1
|
Vieira L, Rodriguez-Lorenzo A. The Role of Deep Inferior Epigastric Perforator and Thoracodorsal Artery Perforator Flaps in Head and Neck Reconstruction. Oral Maxillofac Surg Clin North Am 2024; 36:463-474. [PMID: 39198072 DOI: 10.1016/j.coms.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2024]
Abstract
Head and neck reconstruction has evolved to a more accurate replacement of the missing tissues for aesthetic and functional benefits, besides a concern with the morbidity caused in the donor site. This has led us to the use of perforator flaps. Deep inferior epigastric perforator flap allows the harvest of a large well-vascularized skin paddle with adequate bulk for large and voluminous defects reconstruction. Its main uses described in the literature are: tongue reconstruction, orbitomaxillary reconstruction, and scalp reconstruction. Thoracodorsal artery perforator flap is derived from the subscapular system and allows the harvest of a large array of chimeric flaps.
Collapse
Affiliation(s)
- Luís Vieira
- Department of Plastic, Reconstructive and Aesthetic Surgery, Central Lisbon University Hospital, Lisboa, Portugal.
| | - Andres Rodriguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, VO. Plastik och Käkkirurgi, ing 85, 9 v, Akademiska Sjukhuset, Uppsala 75185, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
2
|
McGregor S, Zaraska K, Lynn M, Turkdogan S, Tran KL, Prisman E. Donor site morbidity after scapula free flap surgery of head and neck reconstruction: A systematic review and meta-analysis. Head Neck 2024. [PMID: 39045822 DOI: 10.1002/hed.27876] [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: 03/18/2024] [Revised: 06/19/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The scapula free flap is becoming increasingly more utilized in head and neck reconstruction due to its natural geometry and soft tissue versatility. This study reviews the incidence rate, risk factors, and treatments of complications of scapula donor site morbidity. METHODS A review was performed for articles published between October 1990 and November 2022 in Medline (OVID), PubMed, Web of Science, and CENTRAL. After screening, 24 articles meeting the criteria were included. RESULTS Overall, 660 head and neck surgeries with the scapula donor bone across 24 studies were included. Twenty studies of 612 scapula free flaps reported a pooled postoperative complication rate of 10.7%, with no major complications. Seven studies of 199 scapula reconstructions showed a mean Disability of Arm, Shoulder and Hand (DASH) score of 14.39/100. CONCLUSION With its low rate of morbidity, the scapula flap presents itself as a good alternative for patients at risk for poor healing.
Collapse
Affiliation(s)
- Sophie McGregor
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katrina Zaraska
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Lynn
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sena Turkdogan
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Khanh Linh Tran
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Jaffar S, Jaiswal D, Shankhdhar VK, Bindu A, Mathews S, Mantri M, Kumar V, Yadav PS. Free Thoracodorsal Artery Perforator Flap for Head and Neck Reconstruction: An Indian Experience. Indian J Plast Surg 2023; 56:499-506. [PMID: 38105872 PMCID: PMC10721372 DOI: 10.1055/s-0043-1776361] [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: 12/19/2023] Open
Abstract
Background We describe our experience with use of free thoracodorsal artery perforator (TDAP) flap for head and neck (H&N) cancer reconstruction, with respect to the patient and disease profile, suitable defect characteristics, the reconstructive technique, and complications. Methods Consecutive patients ( N = 26) undergoing free TDAP flap for H&N onco-reconstruction, in a single center, were included from January 2015 to December 2018 and the data were analyzed. Results Perforator(s) were reliably predicted preoperatively, using handheld Doppler. Lateral position was comfortable for the harvest. Twenty flaps were harvested on a single perforator, more commonly musculocutaneous ( n = 16). The thoracodorsal nerve and latissimus dorsi muscle could be preserved, completely in almost all cases. The skin paddle was horizontally ( n = 5) or vertically ( n = 21) oriented, both giving a satisfactory scar. The flap was used as a single island or two islands by de-epithelializing intervening skin. Pedicle length was sufficient in all cases. Four cases were explored for suspected venous insufficiency. Two had thrombosis, of which one was salvaged, while the other necrosed. One flap had minimal partial necrosis, which was managed with secondary suturing. The 5-year follow-up showed good oral competence, mouth opening, and cosmetic satisfaction among patients. Conclusion TDAP flap provides all the advantages of a perforator-based free flap and of back as a donor site with close color match to the face, relatively hairless, and thickness in between the thigh and the forearm. It can be a useful tool to provide an ideal functional and aesthetic outcome, with a hidden donor site and minimal donor site morbidity in selected cases.
