside, Prescot, United Kingdom
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Muangsiri P, Tanjapatkul R, Sriswadpong P, Jomkoh P, Jirawatnotai S. Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study. Otolaryngol Head Neck Surg 2021; 166:68-73. [PMID: 33784191 DOI: 10.1177/01945998211000432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the anatomy of the transverse cervical artery and to prove its perfusion to the clavicle using indocyanine green fluorescence angiography as an alternative vascularized bone for head and neck reconstruction. STUDY DESIGN Cadaveric dissection. SETTING Anatomy lab. METHODS Twenty-two necks and shoulders from 11 fresh-frozen cadavers were dissected. The transverse cervical artery diameter, length, emerging point, and the length of clavicle segment harvested were described. Photographic and near-infrared video recordings of the bone's medial and longitudinal cut surfaces were taken prior to, during, and after indocyanine green injection. RESULTS The transverse cervical artery originated from the thyrocervical trunk and emerged at the level of the medial one-third of the clavicle in 22 of 22 (100%) specimens. The average length of the pedicle was 3.6 cm (range, 2.2-4.4 cm), and the mean diameter was 2.5 mm (range, 1.8-3.4 mm). The harvested bone had a mean length of 5.1 cm (range, 4.3-5.8 cm). After injecting the indocyanine green, 22 of 22 (100%) specimens showed enhancement in the periosteum, bony cortex, and medulla. CONCLUSION The middle third of the clavicle can be reliably harvested as a vascularized bone with its perfusion solely from the transverse cervical artery pedicle, as shown by the near-infrared fluorescence imaging. The pedicle was sizable and constant in origin.
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Affiliation(s)
- Pichtat Muangsiri
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Rungkit Tanjapatkul
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Papat Sriswadpong
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Pojanan Jomkoh
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Supasid Jirawatnotai
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
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13
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Correia C, Wang W, Vincent AG, Chan D, Ducic Y. Regional Salvage Flap Options in Head and Neck Reconstruction. Semin Plast Surg 2020; 34:293-298. [PMID: 33380916 DOI: 10.1055/s-0040-1721767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Microvascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.
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Affiliation(s)
- Camil Correia
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Chicago, Illinois
| | - Weitao Wang
- Otolaryngology and Facial Plastic Associates, Fort Worth, Texas
| | | | - David Chan
- Section of Otolaryngology - Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Associates, Fort Worth, Texas
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14
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Wang J, Wu J, Xu M, Gao Q, Chen B, Wang F, Niu H, Song H. A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures. Lasers Med Sci 2020; 36:1275-1282. [PMID: 33159309 DOI: 10.1007/s10103-020-03178-w] [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: 07/31/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
The focus of treatment of faciocervical scar contractures includes cervical reconstruction and elimination of hypertrophic scars. Unfortunately, most previous studies have neglected the esthetic appearance of scars. In this study, we tried to combine surgical therapy and ultrapulse fractional CO2 laser (UFCL) to eliminate facial scars while restoring neck reconstruction and to establish the optimal conventional management for faciocervical contracture. Thirty-eight individuals were enrolled and divided into two groups. After received cervical release surgeries, comprehensive UFCL therapy group received treatment of UFCL at 3-month intervals, silicone sheets, and pressure garments, while another group only received treatment of silicone sheeting and compression. Twelve months after the termination of therapy, faciocervical scars of both two groups were assessed by two uninvolved physicians according to the Vancouver Scar Scale (VSS), and patients' satisfaction survey was also recorded by the study participants using a patient four-point satisfaction scale. Thirty-six patients completed the treatment and follow-up. The results show that the VSS scores of both two groups decreased after 12 months, but comprehensive UFCL therapy group dropped more significantly than the conventional treatment group at follow-up session, which was statistically significant (P < 0.001), and the patient satisfaction was higher than that of the conventional treatment group. This comprehensive treatment combined of surgery, UFCL, silicone sheets, and pressure garments works as an effective and esthetic reconstruction for moderate to severe postburn faciocervical scar contractures.
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Affiliation(s)
- Jue Wang
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, 51# Fucheng Road, Haidian District, Beijing, 100048, China
| | - Jiang Wu
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, 51# Fucheng Road, Haidian District, Beijing, 100048, China
| | - Minghuo Xu
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, 51# Fucheng Road, Haidian District, Beijing, 100048, China
| | - Quanwen Gao
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, 51# Fucheng Road, Haidian District, Beijing, 100048, China
| | - Baoguo Chen
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, 51# Fucheng Road, Haidian District, Beijing, 100048, China
| | - Fang Wang
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, 51# Fucheng Road, Haidian District, Beijing, 100048, China
| | - Hao Niu
- Department of Burn Surgery, PLA Army 32122, Zhifu District, Yantai, 264000, Shandong, China
| | - Huifeng Song
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, 51# Fucheng Road, Haidian District, Beijing, 100048, China.
