1
|
Pfister P, Speck NE, Gahl B, Muller L, Fürst T, Kappos EA, Schaefer DJ, Largo RD, Ismail T. Impact of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 91:24-34. [PMID: 38401274 DOI: 10.1016/j.bjps.2024.02.026] [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: 09/13/2023] [Revised: 12/08/2023] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Limited data exist regarding the effect of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction. However, an adequate free flap volume is an important predictor of functional and patient-reported outcomes in head and neck reconstruction. METHODS A systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 6710 abstracts were screened, and 36 full-text papers were reviewed. Nineteen studies met the inclusion criteria and were used to extract data for this analysis. RESULTS A meta-analysis of 14 two-arm studies comparing the impact of adjuvant radiotherapy versus no adjuvant radiotherapy was performed. The main analysis revealed that 6 months postoperatively, irradiated flaps showed a significant reduction of volume (average, 9.4%) compared to nonirradiated flaps. The average interpolated pooled flap volumes 6 months postoperatively were 76.4% in irradiated flaps and 81.8% in nonirradiated flaps. After a median postoperative follow-up of 12 months, the total flap volume was 62.6% for irradiated flaps and 76% for nonirradiated flaps. Four studies reported that chemotherapy had no significant impact on free flap volume. CONCLUSIONS Compared to nonirradiated flaps, irradiated flaps were significantly reduced in volume (range, 5% to 15.5%). Clinicians should take this into account when planning the surgical reconstruction of head and neck defects. Conducting large-scale prospective studies with standardized protocols and well-defined follow-up measurements could contribute to defining the ideal, personalized free flap volume for optimal function and patient-reported outcomes.
Collapse
Affiliation(s)
- Pablo Pfister
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Nicole E Speck
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Surgical Outcome Research Center Basel, University Hospital Basel, Basel, Switzerland
| | - Laurent Muller
- Department of Ear, Nose and Throat Surgery, University Hospital Basel, Basel, Switzerland
| | - Thomas Fürst
- University Medical Library, University of Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
2
|
Utsunomiya H, Tanaka R, Akamine S, Kusano T, Kuroki T, Kadomatsu K. Longitudinal Volume Assessment of Reconstructed Breast Using Three-Dimensional Measurement: How Do DIEP and LD Flap Change Immediately after Surgery? Indian J Plast Surg 2024; 57:99-105. [PMID: 38774730 PMCID: PMC11105820 DOI: 10.1055/s-0044-1781447] [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: 05/24/2024] Open
Abstract
Background The deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps are two widely used autologous breast reconstructions. Despite studies on flap-volume changes, the time of the first measurement is not immediately after surgery. Therefore, this study aimed to investigate the change in volume over time from the immediate postoperative period using a three-dimensional (3D) scanner. Methods Patients who underwent breast reconstruction with a DIEP or LD flap between October 2019 and December 2020 at Showa University Koto Toyosu Hospital were included. The Kinect 3D scanner was used to measure the reconstructed and healthy breast volumes immediately after surgery and at 1, 3, 6, and 12 months. The control group was the healthy side, and the volumes obtained at each time point and ratios (to the immediate postoperative period) were calculated and analyzed using a linear mixed model. Results Of the 25 patients and 26 breasts examined, the postoperative increase in volume ratios was statistically significant in the DIEP flap group, except for the sixth month, but decreased significantly in the LD group. Compared with the control group, the volume ratio was significantly higher up to 3 months in the DIEP flap group and decreased significantly after 3 months in the LD flap group. Conclusions The volume of the LD flap continued to decrease immediately after surgery, whereas the volume of the DIEP flap increased by 10% up to 1M. Therefore, this increase in volume should be taken into consideration in studies where the initial measurements were not taken immediately after surgery.