Collapse
Affiliation(s)
- Samreen Jaffar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dushyant Jaiswal
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vinay Kant Shankhdhar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ameya Bindu
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Saumya Mathews
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mayur Mantri
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vineet Kumar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prabha Subhash Yadav
- Department of Plastic and Reconstructive Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| |
Collapse
|
4
|
Shen YM, Qin FJ, Du WL, Zhang HJ, Zhang C, Wang C, Hu XH. Extended Paraumbilical Perforator Flap Pedicled With the Inferior Epigastric Artery for Coverage of Type III Circumferential Electrical Burns of the Wrist. J Burn Care Res 2023; 44:1339-1348. [PMID: 37590974 DOI: 10.1093/jbcr/irad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 08/19/2023]
Abstract
Type III electrical burns on the wrist are characterized by circumferential wounds, three dimensional with sandwich-like necrosis, and progressive blood circulation disturbances. Limb salvage is challenging, and success in meeting this challenge depends on vascular reconstruction and wound coverage. This article is intended for the following purposes: to investigate the principles of wound debridement, the management of involved blood vessels, and the clinical effects of the extended paraumbilical perforator flap pedicled with the inferior epigastric artery for coverage of type III circumferential electrical burns of the wrist. A total of 13 male patients (age, 20 to 43 years; average, 29 years) were enrolled in the study. After early escharotomy, debridement, and vascular reconstruction, all wounds were repaired with the extended paraumbilical perforator flap pedicled with the inferior epigastric artery. Flap survival was achieved in all 13 patients. Subcutaneous liquefaction necrosis and infection beneath the flap occurred in three patients. Radial or ulnar artery reconstruction via the great saphenous vein (GSV) graft was performed in 12 cases. All patients had a mean follow-up of 6 to 36 months, and the flaps demonstrated satisfactory flexibility and texture. Hand function was preserved in eight patients, and no patients developed abdominal hernia. Thorough debridement, early vascular reestablishment, and wound coverage are essential for the overall limb salvage effort for type III circumferential electrical burns of the wrist. The extended paraumbilical perforator flap may provide a new and appropriate option for the primary repair of extensive soft tissue defects.
Collapse
Affiliation(s)
- Yu-Ming Shen
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University. Beijing 100035, P.R. China
| | - Feng-Jun Qin
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University. Beijing 100035, P.R. China
| | - Wei-Li Du
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University. Beijing 100035, P.R. China
| | - Hui-Jun Zhang
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University. Beijing 100035, P.R. China
| | - Cong Zhang
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University. Beijing 100035, P.R. China
| | - Cheng Wang
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University. Beijing 100035, P.R. China
| | - Xiao-Hua Hu
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University. Beijing 100035, P.R. China
| |
Collapse
|
5
|
Mohamed AAS, Mai L, Rao G, Fan S, Mashrah MA, Holkom MAM, Pan C, Lin Z. Perioperative risk factors impact on intensive care unit length of stay (ICU length of stay) in oral squamous cell carcinoma. BMC Oral Health 2023; 23:624. [PMID: 37658335 PMCID: PMC10474623 DOI: 10.1186/s12903-023-03304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The trend in postoperative care for free flap patients is to deescalate from routine ICU admission into a specialty recovery unit. This study aims to investigate the predictive parameters in a routine perioperative clinical assessment that are expected to be directly correlated with prolonged ICU length of stay in at-risk patients who received oral reconstructive surgery for squamous cell carcinoma (OSCC). METHODS All patients who underwent ablative surgery for OSCC with free flap reconstruction and were managed in the ICU were included in this study. The primary outcome was ICU-length of stay. Perioperative, operative and postoperative parameters were analyzed using single test ( t-test, ANOVA analysis, correlation coefficients, effect size) and multivariate regression test. The P-value was set as < 0.005 to be considered statically significant. RESULTS The study included 136 homogeneous patients, with a mean ICU length of stay of 4.5 (± 4.43 day). Patients with pre-operative positive renal dysfunction (P = 0.004), peripheral vascular disease (P < 0.001), postoperative complications (P = 0.028) or positive heart failure class III (P < 0.001 ) were recognized as at-risk patients for a significantly longer ICU length of stay. CONCLUSION Patients with perioperative severe renal dysfunction, peripheral vascular disease, postoperative complication or high NYHA class are prone to have a significantly longer ICU length of stay. Several factors were considered as confounders contributing to increased ICU management time in combination with other variables. Additionally, in highly risk patient, the presence of the highly trained medical support, including the appropriate nursing care, is more critical than those patients without these risk factors.
