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Schonauer F, Murone V, De Gregorio L, Cavaliere A. The "Ghost shaped" antero-lateral thigh flap for total tongue reconstruction: A case report. JPRAS Open 2024; 41:400-405. [PMID: 39252989 PMCID: PMC11381836 DOI: 10.1016/j.jpra.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/14/2024] [Indexed: 09/11/2024] Open
Abstract
Squamous cell carcinoma is the most common cancer of the oral cavity, particularly of the tongue. Surgery is the treatment of choice, but it can have a dramatic impact on patients' quality of life. Although the primary goal of tongue reconstruction is the restoration of vital functions such as swallowing and speech, a good cosmetic result should also be achieved. Herein we present the case of a 54-year-old woman who underwent total glossectomy, describing and highlighting the advantages of our modified technique: the "Ghost-shaped" anterolateral thigh perforator flap.
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Affiliation(s)
- Fabrizio Schonauer
- Unit of Plastic Surgery, University "Federico II", Via Sergio Pansini, 5 80131, Naples, Italy
| | - Vittoria Murone
- Unit of Plastic Surgery, University "Federico II", Via Sergio Pansini, 5 80131, Naples, Italy
| | - Ludovica De Gregorio
- Unit of Plastic Surgery, University "Federico II", Via Sergio Pansini, 5 80131, Naples, Italy
| | - Annachiara Cavaliere
- Unit of Plastic Surgery, University "Federico II", Via Sergio Pansini, 5 80131, Naples, Italy
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2
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Harper J, Slade E, Cornette A, Kejner AE. Second sensor to improve near-infrared spectroscopy flap monitor utility: A prospective study. Microsurgery 2024; 44:e31142. [PMID: 38376250 DOI: 10.1002/micr.31142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/09/2023] [Accepted: 12/27/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVE This study assesses whether use of continuous noninvasive near-infrared spectroscopy (NIRS) sensor on head and neck free flap (FF) with a second sensor on nonoperated tissue improves distinction between systemic hypoperfusion and FF compromise. METHODS Single-institution, prospective study of patients undergoing head and neck FF reconstruction from December 2018 to April 2020. FFs were continuously monitored using NIRS on a monitor paddle with a second (control) sensor on the shoulder. Crude StO2 and percent change in StO2 were compared between the FF and control sensors on each patient, and percent change and percent difference between the control and the monitor paddle were documented to assess for congruity. Sentinel events (e.g., hypotension and hematoma) were documented to assess the association with change in StO2. These events and timing of StO2 changes were noted to assess associations with change in StO2. RESULTS A total of 48 patients had complete data. Donor sites included 35 soft-tissue FFs and 13 fibula FFs. Average StO2 was 73.7 ± 5.5 for FFs and 71.4 ± 5.0 for control sensors. There were seven sentinel events during the study. At the time of the events, StO2 dropped significantly more for the FF than the control sensor (FF = 52.2% drop; control = 6.2% drop; p = .016). NIRS signal denoted change prior to changes in implantable arterial Doppler in all cases. CONCLUSIONS The addition of a second sensor when using NIRS as a primary modality for FF monitoring may improve distinction between FF compromise events and systemic hypoperfusion. By increasing accuracy of the monitor, there is a potential for decreased resident burden and decreased use of higher level of care nursing, which could reduce overall costs.