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Cordova A, D'Arpa S, Rosatti F, Nichelini M, D'Antonio GM, Giordano S, Toia F. Propeller Flaps in the Head and Neck. Semin Plast Surg 2020; 34:165-170. [PMID: 33041686 DOI: 10.1055/s-0040-1714269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Propeller flaps have significantly expanded the reconstruction possibilities in the head and neck region. They allow for increased flap mobility and better scar concealing, and/or to perform a one-stage reconstruction with local tissue of similar color and texture, where multiple surgeries would be needed with traditional flaps or even free flaps would be required. This article describes the main propeller flaps for one-stage reconstruction in the head-neck region (facial artery perforator, supratrochlear artery axial perforator, deep lingual artery axial perforator, and anterior supraclavicular artery perforator flaps), their indications, and possible complications. Aesthetic and functional results of propeller flaps in the head and neck region are very good and the complication rate is low, but due to their surgical complexity and the availability of many simpler local flaps, they are indicated only in select cases where local flaps are unavailable or would require multiple staged procedures to complete the construction.
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Affiliation(s)
- Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Fernando Rosatti
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marta Nichelini
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giovanni Maria D'Antonio
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Giordano
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesca Toia
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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More A, Sivakumar A, Gaurav GK. Supraclavicular Flap for Large Anterior Chest Wall Defects-A Road Less Travelled. Indian J Plast Surg 2020; 53:427-430. [PMID: 33402778 PMCID: PMC7775245 DOI: 10.1055/s-0040-1716457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Large upper central chest wall defects are a reconstructive challenge. The commonly described flaps for this area do not provide very large skin paddle, and free tissue transfer remains the only option for large skin defects. Supraclavicular flap as a local flap is widely used for head and neck reconstruction and has been described for upper chest wall defects earlier. We have used nonislanded supraclavicular flap for reconstruction of two cases of large chest wall defects, which would otherwise need free tissue transfer, single flap in one case and bilateral flaps in the other. It is easy to do and has minimal morbidity. Supraclavicular flap offers a simple solution for large skin defects of the upper central chest wall and is especially useful in patients with high-operative risk and guarded prognosis.
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Affiliation(s)
- Amrita More
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Anoop Sivakumar
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Gupta K Gaurav
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
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17
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Kokot N, Kim JH, West JD, Zhang P. Supraclavicular Artery Island Flap: Critical Appraisal and Comparison to Alternate Reconstruction. Laryngoscope 2020; 132 Suppl 3:1-14. [PMID: 32492192 DOI: 10.1002/lary.28706] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The supraclavicular artery island (SAI) flap may be a good option for selected head and neck reconstruction due to its reliability, ease of harvest, and favorable color match. The objective of this study was to examine the rates of complications for the SAI flap in head and neck oncologic reconstruction, with examination of risk factors and comparisons to alternative flaps often considered the gold-standard soft-tissue flaps for head and neck reconstruction: the pectoralis myocutaneous (PMC), radial forearm free flap (RFFF), and anterolateral thigh (ALT) flaps. STUDY DESIGN Retrospective cohort study. METHODS Consecutive SAI flaps were compared to PMC, RFFF, and ALT flaps (non-SAI flap group), all performed by the senior author from 2010 to 2018. The non-SAI flaps were included if an SAI flap could have been performed as an alternate flap. The groups were compared based on demographics, flap dimensions, site of reconstruction, operating time, total hospital stay, total hospital costs, and complications. RESULTS One hundred seven SAI flaps and 194 non-SAI flaps were identified. SAI flaps were used less commonly than non-SAI flaps for mucosal defects (P < .001). The SAI flap dimensions were narrower but longer than non-SAI flaps (P < .001). SAI flaps had higher rates of total complications, partial flap necrosis, flap dehiscence at the recipient site, fistula, donor site dehiscence, and minor complications compared to non-SAI flaps (all P < .05). SAI flaps had higher rates of total complications, recipient site dehiscence, fistula, and minor complications in both the oral cavity and all mucosal sites compared to non-SAI flaps (all P < .05). SAI flaps for mucosal reconstruction were associated with higher rates of total complications (54% vs. 34%, P = .04), flap dehiscence at the recipient site (32% vs. 14%, P = .03), and major complications (21% vs. 5%, P = .02), compared to cutaneous reconstruction. Complications were equivalent between SAI flaps and non-SAI flaps for cutaneous reconstruction (all P > .05). Multivariate analysis showed that SAI flaps were associated with any postoperative complication (odds ratio [OR]: 3.47, 95% confidence interval [CI]: 1.85-6.54), partial flap necrosis (OR: 5.69, 95% CI: 1.83-17.7), flap dehiscence (OR: 5.36, 95% CI: 2.29-12.5), donor site complications (OR: 11.6, 95% CI: 3.27-41.0), and minor complications (OR: 5.17, 95% CI: 2.42-11.0). Within the SAI flap group, SAI flap length >24 cm was associated with postoperative complications on multivariate analysis (OR: 5.09, 95% CI: 1.02-25.5, P = .048). CONCLUSIONS The SAI flap is best suited for cutaneous reconstruction of the face, neck, and parotid/temporal bone regions due to the favorable color match; the thin, pliable nature of the skin; ease of harvest; and equivalent complication rates compared to alternate soft-tissue flaps. However, the SAI flap is associated with more complications for oral cavity and mucosal site reconstruction when compared to RFFF and ALT flaps and should be used in selected cases that do not require complex folding. For all sites, flaps longer than 24 cm should be used with caution. LEVEL OF EVIDENCE 3 Laryngoscope, 2020.
