[A new method of tongue reconstruction with neurovascular infrahyoid muscle-fascia flaps]

Interdisciplinary plastic and reconstructive surgery of head and neck squamous cell carcinomas

Squamous cell carcinomas are the most common malignancies in the oral cavity, pharynx, and larynx. Even in the age of the most modern drug treatment methods, radical resection of these tumors is and currently remains the therapeutic gold standard. The loss of anatomical structures associated with surgery inevitably increases the functional deficits caused by the tumor itself. In this context, the extent of functional deficits is largely determined by the extent of resection. Complete organ resections, such as glossectomy, complete palate resection, laryngectomy, or transverse pharyngo-laryngectomy, lead to severe functional deficits, such as swallowing disturbances with life-threatening aspiration and articulation disorders up to the inability to speak. With the help of plastic reconstructive surgery, the lost tissue can be replaced and the specific functions of the upper aerodigestive tract can be preserved or restored.In recent decades, reconstructive surgical procedures have developed enormously in the treatment of malignant tumors of the head and neck. In order to make optimal use of them, a comprehensive, interdisciplinary therapy concept is a prerequisite for positive oncological and functional outcome. In addition to general medical and social parameters, surgical parameters play a crucial role in the choice of the reconstruction method. The extent to which the surgical measures must be interdisciplinary depends on the localization of the defects in the head and neck region and on the type of replacement tissue required. Here, the expertise of plastic surgery, oral and maxillofacial surgery, and abdominal surgery comes into play in particular. The use of different tissues, the combination of different grafts and flaps, or the preforming of donor regions allow reconstructions far beyond the level of simply restoring surface integrity. The functional results and thus the quality of life of patients after surgical therapy of extensive tumors of the mentioned localizations depend decisively on the type of reconstruction. Therefore, in the following review, special emphasis 1 be placed on the choice of reconstruction method and reconstruction technique for tissue loss after resections of HNSCC.

Sternohyoideus-sternothyroideus muscle flap to reconstruct oronasal fistulas due to maxillary cancer in four dogs

OBJECTIVE

To describe the repair of oronasal fistulas in dogs treated for maxillary cancer, with a novel sternohyoideus-sternothyroideus muscle flap, and to report the outcome.

ANIMALS

Client-owned dogs (n = 4) with oronasal fistulas related to cancer.

STUDY DESIGN

Short case series.

METHODS

Maxillary defects were caused by tissue destruction by the tumor and tumor response to radiation therapy in two cases and a complication of caudal maxillectomy in two cases, one of which had neoadjuvant radiation therapy. All tumors were >4 cm at the level of the maxilla. Flaps were harvested by transecting the ipsilateral sternothyroideus and sternohyoideus muscles from their origin at the manubrium and costal cartilage. The muscles were rotated around the base of the cranial thyroid artery and tunneled subcutaneously in the neck and through an incision in the caudodorsal aspect of the oral cavity. The muscle flap was sutured to the edges of the oronasal fistula.

RESULTS

The flap reached as far rostral as the level of the first premolar without tension. All dogs had clinical signs that improved postoperatively. All dogs had partial dehiscence of the flap.

CONCLUSION

This flap was associated with a high rate of complications; however, all flaps were used in challenging cases. Clinical signs related to oronasal fistula were improved in all dogs in this case series.

[Plastic reconstructive surgery in patients with oropharyngeal tumors]

Oropharyngeal tumors can cause severe dysfunctions, which are often worsened by surgical and/or radiotherapy. The severity and type of dysfunction depends on the extent and localization of the resection. In general, entire organ resections lead to greater impairment than partial resections, whereas extended partial resection often equates to total resection. Plastic reconstructive surgery can help to preserve and reconstruct specific functions. Herein, the various surgical techniques with different flaps and tissue grafts are described, and the indications are presented depending on the dysfunctions, the defect location, and the extent of resection (partial versus total).