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Affiliation(s)
- Jonathan Harper
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Emily Slade
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Adrianne Cornette
- Department of Pediatrics, University Hospitals, Cleveland, OH, United States
| | - Alexandra E Kejner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
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3
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Liu MD, Xue XM, Al-Aroomi MA, Xiong JJ, Liu S, Sun CF, Liu FY. A novel flap design technique for subtotal tongue reconstruction with an "Individualized and Convenient Tongue Model". Oral Oncol 2023; 145:106531. [PMID: 37499327 DOI: 10.1016/j.oraloncology.2023.106531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND To achieve improved functional outcomes in subtotal tongue reconstruction, a flap design with sufficient volume and appropriate shape is necessary. In this study, we introduce an "Individualized and Convenient Tongue Model" (ICTM) for flap design in subtotal tongue reconstruction. METHODS By studying the anatomical morphology of the tongue, we found a similar geometry within the dorsum and body of the tongue as well as the mouth floor. This can be used to create an ICTM through folding and splicing. We can simulate tongue defects in the ICTM and transform defect shapes into guide plates for flap design. In this study, fifty-eight patients requiring subtotal tongue reconstruction were randomly divided into two groups: an ICTM group (35 patients) and a conventional group (31 patients). In the ICTM group, we individually designed profunda artery perforator flaps (PAPFs) or anterolateral thigh flaps (ALTFs) using the ICTM method. In the conventional group, the flap was designed according to the surgeon's clinical experience. Patient demographics, operative and follow-up data were recorded. Swallowing, speech intelligibility, and cosmetic results were assessed using appropriate scales. RESULTS All flaps survived, although there were no significant differences in tumor size, operation time, flap size, and complication rate compared to the conventional group. Patients in the ICTM group had significantly improved speech intelligibility (p = 0.019), cosmetic appearance (p = 0.009), and swallowing ability (p = 0.003). CONCLUSIONS The ICTM technique is an effective and convenient solution for subtotal tongue reconstruction that provides an individualized flap design and improves functional outcomes compared to the conventional design.
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Affiliation(s)
- Min-Da Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China.
| | - Xiao-Meng Xue
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Maged Ali Al-Aroomi
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Jian-Jun Xiong
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Sheng Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Chang-Fu Sun
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Fa-Yu Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China.
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Liu MD, Liu DZ, Al-Aroomi MA, Xiong JJ, Liu S, Sun CF, Liu FY. Reconstruction of large defects of anterior floor of mouth with free flaps using a novel individualized flap design method. J Craniomaxillofac Surg 2023; 51:574-579. [PMID: 37604768 DOI: 10.1016/j.jcms.2023.08.006] [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: 01/27/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
The purpose of this study was to introduce a novel individualized flap design method for large anterior floor of the mouth (AFOM) defect reconstruction, review experience with the use of this flap design method for large AFOM defect reconstruction, and assess its functional results. A retrospective study of patients who received large AFOM defect reconstruction with free flaps was conducted. There was a cohort of patients who were treated using the novel individualized flap design method and a cohort without flap design. Functional outcomes were evaluated with appropriate scales. Outcomes were analyzed, and a p-value <0.05 was considered significant. 22 patients received the individualized flap design, while 21 patients were treated without a special flap design. All flaps survived. All free flaps harvested with the novel individualized flap design method better matched AFOM defects. Relative to patients without flap design, patients in the novel individualized flap design group showed significant improvement in speech intelligibility (p = 0.036) and swallowing function (p = 0.019). Within the limitation of the study it seems that large AFOM defect reconstruction with the novel individualized flap design method can not only cover and close the wound to avoid oral-neck fistulae, but also maintains tongue mobility to achieve better functional outcomes than in patients without flap design.
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Affiliation(s)
- Min-Da Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China.
| | - Ding-Zhuo Liu
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R.China
| | - Maged Ali Al-Aroomi
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Jian-Jun Xiong
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Sheng Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Chang-Fu Sun
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China
| | - Fa-Yu Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, 110002, PR China.
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Liu Z, Yang L, Cheng J, Yang C, Gao Q, Huang Y, Sun F, Zhang T, Cao Y, Ju J. Is the oblique branch of the lateral circumflex femoral artery a common variant? J Plast Reconstr Aesthet Surg 2023; 84:540-546. [PMID: 37421678 DOI: 10.1016/j.bjps.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
The oblique branch of the lateral circumflex femoral artery, a short branch of the deep femoral artery, is highly prevalent (32-46%) and is usually considered a normal variant, although this is still controversial. This study aimed to evaluate whether the oblique branch of the lateral circumflex femoral artery is a variant. We reviewed medical record data of patients with skin and soft tissue defects of the extremities who underwent flap repair using free anterolateral thigh (ALT) flaps at our hospital in 2019. The anatomical characteristics of the flaps were examined intraoperatively by high-frequency color Doppler ultrasound. A total of 153 ALT flaps from 146 patients were included. Among the branches, 232 (73.7%) were oblique branches, and 83 (26.4%) were descending branches. Of the 232 oblique branches, 141 (60.8%) were from septocutaneous branches, and the other 83 (39.2%) were from musculocutaneous branches. In addition, 20 (24.1%) descending branches were from septocutaneous branches, and the other 63 (75.9%) were from musculocutaneous branches. Analyzing the prevalence of the oblique branch in septocutaneous branches, more than half of the patients had oblique branches rather than descending branches. The high proportion of oblique branches from septocutaneous branches (median: 100 (0-100) vs. 0 (0-50), p = 0.002) supports the understanding that the oblique branch is a normal anatomical element rather than a variant. The main type was the intramuscular branches, which required significantly less time for flap harvesting. The oblique branch may be the preferred vascular pedicle for free ALT flaps.