Collapse
Affiliation(s)
- Hiroki Utsunomiya
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ryutaro Tanaka
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Shuryo Akamine
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | - Tomoaki Kuroki
- Department of Plastic and Reconstructive Surgery, Showa University Hospital, Tokyo, Japan
| | - Koichi Kadomatsu
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Tokyo, Japan
| |
Collapse
|
3
|
Gewirtz JI, Zhao S, Brock G, Luttrull MD, Sethuraman S, Kang SY, VanKoevering KK, Seim NB. A Pilot Study: Free Flap Atrophy in Tongue Reconstruction Using 3D Volumetric Analysis. Ann Otol Rhinol Laryngol 2024; 133:253-260. [PMID: 37789590 DOI: 10.1177/00034894231204720] [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: 10/05/2023]
Abstract
OBJECTIVE To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. METHODS Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. RESULTS Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P = .0417). Each successive postoperative month, the flap decreased by 1.54% (P < .0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P = .0093), obesity status (P = .0431), and base of tongue involvement (P = .0472). CONCLUSION Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction.
Collapse
Affiliation(s)
- Jordan I Gewirtz
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Michael D Luttrull
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
4
|
Thoenissen P, Najafi R, Sader R, Ghanaati S. Volume reduction of vascularized flaps in the field of cranio-maxillofacial surgery: A narrative-style review. J Craniomaxillofac Surg 2024; 52:203-211. [PMID: 38135647 DOI: 10.1016/j.jcms.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/15/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- Philipp Thoenissen
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany.
| | - Ramin Najafi
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Robert Sader
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Shahram Ghanaati
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| |
Collapse
|
5
|
Free flap volume changes: can we predict ideal flap size and future volume loss? Curr Opin Otolaryngol Head Neck Surg 2022; 30:375-379. [PMID: 36036533 DOI: 10.1097/moo.0000000000000832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Under anticipating free flap volume may lead to deficits in functional and aesthetic outcomes. Alternatively, over anticipating may compromise airway patency, lead to prolonged tracheostomy dependence or poor oral intake, and cause poor cosmetic outcomes. Surgeons face a fine balance in creating a functional reconstruction that accounts adequately for volume changes in the future. RECENT FINDINGS Recent studies are elucidating the complex and multifactorial volume changes of free flaps that are dependent on postoperative radiation, flap composition, weight fluctuations, and site of reconstruction. Radial forearm free flaps typically lose about 40% of their volume, regardless of patient-dependent variables. Muscle flaps exhibit significant fluctuations with patient-dependent variables. Adipose-prevalent flaps are likely more resistant to radiation effects but are more dependent on postoperative weight changes in the patient. SUMMARY Free flap volume over anticipation recommendations range from 1.1 to 1.4 times the final volume to account for future atrophy but patient characteristics including postoperative radiation, anticipated weight loss, and flap composition should be incorporated into intraoperative decisions for final flap volume.
Collapse
|
6
|
Breast Reconstruction- Developing a Volumetric Outcome Algorithm. Aesthetic Plast Surg 2022; 46:2078-2084. [PMID: 35132459 DOI: 10.1007/s00266-021-02759-6] [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: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/01/2022]
Abstract
Postoperative loss of breast volume represents a significant parameter for outcome evaluation of breast reconstruction. Breast volume broadly varies- depending of reconstruction method as well as surgical differences. A structural pattern of breast volume loss provides an essential parameter for preoperative design, helps to reduce postoperative breast asymmetry rate and thereby the need for reoperation. Therefore we hereby compare volume change of the three main reconstruction techniques: autologous flap-based, prosthesis-based and autologous fat transplantation breast reconstruction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. 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 .
Collapse
|
7
|
Yamazaki M, Suzuki T, Hiraga C, Yoshida Y, Baba A, Saitou H, Ogane S, Fujii T, Takano M, Katakura A, Tanaka I, Nomura T, Takano N. Effect of postoperative radiotherapy for free flap volume changing after tongue reconstruction. Oral Radiol 2021; 37:518-523. [PMID: 33184774 DOI: 10.1007/s11282-020-00489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of postoperative radiotherapy (RT) on temporal volume changes with a cutaneous free flap (CF) and a myocutaneous free flap (MCF). METHODS The subjects were 24 men and 11 women (mean age, 50.5 ± 15.5 years) with tongue or floor of mouth cancer. Twenty-seven cases of CF and eight cases of MCF were selected. The flap volume change of the reconstructed tongue was calculated using computed tomography (CT) images taken immediately and at one year postoperatively using the DICOM image processing software OsiriX®. RESULTS The reduction rate in flap volume at one year postoperatively was 82.0 ± 15% in CF without RT, 70.3 ± 26.1% in CF with RT, 88.5 ± 14.7% in MCF without RT, and 99.5 ± 16% in MCF with RT. The MCF volume was significantly higher compared to the CF volume. Although postoperative RT reduced the CF volume by 30%, there was only a slight reduction in the MCF volume. CONCLUSIONS We evaluated the effect of postoperative RT on volume reduction in 35 cases of the reconstructed tongue with CF and MCF using a computer-assisted volume rendering technique. In this study, the effect of RT on volume reduction was different between the CF and MCF.