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Affiliation(s)
- Niels Kokot
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - James H Kim
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Jonathan D West
- Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Paul Zhang
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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18
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Alain C, Fortier P, Belzile M. The infraclavicular pedicled flap in head and neck reconstruction: applications and outcomes. Head Neck 2019; 42:77-84. [DOI: 10.1002/hed.25990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Charles Alain
- Faculty of Medicine and Health SciencesUniversité de Sherbrooke Québec Canada
| | - Pierre‐Hugues Fortier
- Faculty of Medicine and Health Sciences, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Centre intégré universitaire de santé et de services sociaux de l'Estrie‐Centre Hospitalier Universitaire de SherbrookeUniversité de Sherbrooke Québec Canada
| | - Mathieu Belzile
- Faculty of Medicine and Health Sciences, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Centre intégré universitaire de santé et de services sociaux de l'Estrie‐Centre Hospitalier Universitaire de SherbrookeUniversité de Sherbrooke Québec Canada
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19
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Giordano L, Di Santo D, Bondi S, Marchi F, Occhini A, Bertino G, Grammatica A, Parrinello G, Peretti G, Benazzo M, Nicolai P, Bussi M. The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience. ACTA ACUST UNITED AC 2019; 38:497-503. [PMID: 30623895 PMCID: PMC6325652 DOI: 10.14639/0392-100x-1794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
The supraclavicular artery island flap (SCAIF) is a thin and pliable pedicled flap that is easy and quick to harvest. Thanks to its particular features and high reliability, it is best indicated for the elderly or most fragile patients. SCAIF is very versatile, as it can be used for reconstruction of oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. We began using this flap in four Italian tertiary referral centres, with several indications, both as first treatment and as salvage surgery. The aim of the study was to demonstrate the easy reproducibility of the flap among four different centres. A series of 28 patients underwent head and neck reconstructions with SCAIF with no recorded complications during flap harvesting. After the very first cases, harvesting time was approximately 45 minutes; 24 patients had successful flap integration at the recipient site, while the remaining 4 suffered from partial flap necrosis, two of whom needed revision surgery. Other minor complications were reported at the recipient site, always at the most distal and most delicate portion of the flap. Donor site was always closed primarily, with only three cases of partial suture dehiscence. We only selected the most fragile patients for SCAIF reconstruction, such as the elderly or those with one or more comorbidities; for this reason, we reported some serious systemic complications and one intraoperative death. SCAIF is an easy reproducible flap, with multiple possible indications. Its use as an alternative to free flaps in the head and neck region is nowadays under discussion. Its use should be encouraged among head and neck surgeons thanks to its various advantages.
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Affiliation(s)
- L Giordano
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - D Di Santo
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - S Bondi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - F Marchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - A Occhini
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - G Bertino
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - A Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - G Parrinello
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - G Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - P Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - M Bussi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Mannelli G, Agostini T, Arcuri F, Comini LV, Spinelli G. Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients. J Surg Oncol 2019; 120:707-714. [PMID: 31364178 DOI: 10.1002/jso.25655] [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: 02/18/2019] [Accepted: 07/23/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The subclavicular pedicled flap is based on the thoracic branch of the supraclavicular artery, and it represents a versatile reconstructive option for low-middle third face defects. Since its use in head and neck surgical oncology has not been popularized yet, we propose its application for oral cavity reconstruction after cancer resection by showing favorable results. METHODS Eighteen subclavicular pedicled flaps were used to treat intraoral defects after oral squamous-cell cancer resection between June 2015 and December 2018. Tumor dissection type, complications, donor and reconstructed area results, and functional and aesthetic outcomes were assessed. RESULTS No major complications were observed and all of the flaps survived. Adjuvant therapy was administered without delay when needed, and all of the patients had normal functional outcomes and good aesthetic results. CONCLUSIONS The subclavicular flap is an excellent choice for the reconstruction of oral cavity defects. Selection of patients should exclude positive lower-third neck node and include appropriate informed consent for women due to the possibility of deformity of the breast. In our opinion, this flap has the potential for common application given its consistent anatomy and donor site advantages, including long pedicle, high pivot point, and relatively unlimited flap width.