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Affiliation(s)
- Zhijin Liu
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Lin Yang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Junnan Cheng
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Chengpeng Yang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Qinfeng Gao
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Yongtao Huang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Fengwen Sun
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Tao Zhang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Yang Cao
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China
| | - Jihui Ju
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, Jiangsu, China.
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Utility of a palatal speech appliance combined with the five-point eight-line segment technique in total tongue reconstruction. Int J Oral Maxillofac Surg 2022; 51:1016-1021. [DOI: 10.1016/j.ijom.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/20/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022]
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Santanelli di Pompeo F, Longo B, Giovanoli P, Plock JA, Campanale A, Laporta R, Sorotos M, Paolini G, Renzi L, Nuccitelli G, Stoppacciaro A, Lagana B, Pribaz JJ. Facial Transplantation: Nonimmune-Related Hyperacute Graft Failure-The Role of Perfusion Injury: A Case Report. Ann Plast Surg 2021; 86:469-475. [PMID: 33720920 DOI: 10.1097/sap.0000000000002632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to report the first case of acute facial allograft transplantation (facial allograft transplantation) failure with allograft removal and autologous free-flap reconstruction. METHODS A 49-year-old female patient affected by neurofibromatosis type 1 with a massive neurofibroma infiltrating the whole left hemiface was planned for FAT for the left hemiface including the auricle, all skin and soft tissues from the temporal region, periorbital and nasal region, and up to the perioral area. The maxillary process of the zygomatic bone, left hemimaxilla, and hemimandible from contralateral parasyphysis to the incisura mandibulae were also included. RESULTS Total surgical time was 26 hours. There were 2 intraoperative arterial thromboses that were solved with new anastomoses and sufficient flap perfusion. On postoperative day 2, the allograft became pale with suspected arterial occlusion and the patient returned to the operative room for exploration no flow into the FAT was found. The allograft was removed and the recipient site reconstructed with a skin-grafted composite left latissimus dorsi-serratus anterior flap. CONCLUSIONS Hyperacute loss of FAT is a very dramatic event, and the activation of a backup surgical plan is crucial to save patient's life, give a reasonable temporary reconstruction, and return on the waiting-list for a second face transplantation.
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Affiliation(s)
- Fabio Santanelli di Pompeo
- From the Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome
| | - Benedetto Longo
- Division of Plastic and Reconstructive Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Pietro Giovanoli
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan Alexander Plock
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Antonella Campanale
- Directorate General of Medical Devices and Pharmaceutical Services, Medical Device Vigilance System and Inspections, Italian Ministry of Health
| | | | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," PhD School of Translational Medicine of Development and Active Ageing, University of Salerno, Salerno
| | - Guido Paolini
- From the Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome
| | - Luca Renzi
- From the Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome
| | - Gloria Nuccitelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine
| | - Antonella Stoppacciaro
- Department of Pathological Anatomy, School of Medicine and Psychology, Sant'Andrea Hospital
| | - Bruno Lagana
- Autoimmune Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Julian J Pribaz
- Department of Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL
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8
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Baskin RM, Seikaly H, Sawhney R, Danan D, Burt M, Idris S, Shama M, Boyce B, Dziegielewski PT. Tongue reconstruction: Rebuilding mobile three-dimensional structures from immobile two-dimensional substrates, a fresh cadaver study. Head Neck 2019; 41:3693-3699. [PMID: 31347741 DOI: 10.1002/hed.25889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the two-dimensional (2D) characteristics of flaps necessary to create three-dimensional (3D) tongue anatomy. METHODS Dissection of 11 fresh, nonpreserved human cadavers was performed. Six defects in each were created: total tongue, total oral tongue, hemiglossectomy, oral hemiglossectomy, total base of tongue, and hemi-base of tongue. The resections were debulked to create flat, 2D mucosal flaps. The dimensions and shapes of these flaps were determined. RESULTS Each specimen showed consistent dimensions and geometry between cadavers. The total tongue was pear-shaped, the total oral tongue was egg-shaped, the oral hemi-tongue was bullet-shaped, the hemi-tongue resembled a dagger, the total base of tongue was rectangular, and the hemi-base of tongue was hour-glass shaped. CONCLUSION Typical dimensions and shapes of common tongue defects were determined. It is conceivable that customizing reconstructive flaps based on these data will increase the accuracy of neo-tongue reconstruction, and thus, improve functional outcomes.