Collapse
Affiliation(s)
- Masae Yamazaki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Taiki Suzuki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
| | - Chiho Hiraga
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Yoshifumi Yoshida
- Department of Oral Medicine, Hospital Dentistry, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Akira Baba
- Department of Radiology, The Jikei University School of Medicine and University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 1058461, Japan
| | - Hirokazu Saitou
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Satoru Ogane
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Takako Fujii
- Department of Plastic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Masayuki Takano
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Akira Katakura
- Department of Oral Pathological Science and Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Ichiro Tanaka
- Department of Plastic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Nobuo Takano
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| |
Collapse
|
8
|
Kagaya Y, Arikawa M, Sekiyama T, Higashino T, Akazawa S. Chronological flap volume and distribution changes after reconstruction of total maxillectomy defect using a rectus abdominis myocutaneous flap. J Plast Reconstr Aesthet Surg 2021; 74:3341-3352. [PMID: 34215545 DOI: 10.1016/j.bjps.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE After total or subtotal maxillectomy, reconstruction using a free rectus abdominis myocutaneous (RAMC) flap is a fundamental and useful option. The purpose of the present study was to clarify the degree of flap volume change and volume distribution change with time after total or subtotal maxillectomy and free RAMC flap reconstruction and to examine the factors affecting the results. METHODS A total of 20 patients who underwent total or subtotal maxillectomy with free RAMC flap reconstruction were examined, and the flap volume change rate (volume at final evaluation [POD 181-360] / volume at initial evaluation [POD 5-30]) was investigated using the results of imaging tests. Moreover, the flap was divided into four blocks (A-D) in the cranio-caudal direction, and the volume change of each block was individually analyzed. RESULTS The overall volume change rate of fat/muscle/total was 0.84 ± 0.21/0.36 ± 0.08/0.67 ± 0.15, at the mean follow-up period of 309±35 days after the operation. The multiple regression analysis revealed that weight loss (for fat), postoperative RT (for fat and muscle), and young age (for muscle) were independently associated with flap volume loss. The results also indicated that the fat volume was stable, whereas the muscle volume decreased to <40% over time, assuming there were no influencing factors. Regarding flap volume distribution change, the fat volume tended to gather toward the central-cranial direction, while the muscle volume gathered toward the cranial direction, and total flap volume gathered toward the central direction.
Collapse
Affiliation(s)
- Yu Kagaya
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Masaki Arikawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Sekiyama
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba 277-8577, Japan
| | - Satoshi Akazawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| |
Collapse
|
9
|
Melan JB, Philouze P, Pradat P, Benzerdjeb N, Blanc J, Ceruse P, Fuchsmann C. Functional outcomes of soft palate free flap reconstruction following oropharyngeal cancer surgery. Eur J Surg Oncol 2021; 47:2265-2271. [PMID: 33994058 DOI: 10.1016/j.ejso.2021.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/25/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The objective of this study was to assess the impact of surgical resection and free flap reconstruction of soft palate cancer on speech, swallowing and quality of life, and to identify the factors influencing functional outcomes and quality of life. MATERIAL AND METHODS Patients treated with surgical resection of squamous cell carcinoma and free-flap reconstruction of the soft palate were reviewed at least 12 months after surgery. Speech was assessed using the Hirose intelligibility scoring system, nasalance scoring, GRBAS scoring and the Voice Handicap Index 30 (VHI30) questionnaire. Swallowing was assessed by fiberoptic endoscopy and the Deglutition Handicap Index (DHI). Quality of life was assessed using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. RESULTS 29 patients were included. Speech outcomes were satisfactory, demonstrating normal or slightly below normal speech intelligibility in 75.9% of the patients, moderate or no rhinolalia in 72.4% of the patients and mean overall VHI30 scores indicative of slight or no handicap in 86.2% of the patients. Swallowing outcomes were satisfactory, with mean overall DHI scores indicative of slight or no handicap in 82.8% of the patients. Patient quality of life was preserved as demonstrated by mean quality of life and functioning scales scores all superior to 80%. CONCLUSION The sequelae arising from surgical resection and free-flap reconstruction of soft palate cancer are tolerable, involving slight handicap in terms of speech and swallowing and relatively little impact on quality of life.