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Affiliation(s)
- Giuditta Mannelli
- Head and Neck Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tommaso Agostini
- Department of Plastic and Reconstructive Surgery, Casa di Cura San Paolo, Pistoia, Italy
| | - Francesco Arcuri
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lara Valentina Comini
- Head and Neck Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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21
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Indocyanine green fluorescence videoangiography for reliable variations of supraclavicular artery flaps. Arch Plast Surg 2019; 46:318-323. [PMID: 31336419 PMCID: PMC6657196 DOI: 10.5999/aps.2018.01536] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background Pedicled flaps are useful for reconstructive surgery. Previously, we often used vascularized supraclavicular flaps, especially for head and neck reconstruction, but then shifted to using thoracic branch of the supraclavicular artery (TBSA) flaps. However, limited research exists on the anatomy of TBSA flaps and on the use of indocyanine green (ICG) fluorescence videoangiography for supraclavicular artery flaps. We utilized ICG fluorescence videoangiography to harvest reliable flaps in reconstructive operations, and describe the results herein. Methods Data were retrospectively reviewed from six patients (five men and one woman: average age, 54 years; range, 48–60 years) for whom ICG videoangiography was performed to observe the skin perfusion of a supraclavicular flap after it was raised. Areas where the flap showed good enhancement were considered to be favorable for flap survival. The observation of ICG dye indicated good skin perfusion, which is predictive of flap survival; therefore, we trimmed any areas without dye filling and used the remaining viable part of the flap. Results The flaps ranged in size from 13×5.5 cm to 17×6.5 cm. One patient received a conventional supraclavicular flap, four patients received a TBSA flap, and one patient received a flap that was considered to be intermediate between a supraclavicular flap and a TBSA flap. The flaps completely survived in all cases, and no flap necrosis was observed. Conclusions The TBSA flap is very useful in reconstructive surgery, and reliable flaps could be obtained by using ICG fluorescence videoangiography intraoperatively.
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22
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Day AT, Tang L, Emerick K, Patel UA, Deschler DG, Richmon JD. Supraclavicular flap practice patterns and outcomes: A survey of 221 AHNS surgeons. Laryngoscope 2018; 129:2012-2019. [PMID: 30570139 DOI: 10.1002/lary.27641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To describe American Head and Neck Society (AHNS) surgeon supraclavicular flap (SCF) practice patterns and to identify variables associated with SCF complications. METHODS The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between November 11, 2016, and December 31, 2016. The primary outcome was frequency of SCF complications. Independent variables included demographics, training, practice patterns, and SCF techniques. RESULTS Adequate survey responses were obtained from 221 AHNS surgeons. Among these, 54.3% (n = 120) performed supraclavicular flaps (SCFs). Most surgeons used the SCF for cutaneous (n = 85; 78.7%) or parotid-temporal bone (n = 59; 54.6%) defects. Nearly one-third (n = 31; 29.8%) of surgeons experienced more than a "few" SCF complications. Surgeons experienced fewer pectoralis major flap (P < 0.001) and radial forearm free flap (P < 0.001) complications compared to SCF complications. Univariate analysis demonstrated no association between surgeons with "few" SCF complications and Doppler use in SCF design (P = 0.90), harvest location (P = 0.51), and pedicle skeletonization (P = 0.25). Multivariable logistic regression revealed that surgeons performing more than 30 SCFs compared to less than or equal to 30 SCFs had a greater odds of having "few" SCF complications (odds ratio 7.1, 95% confidence interval [1.1-43.9], P = 0.04). CONCLUSION A majority of surgeons performing SCFs use the flap to reconstruct cutaneous and parotid-temporal bone defects. The significance of relatively higher SCF complications compared to other routine flaps should be explored further. Surgeon experience with the SCF appears to be significantly associated with SCF success, whereas training characteristics, practice patterns, and technical variations may not be associated with SCF outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 129:2012-2019, 2019.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Liyang Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Kevin Emerick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Urjeet A Patel
- Department of Otolaryngology-Head and Neck Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois, U.S.A
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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23
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Sukato DC, Timashpolsky A, Ferzli G, Rosenfeld RM, Gordin EA. Systematic Review of Supraclavicular Artery Island Flap vs Free Flap in Head and Neck Reconstruction. Otolaryngol Head Neck Surg 2018; 160:215-222. [PMID: 30296901 DOI: 10.1177/0194599818803603] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this systematic review is to compare the surgical outcomes of supraclavicular artery island flap (SCAIF) and free tissue transfer (FTT) in head and neck reconstruction. DATA SOURCES PubMed, Web of Science, and EMBASE databases. REVIEW METHODS Independent screening and data extraction were performed by 2 authors. Only studies that directly compared SCAIF and FTT were included. Data were pooled with random-effects meta-analysis to determine the standardized mean differences (SMDs), risk differences, and 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistics. The Methodological Index for Non-Randomized Studies tool was used to evaluate extent of bias in studies. RESULTS The initial query yielded 661 results, of which 4 comparative studies remained for final analysis. The pooled sample sizes for the SCAIF and FTT cohorts were 100 and 84, respectively. SCAIF was associated with reduction of operative time by a large effect size (SMD, 1.65; 95% confidence interval, 0.78-2.52). The harvested flap areas and perioperative complications, including rates of total flap loss, partial flap necrosis, and recipient/donor site dehiscences, were comparable between the 2 procedures with low to high heterogeneity among studies. CONCLUSION SCAIF requires less operative time and has comparable short-term perioperative results to FTT. The findings of this study support the viability of SCAIF as an alternative to FTT and provide evidence for its inclusion in the reconstructive armamentarium of major head and neck ablation and trauma.