Collapse
Affiliation(s)
- Abdo Ahmed Saleh Mohamed
- Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road, Guangzhou, 510120, China
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Lianxi Mai
- Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Guangxin Rao
- Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Song Fan
- Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road, Guangzhou, 510120, China
| | - Mubarak Ahmed Mashrah
- Department of Oral Implant, Guangdong Engineering Research of Oral Restoration and reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mohamed Ali Mahyoub Holkom
- Department of Oral & Maxillofacial Surgery- head & neck oncology, School of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Chaobin Pan
- Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road, Guangzhou, 510120, China.
| | - Zhouyu Lin
- Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road, Guangzhou, 510120, China.
| |
Collapse
|
6
|
Abstract
This summary provides a concise overview of oral cavity reconstruction to optimize functional outcomes in the modern era. Soft tissue and osseous reconstruction options for a wide range of oral cavity sites including lip, oral tongue, floor of mouth, buccal, hard palate, and composite oromandibular resections are reviewed. The appropriate applications of primary closure, secondary intention, skin grafts, and dermal substitute grafts are included. Anatomic considerations, indications, contraindications, and complications of local, regional, and free flaps in oral cavity reconstruction are discussed. Specific defects and the appropriate options for reconstruction of those defects are delineated.
Collapse
Affiliation(s)
- Pablo Quadri
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA.
| |
Collapse
|
7
|
Choi JS, An JK, Park JA, Chang LS, Kim YH, Shim HS. Strategy for resurfacing complex extremity defect with chimeric, linked flaps: A review with a 10-year experience at major trauma center. J Plast Reconstr Aesthet Surg 2023; 80:107-114. [PMID: 37003072 DOI: 10.1016/j.bjps.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
For the reconstruction of the extensive and/or three-dimensional soft-tissue defect in upper and lower extremities, chimeric flaps composed of multiple flaps or tissues with separate vascular supplies can supply economical use of tissue and superior esthetic results. Herein, we investigated the effectiveness of the thoracodorsal axis chimeric flap through the review the largest collection of long-term data. A retrospective review of all patients who received the thoracodorsal axis chimeric flap in complex three-dimensional defects of extremities between January of 2012 and December of 2021. A total of 55 type I/IP classical chimeric flaps, 19 type II/IIP anastomotic chimeric flaps, five type III perforator chimeric flaps, and seven type IV mixed chimeric flaps were analyzed. As the reconstructed area became proximal, flap dimensions increased significantly. And the optimal flap type depended on the location. The TDAp flap can provide large dimensions of skin paddle with latissimus dorsi and serratus anterior muscles with acceptable donor-site morbidities. The TDAp chimeric flaps constructed by microvascular anastomosis of two free flaps can provide large skin dimensions but also tissues with different properties. These characteristics make it possible to resurface the large and extensive defects, reconstruct the complex distal extremity defects, needing tissues with different properties, and cover the three-dimensional defect, obliterating the dead space. The thoracodorsal axis chimeric flap could be a favorable option for extensive, complex, or three-dimensional defects of the upper and lower extremities based on its reliability of the vascular system.