[Integrity of swallowing apparatus-past, present, and future]

BACKGROUND

Swallowing is one of the most complex movement patterns. The integrity of the epithelial lining is essential.

OBJECTIVE

Which surgical techniques were developed at the beginnings of modern surgery and what methods are now available to maintain/reconstitute the integrity of the swallowing apparatus?

MATERIALS AND METHODS

This study comprises a selective literature search in early operation manuals and online archives, with incorporation of the authors' own experience.

RESULTS

Up until the 1950s, only very limited techniques were available to reconstruct the epithelial lining. Microvascular reanastomosed grafts were the game changer for reconstructive surgery, enabling reconstitution of the swallowing apparatus in primary surgery but also in challenging secondary interventions after insufficient or complicated primary therapy.

CONCLUSION

The need for anatomical and functional rehabilitation by reconstructive surgery is as pertinent as ever. Particularly in the oncological context, improved early detection and novel local treatment modalities could minimize treatment-associated damage to swallowing.

Infrahyoid flap revisited - A head and neck surgical perspective in the Indian setting

Purpose

In India, head and neck cancer contributes to about 35% of all malignancies. Among head and neck squamous cell cancers, buccal mucosa and tongue are the most common subsites. Reconstruction of defects after resection of primary in these subsites with acceptable cosmetic and functional outcomes remains a challenging task. In the era of free flaps, many pedicled flaps are being overlooked. Infrahyoid flap (IHF) is one among them. This study discusses the feasibility of IHF in reconstruction of small and medium-sized defects in subsites of the oral cavity.

Materials and Methods

This study is a retrospective analysis of 23 patients who underwent IHF and reconstruction after excision of primary in a case of oral cavity squamous cell carcinoma from January 2010 till November 2017 with a median follow-up of 15 months. Patients who were diagnosed as a case of squamous cell carcinoma in oral cavity subsites (T1-T3 and N0/N1-N2) and in whom the anticipated defect size was small to medium were included. The evaluation was then done based on the possibility to reach recipient site, vitality after transposition, definitive integration, and clinical outcome.

Results

Out of 23 patients, 5 patients had flap-related complications of which 1 patient had total skin paddle necrosis and 4 patients had partial skin paddle necrosis at distal end. However, no patient developed oro-cutaneous fistula or required corrective surgery. The maximum flap dimension was 9 × 4 cm and average flap dimension was 6 × 4 cm. The postoperative outcome of all patients remained uneventful.

Conclusion

The infrahyoid myocutaneous flap is a reliable and convenient flap which can be used as a good alternative for free flaps in small and medium-sized defects of the oral cavity.

The infrahyoid myocutaneous flap in intra-oral reconstruction as an alternative to free flaps

CONCLUSIONS

In our experience, monolateral or bilateral infrahyoid myocutaneous flap is less time-consuming and reduces the complication rate and the operation time in both small and large defects if compared with other authors' experience using a microvascular anastomosed flap.

OBJECTIVE

The aim of this study was to describe our results in reconstructive surgery after cancer ablation using the less popular infrahyoid myocutaneous flap as an alternative method to free flaps. The surgical technique and the postoperative outcomes are described.

METHODS

This was a retrospective study: 32 patients with squamous cell carcinoma of the tongue were surgically treated using a pure infrahyoid myocutaneous neurovascular flap.

RESULTS

The flap was successful in all cases without flap necrosis, fistula or complications in the donor site. After radiation therapy, flap tissues remained sufficiently soft, trophic and mobile. Ultrasound evaluation of tongue mobility, performed at the time of discharge, as well as 3 and 6 months after surgery, showed normal bolus propulsion. Cinefluoroscopy also showed good function of the reconstructed tongue.

[Anatomic bases of the infrahyoid flap: vascular pedicles and innervation]

The infrahyoid flap is used in head and neck reconstruction, especially in oral defect. This study is designed to determine vascular pedicles and innervation of the infrahyoid muscles and flap.

MATERIALS AND METHOD

The neck regions of 12 injected cadavers were investigated bilaterally.