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Affiliation(s)
- Daniel C Sukato
- 1 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Alisa Timashpolsky
- 1 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - George Ferzli
- 1 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Richard M Rosenfeld
- 1 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Eli A Gordin
- 1 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA.,2 Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, USA
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Trautman J, Gore S, Potter M, Clark J, Hyam D, Tan NC, Ngo Q, Ashford B. Supraclavicular flap repair in the free flap era. ANZ J Surg 2017; 88:540-546. [DOI: 10.1111/ans.14263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/23/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jodie Trautman
- Division of Surgery; Wollongong Hospital; Wollongong New South Wales Australia
| | - Sinclair Gore
- Plastic and Reconstructive Surgery; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Matthew Potter
- Plastic and Reconstructive Surgery; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Jonathan Clark
- Illawarra Health and Medical Research Institute; University of Wollongong; Wollongong New South Wales Australia
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Dylan Hyam
- Oral and Maxillofacial Surgery Unit; Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Ngian C. Tan
- Division of Surgical Oncology; National Cancer Centre Singapore; Singapore
| | - Quan Ngo
- Plastic and Reconstructive Surgery; Liverpool Hospital; Sydney New South Wales Australia
| | - Bruce Ashford
- Division of Surgery; Wollongong Hospital; Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute; University of Wollongong; Wollongong New South Wales Australia
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
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25
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Abstract
PURPOSE OF REVIEW The purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the context of recent studies. RECENT FINDINGS Current literature regarding the supraclavicular flap has described its expanded uses in a variety of head and neck reconstructive settings. Its reliability and limited morbidity have been well demonstrated, and it has been cited as a reasonable alternative to other reconstructive options including, in some situations, free tissue transfer. SUMMARY The supraclavicular flap has shown dependability in reconstruction of defects in the head and neck, and it warrants consideration among reconstructive surgeons, especially for circumstances in which free tissue or other pedicled flaps are less than ideal.
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Altındaş M, Arslan H, Bingöl UA, Demiröz A. Prelaminated extended temporoparietal fascia flap without tissue expansion for hemifacial reconstruction. J Plast Reconstr Aesthet Surg 2017; 70:1457-1463. [PMID: 28572043 DOI: 10.1016/j.bjps.2017.05.016] [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: 02/06/2017] [Revised: 04/12/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Disfigurement of the face caused by postburn scars, resected congenital nevi and vascular malformations has both functional and psychological consequences. Ideal reconstruction of the facial components requires producing not only function but also the better appearance of the face. The skin of the neck, supraclavicular or cervicothoracic regions are the most commonly used and the most likely source of skin for facial reconstruction in those techniques which prefabrications with tissue expansion are used. This retrospective cohort study describes the two staged prelaminated temporoparietal fascia flap which eliminates the usage of tissue expansion by using skin graft harvested from the neck and occipital region and the application of this flap for the lower three-fourths of the face. METHOD 5 patients received prelaminated temporoparietal fascia flap without tissue expansion for facial resurfacing. The mean age at surgery was 39, 2 years (range, 17-60 years). The average follow up was 21.6 months (range, 10-48 months). RESULT The size of the raised prelaminated temporoparietal fascia flaps ranged from 9 × 8 cm to 14 × 10 cm. All flaps survived after second stage. Varied degrees of venous congestion were observed after flap insets in all cases but none required any further treatment for the congestion. The entire lesion could not be resected due to the large size of the lesion in all patients. CONCLUSION Two stage prelaminated temporoparietal fascia flap with skin graft is an effective technique for the reconstruction of partial facial defects in selected patients. It is simple, quick, safe and reliable, and requires no expansion of skin or no microsurgery.
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Affiliation(s)
- Muzaffer Altındaş
- Plastic, Reconstructive and Aesthetic Surgery Department, Private Office, İstanbul, Turkey.
| | - Hakan Arslan
- Plastic, Reconstructive and Aesthetic Surgery Department, İstanbul University Cerrahpasa Medical Faculty, İstanbul, Turkey.
| | - Uğur Anıl Bingöl
- Plastic, Reconstructive and Aesthetic Surgery Department, Yeditepe University Medical Faculty, İstanbul, Turkey.
| | - Anıl Demiröz
- Plastic, Reconstructive and Aesthetic Surgery Department, İstanbul University Cerrahpasa Medical Faculty, İstanbul, Turkey.
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The pre-expanded subclavicular island flap: A new tool for facial reconstruction. J Plast Reconstr Aesthet Surg 2016; 69:1653-1661. [PMID: 27743876 DOI: 10.1016/j.bjps.2016.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/07/2016] [Accepted: 09/05/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The anterior chest is an excellent donor site for cervicofacial reconstruction. Studies of chest flaps began as early as 1988 at our institution. We identified a new branch of the supraclavicular artery that nourishes the anterior chest, and on the basis of this finding, we created a new flap called the subclavicular flap. Unlike the supraclavicular flap, which is pedicled by the deltoid branch, this flap is primarily pedicled by the thoracic branch, and it shares similar vascular territory with the deltopectoral flap. In China, this flap has been widely used for neck reconstruction since our first publications on it in 1993. However, reports of its application are limited. To popularize the use of this flap, we present our experiences with pre-expanded subclavicular island flaps for the repair of facial scars. METHODS Fifteen patients with facial scars underwent reconstruction with these flaps. All flaps underwent pre-expansion before being transferred to the face through a subcutaneous tunnel. The pivot point was in the supraclavicular region and allowed the flap to reach the mid-face without compulsive positioning. Donor sites were closed primarily. RESULTS Flaps sizes ranged from 4 cm × 5 cm-10 cm × 17 cm. Fourteen flaps survived completely with satisfactory colour and texture. Total flap loss occurred in one patient, who was then treated by harvesting a skin graft from the dying flap. One patient experienced venous congestion, and the flap was successfully salvaged by pure vein anastomosis. CONCLUSION Pre-expanded subclavicular island flaps have similar benefits to supraclavicular and deltopectoral flaps, and they may emerge as one of the best choices for cervicofacial reconstruction globally.