Collapse
|
8
|
Donor Site Morbidity and Quality of Life after Microvascular Head and Neck Reconstruction with a Chimeric, Thoracodorsal, Perforator-Scapular Flap Based on the Angular Artery (TDAP-Scap-aa Flap). J Clin Med 2022; 11:jcm11164876. [PMID: 36013116 PMCID: PMC9410144 DOI: 10.3390/jcm11164876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Extensive defects in the head and neck area often require the use of advanced free flap reconstruction techniques. In this study, the thoracodorsal perforator-scapular free flap technique based on the angular artery (TDAP-Scap-aa flap) was postoperatively evaluated regarding the quality of life and the donor site morbidity using the standardized SF-36 and DASH questionnaires (short form health 36 and disabilities of the arm, shoulder and hand scores). Over a five-year period (2016−2020), 20 selected cases (n = 20) requiring both soft and hard tissue reconstruction were assessed. On average, the harvested microvascular free flaps consisted of 7.8 ± 2.1 cm hard tissue and 86 ± 49.8 cm2 soft tissue components. At the donor site (subscapular region), only a mild morbidity was observed (DASH score: 21.74 ± 7.3 points). When comparing the patients’ postoperative quality of life to the established values of the healthy German norm population, the observed SF-36 values were within the upper third (>66%) of these established norm values in almost all quality-of-life subcategories. The mild donor site morbidity and the observed quality of life indicate only a small postoperative impairment when using the TDAP-Scap-aa free flap for the reconstruction of extensive maxillofacial defects.
Collapse
|
9
|
Composite Reparative Surgery of a Postoperative Through-and-through Facial Defect: Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3601. [PMID: 34881153 PMCID: PMC8647871 DOI: 10.1097/gox.0000000000003601] [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: 11/25/2020] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
We report our positive experience on the treatment of a patient with a composite facial maxillary defect. The stoma was formed following the removal of the adenoid cystic carcinoma of the maxillary sinus. We propose reconstruction repair of the postoperative facial maxillary defect using an inverted cutaneous flap and a split-thickness skin graft.
Collapse
|
10
|
Rubin SJ, Sayre KS, Kovatch KJ, Ali SA, Hanks JE. Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty. Curr Opin Otolaryngol Head Neck Surg 2021; 29:407-418. [PMID: 34387289 DOI: 10.1097/moo.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Options for segmental mandibular reconstruction in patients poorly suited to undergo fibula free flap (FFF). RECENT FINDINGS Although FFF is the current 'gold standard' for segmental mandibular reconstruction, other reconstructive options must be considered when FFF is contraindicated or disfavoured and/or patient frailty precludes a lengthy anaesthetic. In addition to various nonvascularized and soft tissue only reconstructions, excellent osseous free flap alternatives for functional segmental mandibular reconstruction may be employed. The subscapular system free flaps (SSSFF) may be ideal in frail and/or elderly patients, as SSSFF allows for early mobility and does not alter gait. In extensive and/or symphyseal defects, functional mandibular reconstruction in lieu of a free flap is extremely limited. Pedicled segmental mandibular reconstructions remain reasonable options, but limited contemporary literature highlights unpredictable bone graft perfusion and poor long-term functional outcomes. SUMMARY There are several excellent free flap alternatives to FFF in segmental mandibular reconstruction, assuming adequate cervical recipient vessels are present. On the basis of the current literature, the optimal mandibular reconstruction for the medically frail, elderly and/or patients with extreme vessel-depleted necks is limited and debatable. In qualifying (i.e. limited, lateral) defects, soft tissue only reconstructions should be strongly considered when osseous free flaps are unavailable.