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Affiliation(s)
- R Michael Baskin
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Raja Sawhney
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Martha Burt
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Sherif Idris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Brian Boyce
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.,University of Florida Health Cancer Center, Gainesville, Florida
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9
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Fan S, Zhang H, Li Q, Liang F, Bai Z, Chen W, Sun S, Yu P, Li J. A novel anatomy-based five-points eight-line-segments technique for precision subtotal tongue reconstruction: A pilot study. Oral Oncol 2019; 89:1-7. [DOI: 10.1016/j.oraloncology.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/10/2018] [Accepted: 12/08/2018] [Indexed: 12/30/2022]
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10
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Fan S, Li QX, Zhang HQ, Liang MJ, Tian T, Wang YY, Lin ZY, Chen WX, Pan GK, Ahn MHY, He L, Sun S, Wu BH, Yu P, Li JS. "Five-point eight-line" anatomic flap design for precise hemitongue reconstruction. Head Neck 2018; 41:1359-1366. [PMID: 30561069 DOI: 10.1002/hed.25571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/25/2018] [Accepted: 11/21/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Reconstruction of hemiglossectomy defects requires careful flap design to avoid adverse functional and aesthetic outcomes. METHODS Hemitongue specimens were obtained from minipigs to study the three-dimensional anatomy and to define anatomic landmarks for precise measurements of flap requirement. The concept developed in animal models was then applied to hemiglossectomy reconstruction in clinical practice. Sixty-one patients were randomly enrolled into the following two groups: a "five-point eight-line segment" (FIPELS) flap design group (28 patients) and a conventional group (33 patients). Functional and aesthetic outcomes were compared between the two groups. RESULTS All flaps designed with the FIPELS technique matched the hemiglossectomy defects without the need for flap trimming, thus reducing the operating time (P = .03). Swallowing functions, speech intelligibility, and aesthetic outcomes were superior in the FIPELS group than that in the conventional group (P < .05). CONCLUSIONS The FIPELS flap design for hemiglossectomy reconstruction yields improved functional and aesthetic outcomes compared to a conventional flap design.
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Affiliation(s)
- Song Fan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Oral & Maxillofacial-Head & Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Guangzhou, China
| | - Qun-Xing Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Han-Qing Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mao-Jin Liang
- Department of Otorhinolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tian Tian
- Department of Neurobiology, Nanjing Medial University, Nanjing, China
| | - You-Yuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhao-Yu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-Xiong Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guo-Kai Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Michael Ho-Young Ahn
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lile He
- Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Hunan, China
| | - Sheng Sun
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Bing-Hao Wu
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jin-Song Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Oral & Maxillofacial-Head & Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Guangzhou, China
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11
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D’arpa S, Cillino M, Mazzucco W, Rossi M, Mazzola S, Moschella F, Cordova A. An algorithm to improve outcomes of radial forearm flap donor site. Acta Chir Belg 2018; 118:219-226. [PMID: 29202648 DOI: 10.1080/00015458.2017.1411555] [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] [Indexed: 10/18/2022]
Abstract
Abstarct Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site complication rates. METHODS The authors analyzed retrospectively 31 patients who underwent free radial forearm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was harvested suprafascial with those in which the flap was harvested as subfascial. RESULTS Before application of the algorithm, there was a 23.3% complication rate at the RFF donor site, in our experience. After introduction of the algorithm, complication rate has dropped to 3.2%, consisting in a partial skin graft necrosis treated by local wound-care and healed without further intervention. CONCLUSIONS Application of the algorithm described has led to a significant reduction in RFF donor site complication rates. This demonstrates that if flap donor sites are analyzed and tailor treated in the same way as primary defects are, instead of being given secondary importance and just grafted, outcomes improve.