Collapse
Affiliation(s)
- Jean-Baptiste Melan
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Philouze
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Pierre Pradat
- Claude Bernard University, Lyon 1, France; Clinical Research Center, UMR Inserm U1052, CNRS 5286, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nazim Benzerdjeb
- Claude Bernard University, Lyon 1, France; Department of Pathology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jacques Blanc
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Ceruse
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Carine Fuchsmann
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
| |
Collapse
|
10
|
de Vicente JC, Rúa-Gonzálvez L, Barroso JM, Fernández Del Valle-Fernández Á, de Villalaín L, Peña I, Cobo JL. Functional results of swallowing and aspiration after oral cancer treatment and microvascular free flap reconstruction: A retrospective observational assessment. J Craniomaxillofac Surg 2021; 49:959-970. [PMID: 33994072 DOI: 10.1016/j.jcms.2021.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/20/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
This study aimed to assess the functional swallowing outcomes in cohort of oral cancer patients treated with tumor resection and reconstruction by means of microvascular free flaps. Duration from onset to the last examination was classified into three periods: less than 12 months, from 13 to 24 months, and more than 24 months. Type of feeding, dysphagia, and laryngeal aspiration were the dependent variables, and the study was mainly focused on the data from the multivariate analysis. Fifty-one patients were included in the study. Twenty-one patients had dysphagia, 11 showed stasis in vallecula and pyriform sinuses, 9 experienced laryngeal penetration, and 8 aspirations. Surgery combined with radiochemotherapy was associated with a higher prevalence of dysphagia (p = 0.03). Frequency of dysphagia was higher in the first year after treatment and less frequent after 24 months (p = 0.003). Dysphagia was associated with laryngeal penetration (p = 0.001), and this with aspiration (p < 0.0005). In conclusion, as it seems that the method of reconstruction has a major influence on swallowing, when there are relevant alternatives in the way the reconstruction is done, always the approach should be chosen that reduces dysphagia to a minimum.
Collapse
Affiliation(s)
- Juan Carlos de Vicente
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Department of Surgery, University of Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain.
| | - Laura Rúa-Gonzálvez
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - José María Barroso
- Phoniatrician. Department of Rehabilitation, Hospital Universitario Central de Asturias, Oviedo, Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Álvaro Fernández Del Valle-Fernández
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Lucas de Villalaín
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Ignacio Peña
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| | - Juan Luis Cobo
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain
| |
Collapse
|
11
|
Wang SM, Yin SC, Su XZ, Xu Q, Liu YH, Xu ZF. Magnitude of radial forearm free flaps and factors associated with loss of volume in oral cancer reconstructive surgery: Prospective study. Head Neck 2021; 43:2405-2413. [PMID: 33847445 DOI: 10.1002/hed.26704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/23/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adequate flap volume is key to maintaining oral function after oral cancer surgery. This study aimed to evaluate changes in radial forearm free flap (RFFF) volumes after 1 year of follow-up following ablative tumor surgery in the head and neck. METHODS A prospective study that recorded the clinical data of 20 patients with head and neck cancer who underwent RFFF reconstruction. Magnetic resonance (MR) and Mimics Research 19.0 software were used to measure the RFFF volumes at 1, 3, 6, and 12 postoperative months. RESULTS Compared with one postoperative month, the RFFF volume decreased by 15.5%, 29.4%, and 42.0% at 3, 6, and 12 months, respectively, after surgery. A significant positive correlation between postoperative radiotherapy and RFFF volume changes was detected. CONCLUSION The volume of RFFF decreases with time. It is recommended to use overcorrection, with a 40% increase in RFFF volume, to reconstruct head and neck tumor-related defects.