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Abstract
The supraclavicular artery perforator (SAP) flap is a versatile flap for the reconstruction of head and neck defects. Recently, the authors have modified the SAP flap by using an anterior branch of the transverse cervical artery. The anterior SAP flap allows the harvest of a tissue island in the deltopectoral fossa, which is even thinner, is more pliable, and shows a superior color match to the face and neck compared with the original SAP flap. Pre-expansion increases flap size considerably, enabling the coverage of extended defects without the need of microsurgery.
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Affiliation(s)
- Norbert Pallua
- Department of Plastic and Reconstructive Surgery, Hand Surgery - Burn Center, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany.
| | - Bong-Sung Kim
- Department of Plastic and Reconstructive Surgery, Hand Surgery - Burn Center, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
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The Supraclavicular Flap in Head and Neck Reconstruction. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yoo J, Low THH, Tam S, Partridge A, MacNeil SD, Nichols AC, Fung K. Pedicled adipofascial infraclavicular flap: Elevation technique and its use for maintaining neck contour and vessel coverage after radical and modified radical neck dissection. Head Neck 2016; 38:1579-82. [PMID: 27126378 DOI: 10.1002/hed.24472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The pedicled adipofascial infraclavicular flap (ICF) is based on the anterior perforator of the supraclavicular artery and supplies the fasciocutaneous tissue of the upper chest. This flap may be used to address neck contour defects and vessel coverage after radical and modified radical neck dissections (MRNDs). METHODS We described the pedicled adipofascial ICF elevation technique and its use immediately after neck dissections in order to maintain soft tissue volume and vessel coverage. A video of the operation is provided. RESULTS Our results demonstrated satisfactory neck contours with adequate volume replacement, great vessel coverage, and little donor-site morbidity. CONCLUSION The pedicled adipofascial ICF is a technically straightforward operation with broad possible applications in head and neck surgery. It may be useful to provide vascularized soft-tissue coverage and maintain neck contour after neck dissections. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1582, 2016.
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Affiliation(s)
- John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada.
| | - Tsu-Hui Hubert Low
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
| | - Samantha Tam
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
| | - Allison Partridge
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada
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Chen B, Song H, Xu M, Gao Q. Reconstruction of cica-contracture on the face and neck with skin flap and expanded skin flap pedicled by anterior branch of transverse cervical artery. J Craniomaxillofac Surg 2016; 44:1280-6. [PMID: 27527674 DOI: 10.1016/j.jcms.2016.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/15/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE A high-quality flap is necessary for repairing faciocervical scar contractures. The supraclavicular region and chest wall are the preferred choices for reconstruction. The supraclavicular island flap (SIF) pedicled by the transverse cervical artery (TCA) has been reported. Compared to the traditional SIF flap, another type of flap pedicled by the anterior perforator of transverse cervical artery (ap-TCA) is more convenient for transfer to the faciocervical area. In this article, we use this type of perforator flap and expanded perforator flap to repair the faciocervical contracture. MATERIAL AND METHODS In this study, 10 cases (deformity caused by burn or trauma to the face and neck sites) with an average age of 32 years-old, were treated by ap-TCA flap and this type of expanded flap. In between, the flap was pre-expanded for approximately 3 months prior to transfer in 6 patients. Another 4 cases did not want the expander because of the long duration required for saline filling and potential complications of the expander. Bilateral prefabricated flaps were designed in two female cases. RESULTS All 12 flaps in 10 patients were transferred tension-free to the defects and no flap was lost. The size of the flap ranged from 12 cm × 8 cm to 15 cm × 20 cm. All 12 flaps survived completely. The donor sites were closed directly in the above 6 patients where an expander had been used and reconstructed by split skin graft in 4 patients where no expander had been employed. Through a mean time of 6 months' follow-up, only one female patient was disappointed with the cicatrix that presented on the upper polar skin of both breasts, the other 9 patients were satisfied with both recipient function and appearance. The color and the texture matched well with the recipient area. CONCLUSION The ap-TCA flap and expanded ap-TCA flap can be considered reliable options for faciocervical deformities as it can be easily elevated and it matches well with faciocervical area in color. With regards to the expanded flap, we cannot only reconstruct the face and neck region, but also suture the donor site directly.
