Longitudinal Contraction Venoplasty in Prevention of Internal Jugular Vein Thrombosis After Free Flap Vascular Anastomosis

Reconstruction of Complex Lateral Skull Base Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Flap

Objectives

Complex lateral skull base defects resulting from advanced or recurrent oral cancer resection are continuously challenging reconstructive surgeons. This study aimed to use reconstructive methods for lateral skull base defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) flaps.

Patients and Methods

We performed a retrospective case series of 37 patients who underwent lateral skull base defect reconstruction using the ALT/anteromedial thigh (AMT) flap between March 2016 and May 2021 at the Second Xiangya Hospital. The design and harvest of the flaps, methods for defect reconstruction, and reconstructive efficacy are described.

Results

Of the 37 patients, 3 were women and 34 were men, with a mean age of 51.7 years. Among the defects, 26 were through-and-through defects and were reconstructed using ALT chimeric flaps, double ALT flaps, folded ALT flap, combined ALT chimeric flaps and AMT flaps, or combined ALT chimeric flaps and pectoralis major flaps; the large lateral skull base dead spaces were filled with muscle tissues or fatty tissues. Postoperatively, 38 of the 39 ALT/AMT flaps survived completely, and the remaining flap experienced partial necrosis. Venous compromise occurred in one patient who was salvaged after operative exploration. Oral and maxillofacial wound infections occurred in two patients, salivary fistula in three patients, and thigh wound effusion in three patients. The wounds healed gradually in all patients after repeated dressing changes. Thirty-three patients were followed up for approximately 3–60 months; their oral functions and appearance were acceptable, and thigh motor dysfunction was not observed.

Conclusions

With the convenient flap design and muscle flap harvest, large and individualized tissue supply, feasible combination with other flaps, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT flap is an appropriate choice for complex lateral skull base defect reconstruction.

Femoral artery-nourished anteromedial thigh flap: A new perspective in oral and maxillofacial defect reconstruction

OBJECTIVES

The aim of this study was to evaluate the feasibility and efficacy of the femoral artery (FA)-nourished anteromedial thigh (AMT) flap for reconstructing oral and maxillofacial defects.

PATIENTS AND METHODS

The authors analyzed a retrospective case series of 13 patients who underwent the reconstruction of oral and maxillofacial defects with the FA-nourished AMT flap. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported.

RESULTS

Of the 13 patients, 12 were men, and 1 was woman, with an average age of 52.2 years. Of these FA-supplied AMT flaps, 7 were singly used, 5 were combined with the anterolateral thigh (ALT) flap or its chimeric flaps, and 1 was separately used with the ALT flap. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications.

CONCLUSIONS

The FA-nourished AMT flap can also be used to reconstruct some common oral and maxillofacial defects, especially as a new alternative to the ALT flap. In addition, this flap can be combined with the ALT flap or its chimeric flaps or separately used with the ALT flap for the reconstruction of complex defects.

Double Thread Suspension: A Novel Technique to Facilitate End-to-Side Venous Anastomosis With a Microvascular Coupling Device in Head and Neck Reconstruction

PURPOSE

Microvascular free tissue transfer has become a mainstay for head and neck reconstruction, and vascular anastomosis is 1 of the most challenging aspects. This study aimed to explore a safe, convenient, and efficient technique for end-to-side venous anastomosis using the coupling device.

MATERIALS AND METHODS

We evaluated a novel surgical strategy, double thread suspension (DTS), by reviewing data collected in a consecutive series of 60 patients who underwent free tissue grafting after surgical resection of head and neck tumors. Patients who underwent end-to-side microvascular anastomosis using the microvascular coupler device were randomly divided into the DTS group (n = 30) and the traditional procedure group (TRA, n = 30), the demographic data, coupler size, anastomosis time, microvascular complications, and flap survival were determined.

RESULTS

The optional size range of coupler devices in the DTS group is better than that of the conventional group, ranging from 1.5 to 4.0 mm compared with 2.0 to 4.0 mm. The average anastomosis time was 4.68 ± 0.43 minutes in the DTS group which was significantly lower than the conventional group that was 9.24 ± 1.46 minutes (P < .0001) . There was no statistically significant difference between the 2 groups in coupler related complications or flap survival.

CONCLUSION

The novel DTS technique provides the advantages of lowering procedure complexity, reducing operative time, and preventing tearing of vessel wall, therefore making DTS-guided end-to-side anastomosis a safe, relatively straightforward, and reliable technique.

Characteristics and Management of Free Flap Compromise Following Internal Jugular Venous Thrombosis

PURPOSE

Free flap compromise after internal jugular venous thrombosis (IJVT) occurs fairly infrequently in oral and maxillofacial rehabilitation and reconstruction but could seriously affect the patient's postoperative recovery. The aim of this study was to analyze and discuss the characteristics and management of such flap compromise.

PATIENTS AND METHODS

The authors performed a retrospective case series of 13 patients who underwent reconstruction of oral and maxillofacial defects with anterolateral thigh flaps and developed flap compromise from IJVT from July 2014 through December 2016 at the Second Xiangya Hospital of Central South University (Changsha, China). The clinical features of flap compromise are described, and the precautions and improvement measures are reported.

RESULTS

All 13 patients were men with an average age of 50.3 years. Flap compromise caused by IJVT occurred on postoperative days 3 to 7, of which 2 flaps were salvaged (15.4%) and 11 flaps failed completely after immediate urgent re-exploration. Four patients presented with orocutaneous fistula after salvage surgery that healed well after a period of wound dressing.

CONCLUSIONS

Because of the late occurrence and low salvage rate of flap compromise caused by IJVT, intensive flap monitoring after reconstruction surgery is necessary for patients with free flap transfer.