Collapse
Affiliation(s)
- Samuel J Rubin
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine
| | - Kelly S Sayre
- Department of Oral and Maxillofacial Surgery, Boston University School of Dentistry
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center
| | - S Ahmed Ali
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System
| | - John E Hanks
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine
- Department of Otolaryngology-Head and Neck Surgery, VA Boston Medical Center, MA, USA
| |
Collapse
|
11
|
Wallner J, Schwaiger M, Edmondson SJ, Mischak I, Egger J, Feichtinger M, Zemann W, Pau M. Effects of Pre-Operative Risk Factors on Intensive Care Unit Length of Stay (ICU-LOS) in Major Oral and Maxillofacial Cancer Surgery. Cancers (Basel) 2021; 13:cancers13163937. [PMID: 34439092 PMCID: PMC8394988 DOI: 10.3390/cancers13163937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively. MATERIAL AND METHODS Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18-90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (t-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS. RESULTS This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (±2.2) h, mean ICU-LOS was 3.6 (±2.6) days. Patients with pre-operative renal dysfunction (p < 0.001), peripheral vascular disease-PVD (p = 0.01), increasing heart failure-NYHA stage categories (p = 0.009) and higher-grade categories of post-operative complications (p = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS. CONCLUSIONS At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.
Collapse
Affiliation(s)
- Juergen Wallner
- Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria; (J.W.); (J.E.); (M.F.); (W.Z.); (M.P.)
- Department of Cranio-Maxillofacial Surgery, AZ Monica and the University Hospital Antwerp, 2018 Antwerp, Belgium
| | - Michael Schwaiger
- Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria; (J.W.); (J.E.); (M.F.); (W.Z.); (M.P.)
- Correspondence: ; Tel.: +43-(0)316-385-80722
| | - Sarah-Jayne Edmondson
- Department of Plastic and Reconstructive Surgery, Guy’s and St. Thomas’ Hospital, London SE1 7EH, UK;
| | - Irene Mischak
- University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria;
| | - Jan Egger
- Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria; (J.W.); (J.E.); (M.F.); (W.Z.); (M.P.)
- Institute for Computer Graphics and Vision, Graz University of Technology, 8036 Graz, Austria
| | - Matthias Feichtinger
- Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria; (J.W.); (J.E.); (M.F.); (W.Z.); (M.P.)
| | - Wolfgang Zemann
- Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria; (J.W.); (J.E.); (M.F.); (W.Z.); (M.P.)
| | - Mauro Pau
- Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria; (J.W.); (J.E.); (M.F.); (W.Z.); (M.P.)
| |
Collapse
|
12
|
Ou Q, Wu P, Zhou Z, Lei Z, Pan D, Tang JY. Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation. Injury 2021; 52:1356-1362. [PMID: 33051078 DOI: 10.1016/j.injury.2020.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Coverage of circumferential wounds on limbs is a challenging reconstructive job. Here, we propose a skin flap-based algorithm to reconstruct circumferential wound with the chain-linked design and combined transplantation of ALTP and DIEP flap, which could achieve full-coverage and simultaneously primary donor-site closure. PATIENT AND METHODS From December 2007 to December 2018, 14 patients with circumferential would on upper or lower limbs underwent reconstruction with ALTP or DIEP flap, by the technique of combined transplantation or chain-linked design, or both. The wound was classified into five different types according to the width compared to the donor site (overall magnitudes and regularity), which was separately reconstructed by five different wound decomposition and corresponding flap design. Flap survivorship, complication on recipient or donor site and any secondary surgeries have been recorded. RESULTS 14 patients were successfully treated with 22 flaps, including seven patients reconstructed with one flap (4 bi-pedicled, 2 tri-pedicled), 6 patients reconstructed with two flaps (1 in mono-pedicled, 5 in multi-pedicled), one with 3 flaps and skin grafts. Only one donor site was not directly closed, and one experienced dehiscence but finally healed. All flaps survived uneventfully but three had minor edge necrosis and later treated with skin graft. CONCLUSION The algorithm is practical in circumferential wound resurfacing on limbs for allowing flexible design, sufficient coverage, and low donor site morbidity.