Collapse
Affiliation(s)
- Si-Min Wang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Shou-Cheng Yin
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Xing-Zhou Su
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Qiang Xu
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Yi-Hao Liu
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Zhong-Fei Xu
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| |
Collapse
|
12
|
Factors Affecting Volume Change of Anterolateral Thigh Flap in Head and Neck Defect Reconstruction. J Oral Maxillofac Surg 2020; 78:2090-2098. [DOI: 10.1016/j.joms.2020.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/22/2022]
|
13
|
Feasibility of virtual surgical simulation in the head and neck region for soft tissue reconstruction using free flap: a comparison of preoperative and postoperative volume measurement. Int J Oral Maxillofac Surg 2020; 50:316-322. [PMID: 32826125 DOI: 10.1016/j.ijom.2020.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/25/2020] [Accepted: 07/22/2020] [Indexed: 01/17/2023]
Abstract
In the head and neck region, preoperative evaluation of the free flap volume is challenging. The current study validated preoperative three-dimensional (3D) virtual surgical simulation for soft tissue reconstruction by assessing flap volume and evaluated fat and muscle volume changes at follow-up in 13 head and neck cancer patients undergoing anterolateral craniofacial resection. Patients received 3D virtual surgical simulation, and the volume of the planned defects was estimated by surgical simulation. Following en bloc resection of the tumor, the defect in the skull base was covered using a rectus abdominis myocutaneous flap. Following surgery, computed tomography scans were acquired at day 1 and at 6 and 12 months. Virtual planned defect was on average 227 ml (range, 154-315) and was 10% smaller than the actual flap volume in patients without skin involvement of the tumor. Between day 1 and 12 months post-surgery, the volume of fat and muscle tissue in the free flap dropped by 9% and 58%, respectively. Our results indicate that 3D virtual surgical simulation provides essential information in determining the accurate volume of the required free flap for surgical defect repair and may thus help improve surgical planning and functional and esthetic outcome.
Collapse
|
14
|
Razavi CR, Hostetter J, Shukla A, Cheng Z, Aygun N, Boahene K, Byrne PJ, Richmon J, Quon H, Desai SC. Predictors of Free Flap Volume Loss in Nonosseous Reconstruction of Head and Neck Oncologic Defects. EAR, NOSE & THROAT JOURNAL 2020; 101:48-53. [PMID: 32633655 DOI: 10.1177/0145561320938903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Free tissue reconstruction of the head and neck must be initially overcorrected due to expected postoperative free flap volume loss, which can be accelerated by adjuvant radiation therapy. In this study, we aim to identify patient and treatment-specific factors that may significantly contribute to this phenomenon and translate these characteristics into a predictive model for expected percent free flap volume loss in a given patient. METHODS Patients with a history of oral cavity and/or oropharyngeal cancer who underwent nonosseous free flap reconstruction were reviewed between January 2009 and November 2018 at a tertiary care center. Demographics/characteristics, total radiation dose, radiation fractionation (RF), and pre/postradiation free flap volume as evaluated by computed tomography imaging were collected. Free flap volume was measured by a fellowship-trained neuroradiologist in all cases. Only patients receiving adjuvant radiotherapy with available pre/postradiation imaging were included. Multivariable linear regression modeling for prediction of free flap volume loss was performed with optimization via stepwise elimination. RESULTS Thirty patients were included for analysis. Mean flap volume loss was 42.7% ± 17.4%. The model predicted flap volume loss in a significant fashion (P = .004, R2 = 0.49) with a mean magnitude of error of 9.8% ± 7.5%. Age (β = 0.01, P = .003) and RF (β = -0.01, P = .009) were individual predictors of flap volume loss. CONCLUSIONS Our model predicts percent free flap volume loss in a significant fashion. Age and RF are individual predictors of free flap volume loss, the latter being a novel finding that is also modifiable through hyperfractionation radiotherapy schedules.