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Affiliation(s)
- Baoguo Chen
- The First Hospital Affiliated to the People's Liberative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing 100048, China
| | - Huifeng Song
- The First Hospital Affiliated to the People's Liberative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing 100048, China.
| | - Minghuo Xu
- The First Hospital Affiliated to the People's Liberative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing 100048, China
| | - Quanwen Gao
- The First Hospital Affiliated to the People's Liberative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing 100048, China
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Glass GE, Mosahebi A, Shakib K. Cross-specialty developments: a summary of the mutually relevant recent literature from the journal of plastic, reconstructive and aesthetic surgery. Br J Oral Maxillofac Surg 2015; 54:13-21. [PMID: 26628201 DOI: 10.1016/j.bjoms.2015.08.272] [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: 08/11/2014] [Accepted: 08/26/2015] [Indexed: 12/18/2022]
Abstract
Keeping abreast of current developments is increasingly challenging when the volume of specialty articles being published is rising exponentially, and it is most acute when surgical specialties overlap, as in the case of head, neck, and facial reconstructive surgery. Here, the potential for missing key developments presents a compelling case for a summary article that highlights articles likely to be of mutual relevance. We evaluated 129 original studies and 6 reviews published in the Journal of Plastic, Reconstructive, and Aesthetic Surgery between September 2012 and August 2014, and summarised the main papers of interest and merit under the subheadings of head and neck reconstruction, cleft lip and palate, craniomaxillofacial surgery, facial palsy, facial trauma, and aesthetic surgery. Most of the evidence presented (86%) is level 4.
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Affiliation(s)
- Graeme E Glass
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kennedy Institute of Rheumatology, Roosevelt Drive, Oxford, OX 3 7FY.
| | - Ash Mosahebi
- Royal Free Hospital NHS Foundation trust, Pond Street, Hampstead, London, NW3 2QG
| | - Kaveh Shakib
- Royal Free Hospital NHS Foundation trust, Pond Street, Hampstead, London, NW3 2QG
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Kim JT, Kim YH, Ghanem AM. Perforator chimerism for the reconstruction of complex defects: A new chimeric free flap classification system. J Plast Reconstr Aesthet Surg 2015; 68:1556-67. [PMID: 26323993 DOI: 10.1016/j.bjps.2015.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/09/2015] [Accepted: 07/06/2015] [Indexed: 11/25/2022]
Abstract
Complex defects present structural and functional challenges to reconstructive surgeons. When compared to multiple free flaps or staged reconstruction, the use of chimeric flaps to reconstruct such defects have many advantages such as reduced number of operative procedures and donor site morbidity as well as preservation of recipient vessels. With increased popularity of perforator flaps, chimeric flaps' harvest and design has benefited from 'perforator concept' towards more versatile and better reconstruction solutions. This article discusses perforator based chimeric flaps and presents a practice based classification system that incorporates the perforator flap concept into "Perforator Chimerism". The authors analyzed a variety of chimeric patterns used in 31 consecutive cases to present illustrative case series and their new classification system. Accordingly, chimeric flaps are classified into four types. Type I: Classical Chimerism, Type II: Anastomotic Chimerism, Type III: Perforator Chimerism and Type IV Mixed Chimerism. Types I on specific source vessel anatomy whilst Type II requires microvascular anastomosis to create the chimeric reconstructive solution. Type III chimeric flaps utilizes the perforator concept to raise two components of tissues without microvascular anastomosis between them. Type IV chimeric flaps are mixed type flaps comprising any combination of Types I to III. Incorporation of the perforator concept in planning and designing chimeric flaps has allowed safe, effective and aesthetically superior reconstruction of complex defects. The new classification system aids reconstructive surgeons and trainees to understand chimeric flaps design, facilitating effective incorporation of this important reconstructive technique into the armamentarium of the reconstruction toolbox.
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Affiliation(s)
- Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Centre, Seoul, Republic of Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Centre, Seoul, Republic of Korea
| | - Ali M Ghanem
- Barts and the London School of Medicine and Dentistry, London, UK.
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Pre-expanded cervico-acromial fasciocutaneous flap based on the supraclavicular artery for resurfacing post-burn neck scar contractures. Ann Plast Surg 2015; 73 Suppl 1:S92-8. [PMID: 25003460 DOI: 10.1097/sap.0000000000000245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Post-burn cicatricle contractures of neck pose a challenge for plastic and reconstructive surgeons. To improve functional and cosmetic results, and to minimize the donor-site morbidity, we use pre-expanded cervico-acromial fasciocutaneous flap based on the supraclavicular artery as a feasible choice for resurfacing large skin defects of the neck. METHODS In this series, from 2008 to 2012, 18 patients with ages ranging between 11 and 42 years (20 flaps with 2 patients in bilateral fashion) suffering from post-burn scar contractures of the neck were treated. In the first stage, an expander was implanted on the deep fascia layer of the cervico-acromial region; 600 to 800 mL of saline was then injected during a 10- to 16-week period. In the second stage after expansion, sufficient skin and tissue was obtained to resurface the defects of the neck after releasing the contractures and excision of post-burn scars. RESULT All 20 flaps healed primarily with good functional and cosmetic results. The maximum size was 23×16 cm, whereas the minimum was 20×8 cm. After an average follow-up time of 12 months, significant improvement in range of motion with good esthetic outcomes were achieved, and the scars in donor sites seemed acceptable. There ware no significant complications. CONCLUSIONS The pre-expanded cervico-acromial fasciocutaneous flap based on the supraclavicular artery can provide a large amount of thin tissue with both good color and texture, and without the need for microsurgery, and avoid the disadvantages of donor-site morbidity. This flap is reliable and safe for resurfacing large skin defects of the neck.