RESULTS

The arterial pedicles of the infrahyoid muscles are the superior and inferior thyroid arteries. The arterial pedicles of the flap are the superior thyroid artery. The venous pedicles of the muscles and flap are the superior thyroid, lingual and facial veins. The infrahyoid flap is innervated by the ansa cervicalis.

CONCLUSION

The infrahyoid flap seems to be an excellent flap for oral, oropharynx and superior facial part reconstruction. It can be harvested easily in the same operation area.

Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach--report of six cases

A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect was then closed using a vascular pedicled musculofascia flap derived from the infrahyoid musculature. In all cases, the flap healed into place without complications. The patients began taking oral nutrients after an average of seven postoperative (5-12) days. In none of the cases did functional disorders or complications arise during the follow-up period (1-5 years). The infrahyoid muscle flap is well suited for reconstruction of the posterior pharyngeal wall and the upper esophagus.

[Modified set back tongue flap: an alternative surgical approach in the reconstruction of defects of the base of the tongue]

The base of the tongue after tumor resection can be reconstructed in several ways. In addition to direct suturing of small defects, a variety of local or microvascularly anastomosed flaps have been described. The present paper is aimed at introducing a local tongue flap for the reconstruction of medium-sized defects. Six patients were treated at the hospital between 1999 and 2002 with the above technique to cover defects affecting one-half to three-fourths of the base of the tongue. One patient had secondary bleeding and the other one experienced no complications. Nutrition could be started after 7.5 days (4-12) postoperatively on average. The tracheostomy was closed at 16.2 days (12-22) on average after the initial operation. The hospitalization of the patients was 20.3 days (15-27) on average. The modified set back tongue flap is an alternative in the reconstruction of subtotal defects of the base of the tongue. Easy handling, good functional outcome in swallowing, and the low complication rate were advantageous in the present series.

Defect-related variations in mandibular reconstruction using fibula grafts. A review of 96 cases

Despite the popularity of the donor region 'laterodorsal calf' with the fibula, the flexor muscles and the overlying skin for microsurgical bone and soft tissue transfer some limitations and possible pitfalls have to be considered. We report on 93 patients who had 96 reconstructions, 65 with and 31 without soft tissue transfer in 8 years using microvascular fibular grafts for mandibular replacement and oromandibular reconstruction. Six patients died within 4 weeks and eight flaps were lost. Necrosis of the skin paddle occurred in 7 (11%) of 61 cases with uncomplicated bony healing.

Infrahyoid myocutaneous flap in reconstructive maxillofacial cancer and trauma surgery

We report the use of an island infrahyoid myocutaneous flap, pedicled on the superior thyroid vessels, in a group of 21 patients. This flap allows reconstruction of intraoral defects or defects of the lower portion of the face, as large as 10 x 4 cm. We used it in 15 cases to repair parts of the oral cavity, after tumour resection, in 2 patients with mandibular osteoradionecrosis and in 4 patients with gunshot injuries. Among the 21 flaps, no muscular necrosis was observed; however, 4 total necrosis and 4 partial necrosis (< or = 25% of the skin area) of the skin paddle were recorded. Loss of the skin paddle was primarily attributable to the anatomical variations of the veins draining this flap.

The infrahyoid flap. A technique for defect closure in the floor of the mouth, the tongue, the buccal mucosa, and the lateral pharyngeal wall

The surgical technique, indications, and results of the infrahyoid muscle flap are presented. This flap is fed by the superior thyroid vessels and innervated by the ansa cervicalis. The flap is indicated in case of medium-sized defects in the floor of the mouth, the tongue, the buccal mucosa, and the lateral pharyngeal wall. The advantages of the technique presented include the rapid flap elevation close to the original operating field, the ability to use the motor capability of the flap, and the ability to combine it with other local flaps--for example, the platysma flap. This technique appeared to render excellent function for swallowing and speech. Safe flap grafting is possible only if the internal jugular vein is preserved.