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Affiliation(s)
- Salvatore D’arpa
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
- Deparment of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michele Cillino
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Cancer Registry of Palermo and Province Department for Health Promotion Science and Mother and Child, “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Sergio Mazzola
- Cancer Registry of Palermo and Province Clinical Epidemiology and Cancer Registry Operative Unit, University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Francesco Moschella
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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12
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Is it possible to calculate surface areas of intraoral structures from preoperative CT scan? J Plast Reconstr Aesthet Surg 2017; 70:1143-1146. [PMID: 28566204 DOI: 10.1016/j.bjps.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022]
Abstract
Microsurgical reconstruction of intraoral structures requires accurate planning of flap shape and dimensions. The goal of this study is to describe a method that allows to calculate surfaces of oral structures from preoperative CT-scan in order to determine a precise flap design before the surgery. We created casts of the human mouth from cadavers with a head and neck CT-scan available using an impression material. We digitalized the mouth casts and unwrapped the surfaces of the different structures of the mouth in a bi-dimensional plane in order to measure the area. Furthermore, we measured distances from pre-determined bony landmarks using the CT-scan 3D reconstruction model and we correlated the two type of measurements. We performed a simple regression analysis and afterwards a multivariate analysis using the more statistically correlated measurements. We found a statistical correlation between the surface of the tongue and the surface floor of the mouth with three bone distances that let us to create three mathematical formulas. With those formulas, we can calculate the surfaces of the tongue and the floor of the mouth using simple bony distances that can be easily measured from the head and neck preoperative CT scan. Using standard template's layouts, we can create a precise preoperative flap design in the reconstruction of the tongue and of the floor of the mouth.
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Use of Extended Lateral Upper Arm Free Flap for Tongue Reconstruction After Radical Glossectomy for Tongue Cancer. Aesthetic Plast Surg 2015; 39:562-9. [PMID: 26044397 DOI: 10.1007/s00266-015-0512-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study evaluated the safety and effectiveness of the extended lateral arm free flap (ELAFF) for repair of partial tongue defects after radical resection of tongue cancer. METHODS The study included nine consecutive patients who underwent repair of a partial tongue defect with an ELAFF after radical resection of tongue cancer from November 2010 to December 2013. Lesions were at the tip or margin of the tongue. Details of the reconstructive surgery, donor-site and recipient-site morbidity, and functional and esthetic outcomes were evaluated during a minimum of 12 months follow-up. Patient-reported Visual Analog Scale (VAS) scores on a scale of 0 (minimum satisfaction) to 10 (maximum satisfaction) were used to evaluate esthetic outcomes. RESULTS All patients were followed up for 12 months (median 24 months). The overall survival rate was 88 % (8/9). The donor site was closed primarily in all patients. The most frequent donor-site morbidity was a broad scar. Poor functional outcomes were associated with postoperative adjuvant radiotherapy. The shape and function of the reconstructed tongue were satisfactory. VAS scores (mean ± SD) for patient satisfaction with recipient-site and donor-site esthetics were 6.92 ± 1.70 and 7.33 ± 2.01, respectively. CONCLUSION The ELAFF is a safe and effective option for repair of partial tongue defects after radical resection of tongue cancer. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Canis M, Weiss BG, Ihler F, Hummers-Pradier E, Matthias C, Wolff HA. Quality of life in patients after resection of pT3 lateral tongue carcinoma: Microvascular reconstruction versus primary closure. Head Neck 2015; 38:89-94. [DOI: 10.1002/hed.23862] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Göttingen; Germany
| | - Bernhard G. Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Göttingen; Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Göttingen; Germany
| | - Eva Hummers-Pradier
- Department of General Practice/Family Medicine; University of Göttingen; Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Göttingen; Germany
| | - Hendrik A. Wolff
- Department of Radiation Oncology; University of Göttingen; Germany
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15
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Interdental Papillae Reconstruction in Glossopelvectomy Defects. J Craniofac Surg 2015; 26:951-2. [DOI: 10.1097/scs.0000000000001422] [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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16
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Sirimahachaiyakul P, Orfaniotis G, Gesakis K, Kiranantawat K, Ciudad P, Nicoli F, Maruccia M, Sacak B, Chen HC. Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel. Microsurgery 2015; 35:356-63. [PMID: 25597746 DOI: 10.1002/micr.22377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Pornthep Sirimahachaiyakul