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Nicoli F, Orfaniotis G, Gesakis K, Lazzeri D, Ciudad P, Chilgar RM, Sapountzis S, Sönmez TT, Maruccia M, Constantinides J, Sacak B, Chen HC. Supraclavicular osteocutaneous free flap: clinical application and surgical details for the reconstruction of composite defects of the nose. Microsurgery 2015; 35:328-32. [PMID: 25580712 DOI: 10.1002/micr.22375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022]
Abstract
The supraclavicular fasciocutaneous flap is a well-recognized flap in head and neck reconstruction. In this report, we describe for the first time a variation of this flap, the osteocutaneous supraclavicular (SOC) free flap, which was used to reconstruct a composite nasal defect. The defect arose after resection of a recurrent squamous cell carcinoma and involved dorsal nasal skin, cartilage, and the entire nasal bone. A 6 cm × 4 cm size flap including skin, subcutaneous tissue, and a vascularized cortico-periosteal segment of the clavicle was raised based on the transverse cervical artery. The flap survived with no complications. A satisfactory aesthetic outcome was achieved following two revision procedures. We believe that the incorporation of bone to the supraclavicular flap may expand its applications in reconstruction of composite nasal and facial defects.
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Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, UK
| | - Kanellos Gesakis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, UK
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ram M Chilgar
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, Maharashtra University of Health Sciences, Nashik, Maharashtra, India
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tolga Taha Sönmez
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Joannis Constantinides
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, UK
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Hung Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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Zan T, Yuan Y, Li H, Li Q. Comment Re: Moving forwards: The anterior supraclavicular artery perforator (a-SAP) flap: A new pedicled or free perforator flap based on the anterior supraclavicular vessels. J Plast Reconstr Aesthet Surg 2014; 67:1005-7. [DOI: 10.1016/j.bjps.2014.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
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Yoo J, Belzile M. Infraclavicular free flap for head and neck reconstruction: Surgical description and early outcomes in 7 consecutive patients. Head Neck 2014; 37:309-16. [DOI: 10.1002/hed.23597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/01/2013] [Accepted: 12/20/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- John Yoo
- Department of Otolaryngology-Head and Neck Surgery; London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University; London Ontario Canada
| | - Mathieu Belzile
- Department of Otolaryngology-Head and Neck Surgery; London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University; London Ontario Canada
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Emerick KS, Herr MA, Deschler DG. Supraclavicular flap reconstruction following total laryngectomy. Laryngoscope 2014; 124:1777-82. [PMID: 24431133 DOI: 10.1002/lary.24530] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/09/2013] [Accepted: 11/18/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Report on the successful use of the supraclavicular flap for reconstruction following total laryngectomy and highlight the utility and versatility of the supraclavicular flap for reconstruction after total laryngectomy. STUDY DESIGN Retrospective review of a single institution experience. METHODS A single institution database was reviewed to identify patients undergoing total laryngectomy and supraclavicular flap reconstruction. The following data were collected: indication for reconstruction, flap viability, flap size, reconstruction site complication, and donor site complication. RESULTS Forty-six supraclavicular flaps were identified in the database from July 2011 to September 2013. Fifteen of these were used following total laryngectomy. Ten flaps were used for patch graft pharyngeal reconstruction, three flaps for cutaneous defects related to previous tracheotomy, one flap for cutaneous and tracheal reconstruction following resection of a recurrence in the stoma, and one flap as a pharyngeal interposition graft. Twelve of these cases were performed in the salvage setting after previous radiation. Three cases had significant oropharyngeal resection that required reconstruction. There was one near complete flap loss. Three patients developed pharyngocutaneous fistula. One patient required an additional surgical procedure to address a complication. Three patients had minor incisional dehiscence. All minor complications resolved with basic wound care. No significant donor site morbidity was identified. CONCLUSIONS The supraclavicular flap can be successfully used for multiple purposes following total laryngectomy. This has been successfully used for reconstruction of limited pharyngeal defects, extensive pharyngeal resection, and skin reconstruction following previous tracheotomy. This flap can be successfully used following previous radiation and with limited morbidity.
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Affiliation(s)
- Kevin S Emerick
- Massachusetts Eye and Ear Infirmary, Head and Neck Division; Harvard Medical School, Department of Otology and Laryngology, Boston, Massachusetts, U.S.A
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40
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Huguier V, Dagrégorio G, Darsonval V, Arnaud D, Potier B, Rousseau P. [Cheek reconstruction]. ANN CHIR PLAST ESTH 2013; 58:457-514. [PMID: 24125779 DOI: 10.1016/j.anplas.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
Abstract
We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.
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Affiliation(s)
- V Huguier
- Service de chirurgie plastique, CHU, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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The evolving role of free flaps and pedicled flaps in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2013; 21:305-10. [DOI: 10.1097/moo.0b013e328362ceef] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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