Collapse
Affiliation(s)
- Christopher R Razavi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jason Hostetter
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aishwarya Shukla
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nafi Aygun
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kofi Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shaun C Desai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| |
Collapse
|
15
|
Liang KY, Breen MS, Tracy JC, Vaezi AE. Submandibular gland flap for reconstruction after parotidectomy. Laryngoscope 2020; 130:E155-E162. [DOI: 10.1002/lary.28037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/15/2019] [Accepted: 04/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Kevin Y. Liang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Matthew S. Breen
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Jeremiah C. Tracy
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Alec E. Vaezi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| |
Collapse
|
16
|
Kim MS, Oh KH, Cho JG, Baek SK, Woo JS, Jung KY, Kwon SY. Assessment of Chronological Volume Changes in Radial Forearm Free Flaps for Tongue Cancer. ORL J Otorhinolaryngol Relat Spec 2020; 82:1-7. [PMID: 31905363 DOI: 10.1159/000504196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The radial forearm free flap (RFFF) is a commonly used free flap for tongue cancer. Postoperative changes in the volume of free flap are known to influence the functional restoration of the resected tongue. This study aimed to estimate chronological volume changes in RFFFs for tongue cancer and to determine the clinical factors affecting these changes. METHODS Clinical data for 19 patients who underwent RFFF reconstruction for tongue cancer between May 2004 and September 2013 were retrospectively reviewed. The flap volume was measured 3, 6, 12, 24, and 36 months after surgery using CT and the Picture Archiving and Communication System software. RESULTS Relative to volumes at 3 months, median flap volumes decreased to 98.55, 70.16, 62.86, and 58.84% at 6, 12, 24, and 36 months, respectively. None of the evaluated parameters were correlated with volume changes. CONCLUSIONS Over time, the volume of RFFF in the tongue decreased. Considering this, free flap reconstruction should be carried out in tongue cancer surgery.
Collapse
Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Kyoung Ho Oh
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeong-Soo Woo
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kwang-Yoon Jung
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea,
| |
Collapse
|
17
|
Scarano A, Lorusso F, Di Cerbo A, Lucchina AG, Carinci F. Eradication of hairy mouth after oncological resection of the tongue and floor mouth using a diode laser 808 nm. Postoperative pain assessment using thermal infrared imaging. Lasers Surg Med 2019; 51:516-521. [PMID: 30614012 DOI: 10.1002/lsm.23054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Vascularized soft tissue flaps are often harvested from hair-bearing areas, such as the radial forearm or anterolateral thigh, making their use in oral reconstruction problematic due to postoperative hair growth. The presence of intact hair follicles in free tissue transfer and continued hair growth at the recipient site can result in difficulties with oral hygiene, intraoral irritation, food trapping, and patient distress. This study was to evaluate the intraoral efficacy and safety of a diode laser 808 nm when used for hair removal. MATERIALS AND METHODS Sixteen male patients, between 2010 and 2017, were referred for intraoral hair eradication with a history of squamous cell carcinoma of the tongue or floor mouth resection. An 808 nm diode laser (Stark 808, Plume s.r.l., Rome, Italy) was used to remove the intraoral hair. Each patient received a total of six treatments at 4-week intervals. Perifollicular pain was quantified by the physician using visual analog scales. Follow-up visits were scheduled at 1, 4, and 6 days to check the state of the tissues. The recall program included assessments of VAS, erythema, and perifollicular temperature. Patients were followed up for long-term assessments at 6 and 12 months after the final treatment session. RESULTS All patients presented well with no occurrence of symptoms, indicating possible perifollicular inflammation. Based on the VAS scores, very mild discomfort during laser irradiation was recorded in all patients, with average pain score of 10.98 ± 1.42. No pain or discomfort was recorded 1, 4, and 6 days after the procedure. After the third pulse of light was applied, the average temperature with standard deviation of the hair tip with both the dark and light skin was 74.4 ± 11.7°C. The difference in temperature before the procedure (basal measurement 37.5 ± 2.8°C) and immediately after laser irradiation was 36.9 ± 3.7°C. The difference in temperature disappeared after 0.29 seconds, and no temperature increase was recorded on days 1, 4, or 6. In all the patients, the hair clearance between baseline and the 6th treatment, the 6-month follow-up, and the 12-month follow-up rated as significant P < 0.05. The mean percentage of hair reduction was 97.3% at 12 months. CONCLUSION In conclusion, the clinical findings demonstrate the safety and efficacy of the 808 nm diode laser system for intraoral hair removal Lasers Surg. Med. 51:516-521, 2019. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences and CeSi Met, University of Chieti-Pescara, Chieti, Italy
