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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Ma C, Gao W, Abdelrehem A, Zhu D, Zhu Y, Sun J, Shen Y. Anteromedial thigh septocutaneous perforator flap as a first choice for head and neck reconstruction: A clinical algorithm based on perforator-pedicle relationship. Oral Oncol 2022; 126:105738. [PMID: 35114613 DOI: 10.1016/j.oraloncology.2022.105738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anterolateral thigh perforator flaps (ALTPFs) have long been considered workhorse flaps for head and neck reconstructions. However, in some instances, anteromedial thigh septocutaneous perforator flaps (AMTPFs) are easier to harvest than ALTPFs. This study aimed to determine when and how the AMTPF should be considered the first choice as a reconstructive tool. METHODS A retrospective cohort study was performed in the Department of Oral and Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People Hospital, from January 2014 to December 2018. Both the perforator-pedicle relationships and postoperative functional outcomes were compared. RESULTS A total of 168 patients were included in this study, among whom 49 underwent AMTPF reconstructions. The AMTPF perforators in this study were mostly septocutaneous (n = 38, 77.5%). Notably, the AMTPF perforators mainly originated from the medial branch of the descending branches of the lateral circumflex femoral arteries (n = 44, 89.8%), while for the other 5 patients, the perforators were found to originate from the superficial femoral arteries. Additionally, the average pedicle length of the AMTPFs was 8.7 cm (range: 6.0 to 13.0 cm), which was comparable to that of the ALTPFs (8.9 cm) (p = 0.442). The postoperative complication rate and functional outcomes were comparable between the two groups. The algorithm and harvesting approaches are presented. CONCLUSIONS The role of AMTPF should not be downplayed. After careful preoperative evaluation, we believe that AMTPF should not be considered a second choice in patients with sizable septocutaneous perforators.
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Affiliation(s)
- Chunyue Ma
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Weijin Gao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Dan Zhu
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, Chinas
| | - Yaxin Zhu
- Department of CT Clinical Research, CT Business Unit, Canon Medical Systems (China) CO. LTD., Beijing, China
| | - Jian Sun
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Yi Shen
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Ettyreddy AR, Chen CL, Zenga J, Simon LE, Pipkorn P. Complications and Outcomes of Chimeric Free Flaps: A Systematic Review. Otolaryngol Head Neck Surg 2019; 161:568-575. [PMID: 31109239 DOI: 10.1177/0194599819844997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ablations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making. DATA SOURCES The librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997). REVIEW METHODS Candidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates. RESULTS A total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively. CONCLUSION Chimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.
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Affiliation(s)
- Abhinav R Ettyreddy
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Collin L Chen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Simon
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Zhao F, Chen W, Zhao H, Zhang H, Chen Z, Luo Y, Chen T. Therapeutic effects of anterolateral thigh flap transfer in repairing oral and maxillofacial defects after ablative surgery of neoplasms. MINERVA CHIR 2019; 74:452-457. [PMID: 30600961 DOI: 10.23736/s0026-4733.18.07820-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To investigate the therapeutic effects of anterolateral thigh flap transfer in repairing oral and maxillofacial defects after ablative surgery of neoplasms and to discuss perioperative psychological care. METHODS A total of 80 patients who received oral and maxillofacial surgery for tumor resection in Nanfang Hospital from October 2014 to August 2016 were selected. Patients were randomly divided into control group and observation group, 40 patients in each group. Patients in control group received forearm flap transfer, while patients in observation group were treated with anterolateral thigh flap transfer. RESULTS The survival rate of flap, food intake ability, quality of life and incidence of complication were compared between groups. There was no significant difference in survival rate of the flaps between two groups (P>0.05). No significant difference in food intake was found between groups at 3 months after operation (P>0.05). The UW-QOL scores of the two groups at 1 year after operation were significantly higher than those before operation (P<0.05), and no significant differences in UW-QOL scores were found between two groups at 1 year after operation (P>0.05). Incidence of temporary dysfunction, hyperplastic scar, permanent dysfunction, pigmentation and pruritus was significantly lower in observation group than in control group (P<0.05). There was no significant difference in the incidence of necrosis between two groups (P>0.05). CONCLUSIONS The results showed that anterolateral thigh flap transfer has similar therapeutic effects to those of forearm flap transfer in repairing oral and maxillofacial defects after ablative surgery of neoplasms and improving food intake and quality of life. But Anterolateral thigh flap transfer can reduce the incidence of postoperative complications, so this treatment should be popularized.