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Division of Plastic Surgery; Department of Surgery; Faculty of Medicine Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kanellos Gesakis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Maxillofacial Surgery; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; Sapienza University; Rome Italy
| | - Bulent Sacak
- 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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17
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Santanelli Di Pompeo F, Longo B, Pagnoni M, Laporta R. Sensate anterolateral thigh perforator flap for ischiatic sores reconstruction in meningomyelocele patients. Microsurgery 2014; 35:279-83. [PMID: 25241659 DOI: 10.1002/micr.22330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 09/06/2014] [Accepted: 09/08/2014] [Indexed: 11/11/2022]
Abstract
Recidivating pressure sores are a frequent complication in meningomyelocele patients because of their limitation in motility and their scarce ability to monitor the pressure applied on insensate areas while seated. We report the utilization of the sensate pedicled anterolateral thigh perforator flap for reconstruction of ischiatic sores in meningomyelocele patients. Between May 2011 and September 2013, five patients underwent transfer of a sensate pedicled anterolateral thigh flap, by an intermuscular passageway through the upper thigh, to reach the ischial defect. Flap was properly harvested from the thigh after assessment of the lateral cutaneous femoral nerve sensitive area with the Pressure-Specified Sensory Device. In all cases the flap reached the ischial defect harmlessly, healing was uneventful with no immediate nor late complications. Each patient showed persistence of sensitivity at the reconstructed area and no recurrent ischiatic sore was observed at mean follow-up of 26.4 months. The sensate pedicled anterolateral thigh flap is a valuable solution for coverage of recurrent ischial sores in meningomyelocele patients, in which pressure consciousness is fundamental. The intermuscular passageway allows to reduce the distance between flap's vascular pedicle origin and the ischial defect, hence to use the more reliable skin from the middle third of the anterolateral thigh.
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Affiliation(s)
- Fabio Santanelli Di Pompeo
- Plastic Surgery Unit, NESMOS department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Italy
| | - Benedetto Longo
- Plastic Surgery Unit, NESMOS department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Italy
| | - Marco Pagnoni
- Plastic Surgery Unit, NESMOS department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Italy
| | - Rosaria Laporta
- Plastic Surgery Unit, NESMOS department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Italy
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18
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Multipaddled anterolateral thigh chimeric flap for reconstruction of complex defects in head and neck. PLoS One 2014; 9:e106326. [PMID: 25180680 PMCID: PMC4152256 DOI: 10.1371/journal.pone.0106326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022] Open
Abstract
The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck.
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Longo B, Laporta R, Pagnoni M, Campanale A, Grippaudo FR, Santanelli Di Pompeo F. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face. Microsurgery 2014; 35:177-82. [DOI: 10.1002/micr.22305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Benedetto Longo
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Rosaria Laporta
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Marco Pagnoni
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Antonella Campanale
- Italian Ministry of Health, Directorate General for Medical Devices, Pharmaceutical Services and Safety in Health CareRome Italy
| | - Francesca Romana Grippaudo
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Fabio Santanelli Di Pompeo
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
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Kelahmetoglu O, Yagmur C, Aslan O, Firinciogullari R. The bilobed flap for popliteal defect reconstruction. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2014; 1:8-10. [PMID: 27252948 PMCID: PMC4627107 DOI: 10.3109/23320885.2014.961459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 11/13/2022]
Abstract
Bilobed flaps were first introduced to close small nasal defects. We reconstructed a defect of the popliteal fossa using a random-pattern bilobed flap. We recommend the use of random-pattern bilobed flaps as a reliable technique for covering defects of the popliteal fossa.
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Affiliation(s)
- Osman Kelahmetoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Tarsus State Hospital , Tarsus/Mersin, Turkey
| | | | - Ozan Aslan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Haydarpasa Numune Research and Education Hospital , Istanbul, Turkey
| | - Remzi Firinciogullari
- Department of Plastic, Reconstructive and Aesthetic Surgery, Private Tarsus Medical Park Hospital , Tarsus/Mersin, Turkey
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