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences and CeSi Met, University of Chieti-Pescara, Chieti, Italy
| | - Alessandro Di Cerbo
- Department of Medical, Oral and Biotechnological Sciences and CeSi Met, University of Chieti-Pescara, Chieti, Italy.,Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberta Greco Lucchina
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.,University of Eastern Piedmont, Novara, and Oral Surgery Unit, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Francesco Carinci
- Department of Morphology, Experimental Medicine and Surgery, University of Ferrara, Ferrara, Italy
| |
Collapse
|
18
|
Sudden shrinkage of free rectus abdominis musculocutaneous flap 15 years after maxilla reconstruction. JPRAS Open 2017; 15:46-50. [PMID: 32158797 PMCID: PMC7061601 DOI: 10.1016/j.jpra.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/20/2017] [Indexed: 11/23/2022] Open
Abstract
A 60-year-old male displayed sudden shrinkage of a left free rectus abdominis musculocutaneous flap, which had been grafted to his left maxilla 15 years previously. No post-reconstructive irradiation had been performed, and no late occlusion of the vascular anastomosis, local infection, recurrence of the maxillary cancer, or body weight loss was observed. However, the shrinkage amounted to approximately 50%. This is considerably more than previously reported cases of shrinkage of various free flaps, which ranged between 10% and 25%. The resultant depression was successfully augmented with a right free deep inferior epigastric artery perforator flap. The residual fat volume of the previously grafted shrunken flap was revealed to be compatible with that of the newly harvested contralateral perforator flap. Thus, the volume of the previously grafted flap may reflect the status of the intact contralateral donor site, although the mechanism of sudden flap shrinkage is unclear.
Collapse
|
19
|
Aladimi MT, Han B, Li C, Helal H, Gao Z, Li L. Factors to Consider When Deciding on the Type of Free-Flap Reconstruction of Head and Neck Soft Tissue Defects. ORL J Otorhinolaryngol Relat Spec 2017; 79:230-238. [DOI: 10.1159/000478103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/31/2017] [Indexed: 11/19/2022]
|
20
|
Kimura M, Takada K, Ishibashi K, Ohto H, Shibata A, Yamada H, Nishiwaki S, Naganawa Y, Umemura M. Quantitative analysis of chronological changes in the volume of flaps used for reconstruction of oral cavity defects. J Oral Sci 2017; 59:499-503. [DOI: 10.2334/josnusd.16-0683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Masashi Kimura
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital
| | - Ken Takada
- Department of Medical Technology, Ogaki Municipal Hospital
| | | | - Hiroyuki Ohto
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital
| | - Akio Shibata
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital
| | - Hiroki Yamada
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital
| | - Shusuke Nishiwaki
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital
| | | | - Masahiro Umemura
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital
| |
Collapse
|
21
|
Sakamoto Y, Yanamoto S, Ota Y, Furudoi S, Komori T, Umeda M. Magnitude of Myocutaneous Flaps and Factors Associated With Loss of Volume in Oral Cancer Reconstructive Surgery. J Oral Maxillofac Surg 2016; 74:644-9. [DOI: 10.1016/j.joms.2015.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
|
22
|
Long-term Follow-up Study of Radial Forearm Free Flap Reconstruction After Hemiglossectomy. J Craniofac Surg 2015; 26:44-7. [DOI: 10.1097/scs.0000000000001176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
23
|
Joo YH, Hwang SH, Park JO, Cho KJ, Kim MS. Functional outcome after partial glossectomy with reconstruction using radial forearm free flap. Auris Nasus Larynx 2013; 40:303-7. [DOI: 10.1016/j.anl.2012.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/11/2012] [Accepted: 07/14/2012] [Indexed: 11/29/2022]
|
24
|
Higgins KM, Erovic BM, Ravi A, Yeung R, Lee JW, Yao C, Enepekides DJ. Volumetric changes of the anterolateral thigh free flap following adjuvant radiotherapy in total parotidectomy reconstruction. Laryngoscope 2012; 122:767-72. [DOI: 10.1002/lary.22509] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/13/2011] [Accepted: 11/28/2011] [Indexed: 11/09/2022]
|