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Affiliation(s)
- Fang Zhao
- Department of Stomatology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China -
| | - Wei Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Hui Zhao
- Department of Blood Transfusion, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Hongxia Zhang
- Department of Stomatology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Zhifeng Chen
- Department of Stomatology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Yuling Luo
- Department of Oncology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Ting Chen
- Department of Nephrology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
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The anteromedial thigh free flap: a primary reconstructive option or second best? Curr Opin Otolaryngol Head Neck Surg 2018; 26:312-318. [DOI: 10.1097/moo.0000000000000475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang W, Xu B, Zhu J, Yang C, Shen S, Qian Y. Maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle. Med Oral Patol Oral Cir Bucal 2018; 23:e619-e624. [PMID: 30148478 PMCID: PMC6167095 DOI: 10.4317/medoral.22505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/04/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Maxillary reconstruction using various pedicled and free-tissue transfer techniques with bone graft or without bone graft has some drawbacks. In this study, we demonstrate maxillary reconstruction using femoris rectus muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle through the modified lateral lip-submandibular approach. MATERIAL AND METHODS Nine patients suffering from maxillary defects secondary to maxillary cancer ablation, who underwent maxillary reconstruction using rectus femoris muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle, were enrolled into this study between November 2015 and August 2017. RESULTS All patients who underwent the maxillary reconstruction using femoris rectus muscle flap and sagittal mandibular ramus/coronoid process graft pedicled with temporalis muscle presented satisfactory postoperative function, with adequate mouth opening, optimal esthetic outcome and no restrictions on the diet. Every rectus femoris muscle flaps mucosalized well within five weeks. No donor site functional impairment or complications were observed. CONCLUSIONS The technique is a feasible and acceptable technique for the maxillary reconstructions. It is safe, quick and simple to harvest. It also presents an optimal esthetic and satisfactory functional outcome with the advantage of low morbidity of the donor site. Combined with the three-dimension reconstruction, this technique can improve the postoperative outcomes.
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Affiliation(s)
- W Wang
- No. 1088 Mid Hai Yuan Road Gaoxin District, Kunming Yunnan 650106, China,
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Shetty N, Mashalkar NS, Ellur SR, Kagodu K. Double free-flap for a bimalleolar defect of lower leg and ankle. Indian J Plast Surg 2016; 49:95-8. [PMID: 27274130 PMCID: PMC4878253 DOI: 10.4103/0970-0358.182250] [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] [Indexed: 11/09/2022] Open
Abstract
Double free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.
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Affiliation(s)
- Naren Shetty
- Department of Plastic Surgery, St. John's Medical College, Bengaluru, Karnataka, India
| | - Narendra S Mashalkar
- Department of Plastic Surgery, St. John's Medical College, Bengaluru, Karnataka, India
| | - Sunder Raj Ellur
- Department of Plastic Surgery, St. John's Medical College, Bengaluru, Karnataka, India
| | - Karishma Kagodu
- Department of Plastic Surgery, Columbia Asia Hospital, Bengaluru, Karnataka, India
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Clerico C, Dassonville O, Bozec A. Free-style free flap: Anterior thigh flap: Report of a case of subtotal glossectomy reconstruction. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 133:73-4. [PMID: 26683893 DOI: 10.1016/j.anorl.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- C Clerico
- Service d'ORL et chirurgie cervico-faciale, Institut universitaire de la face et du cou, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France.
| | - O Dassonville
- Service d'ORL et chirurgie cervico-faciale, Institut universitaire de la face et du cou, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - A Bozec
- Service d'ORL et chirurgie cervico-faciale, Institut universitaire de la face et du cou, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
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