Collapse
Affiliation(s)
- Qifeng Ou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University. No.87 XiangYa Road, Changsha, Hunan, 410008, China
| | - Panfeng Wu
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University. No.87 XiangYa Road, Changsha, Hunan, 410008, China
| | - Zhengbing Zhou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University. No.87 XiangYa Road, Changsha, Hunan, 410008, China
| | - Zeng Lei
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University. No.87 XiangYa Road, Changsha, Hunan, 410008, China
| | - Ding Pan
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University. No.87 XiangYa Road, Changsha, Hunan, 410008, China
| | - Ju-Yu Tang
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University. No.87 XiangYa Road, Changsha, Hunan, 410008, China.
| |
Collapse
|
13
|
Fiacchini G, Benettini G, Vianini M, Picariello M, Sparacino L, Berrettini S, Bruschini L, Dallan I. Functional and aesthetic outcomes of pedicled temporalis muscle flap for mesostructure reconstruction. J Craniomaxillofac Surg 2021; 49:231-237. [PMID: 33518398 DOI: 10.1016/j.jcms.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/08/2020] [Accepted: 01/13/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this work is to analyse the soundness of the Temporalis Muscle Flap as a safe and reliable flap to restore the aesthetic and functions of the facial mesostructure after its partial resection. Subjects were selected retrospectively and were invited to come to our outpatient clinic. Here, subjects completed a clinical evaluation in which the medical examiners evaluated the aesthetic outcome, the phonation, the ocular motility and the swallowing. Twenty-two subjects were enrolled in this study and completed the clinical evaluation. The mean value of the score obtained for the aesthetic outcome was 2.91 ± 0.92, slightly less than good. The VHI-30 questionnaire for voice evaluation obtained a mean score of 22.5 ± 11.5, pointing out minor voice problems. The mean value of the P-score evaluated during Fiberoptic Endoscopic Evaluation of Swallowing was 4.64 ± 0.95, highlighting the near absence of endoscopic signs of dysphagia. On the evaluation of ocular function, only one subject showed an inferior displacement of his right eyeball without vertical diplopia. The Temporalis Muscle Flap is a safe and reliable flap that can be used to reconstruct numerous surgical defects of the maxilla, giving an excellent recovery of physical aspect, phonation, and swallowing.
Collapse
Affiliation(s)
- Giacomo Fiacchini
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy.
| | - Giacomo Benettini
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy
| | - Matteo Vianini
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy
| | - Miriana Picariello
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy
| | - Lucrezia Sparacino
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy
| | - Iacopo Dallan
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2 - 56124, PISA, Italy
| |
Collapse
|
14
|
Memon AR, Wang E, Hu J, Egger J, Chen X. A review on computer-aided design and manufacturing of patient-specific maxillofacial implants. Expert Rev Med Devices 2020; 17:345-356. [PMID: 32105159 PMCID: PMC7175472 DOI: 10.1080/17434440.2020.1736040] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/25/2020] [Indexed: 10/25/2022]
Abstract
Introduction: Various prefabricated maxillofacial implants are used in the clinical routine for the surgical treatment of patients. In addition to these prefabricated implants, customized CAD/CAM implants become increasingly important for a more precise replacement of damaged anatomical structures. This paper reviews the design and manufacturing of patient-specific implants for the maxillofacial area.Areas covered: The contribution of this publication is to give a state-of-the-art overview in the usage of customized facial implants. Moreover, it provides future perspectives, including 3D printing technologies, for the manufacturing of patient-individual facial implants that are based on patient's data acquisitions, like Computed Tomography (CT) or Magnetic Resonance Imaging (MRI).Expert opinion: The main target of this review is to present various designing software and 3D manufacturing technologies that have been applied to fabricate facial implants. In doing so, different CAD designing software's are discussed, which are based on various methods and have been implemented and evaluated by researchers. Finally, recent 3D printing technologies that have been applied to manufacture patient-individual implants will be introduced and discussed.
Collapse
Affiliation(s)
- Afaque Rafique Memon
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Enpeng Wang
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junlei Hu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jan Egger
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute for Computer Graphics and Vision, Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Graz, Austria
- Department of Oral &maxillofacial Surgery, Medical University of Graz, Graz, Austria
- The Laboratory of Computer Algorithms for Medicine, Medical University of Graz, Graz, Austria
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|