1
|
Riantiningtyas RR, Dougkas A, Kwiecien C, Carrouel F, Giboreau A, Bredie WLP. A review of assessment methods for measuring individual differences in oral somatosensory perception. J Texture Stud 2024; 55:e12849. [PMID: 38961563 DOI: 10.1111/jtxs.12849] [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: 10/30/2023] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024]
Abstract
While taste and smell perception have been thoroughly investigated, our understanding of oral somatosensory perception remains limited. Further, assessing and measuring individual differences in oral somatosensory perception pose notable challenges. This review aimed to evaluate the existing methods to assess oral somatosensory perception by examining and comparing the strengths and limitations of each method. The review highlighted the lack of standardized assessment methods and the various procedures within each method. Tactile sensitivity can be assessed using several methods, but each method measures different tactile dimensions. Further investigations are needed to confirm its correlation with texture sensitivity. In addition, measuring a single textural attribute may not provide an overall representation of texture sensitivity. Thermal sensitivity can be evaluated using thermal-change detection or temperature discrimination tests. The chemesthetic sensitivity tests involve either localized or whole-mouth stimulation tests. The choice of an appropriate method for assessing oral somatosensory sensitivity depends on several factors, including the specific research objectives and the target population. Each method has its unique intended purpose, strengths, and limitations, so no universally superior approach exists. To overcome some of the limitations associated with certain methods, the review offers alternative or complementary approaches that could be considered. Researchers can enhance the comprehensive assessment of oral somatosensory sensitivity by carefully selecting and potentially combining methods. In addition, a standardized protocol remains necessary for each method.
Collapse
Affiliation(s)
- Reisya Rizki Riantiningtyas
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark
- Health Systemic Process (P2S) Research Unit UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Institut Lyfe (Ex. Institut Paul Bocuse) Research Center, Ecully, France
| | - Anestis Dougkas
- Institut Lyfe (Ex. Institut Paul Bocuse) Research Center, Ecully, France
- Laboratoire Centre Européen Nutrition et Santé (CENS), CarMeN, Unité INSERM 1060, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Camille Kwiecien
- Danone Global Research & Innovation Center, Utrecht, Netherlands
| | - Florence Carrouel
- Health Systemic Process (P2S) Research Unit UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Agnès Giboreau
- Health Systemic Process (P2S) Research Unit UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Institut Lyfe (Ex. Institut Paul Bocuse) Research Center, Ecully, France
| | - Wender L P Bredie
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark
| |
Collapse
|
2
|
Ismail T, Padilla P, Kurlander DE, Corkum JP, Hanasono MM, Garvey PB, Chang EI, Yu P, Largo RD. Profunda Artery Perforator Flap Tongue Reconstruction: An Effective and Safe Alternative to the Anterolateral Thigh Flap. Plast Reconstr Surg 2024; 153:1191e-1200e. [PMID: 37384852 DOI: 10.1097/prs.0000000000010890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND The anterolateral thigh (ALT) perforator flap is a workhorse flap for tongue reconstruction. The authors present an alternative option using the profunda artery perforator (PAP) flap for glossectomy reconstruction compared with the ALT flap. METHODS A retrospective review was conducted of 65 patients who underwent subtotal or total glossectomy reconstruction between 2016 and 2020 (46 ALT versus 19 PAP flaps). Flap volume was assessed using computed tomography scans at two different time points. Quality of life and functional outcomes were measured using the MD Anderson Symptom Inventory for Head and Neck Cancer. RESULTS Patients receiving a PAP flap had significantly lower body mass index compared with those receiving an ALT flap (22.7 ± 5.0 versus 25.8 ± 5.1; P = 0.014). Donor-site and recipient-site complications were similar, as was the mean flap volume 7 months after surgery (30.9% for ALT versus 28.1% for PAP; P = 0.93). Radiation and chemotherapy did not appear to have a significant effect on flap volume change over time. The most frequently reported high-severity items in MD Anderson Symptom Inventory for Head and Neck Cancer were swallowing/chewing and voice/speech for both cohorts. Patients who had reconstruction with a PAP flap had significantly better swallowing function ( P = 0.034). CONCLUSIONS Both the PAP and ALT flaps appear to be safe and effective choices for subtotal and total tongue reconstruction. The PAP flap can serve as an alternative donor site, especially in patients with low body mass index and thin lateral-thigh thickness undergoing reconstruction of extensive glossectomy defects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Tarek Ismail
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Pablo Padilla
- Division of Plastic Surgery, University of Texas Medical Branch
| | - David E Kurlander
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Joseph P Corkum
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Matthew M Hanasono
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Patrick B Garvey
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Edward I Chang
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Peirong Yu
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Rene D Largo
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| |
Collapse
|
3
|
Marchiano E, Kana L, Bellile E, Smith JD, Casper KA, Malloy KM, Chinn SB, Stucken CL, Prince MEP, Chepeha DB, Rosko AJ, Spector ME. Neurotization of the radial forearm free flap improves swallowing outcomes in hemiglossectomy defects. Head Neck 2023; 45:798-805. [PMID: 36579434 DOI: 10.1002/hed.27290] [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: 08/22/2022] [Revised: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We examined the effect of free tissue neurotization on speech and swallowing outcomes for patients undergoing reconstruction of hemiglossectomy defects with a radial forearm free flap (RFFF). METHODS A retrospective study was performed in patients with oral cavity squamous cell carcinoma undergoing a hemiglossectomy and reconstruction with a RFFF. Functional outcomes including nutritional mode, range of liquids and solids, and speech understandability were analyzed 1-year post-treatment. RESULTS Eighty-four patients were included in this analysis, 41 of whom had neurotized flaps (49%). No significant differences in demographic or clinical variables were seen between the neurotized and non-neurotized groups. On multivariate analysis controlling for BMI, flap area, and N-classification, patients with neurotized flaps were significantly more likely to have normal range of liquids and solids and less likely to have a G-tube. CONCLUSIONS Neurotization of RFFF reconstructing hemiglossectomy defects results in decreased G-tube dependence and improved range of liquids and solids.
Collapse
Affiliation(s)
- Emily Marchiano
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Lulia Kana
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Douglas B Chepeha
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Watfa W, Sapino G, Teatini F, Oranges CM, Cherubino M, Guiller D, Raffoul W, di Summa PG. Lower limb soft tissue reconstruction using free ALT flaps: multimodal parameter analysis to predict the level of spontaneous reinnervation. J Plast Surg Hand Surg 2023; 57:545-550. [PMID: 36731503 DOI: 10.1080/2000656x.2023.2172025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This work aims to assess lower limb free flaps spontaneous sensory recovery by comparing and analyzing a single standardized reconstructive procedure, namely the free noninnervated anterolateral thigh (ALT) flap in order to evaluate which flap or patient-related factors may predict flap reinnervation. METHODS Between January 2010 and March 2018 all nonreinnervated ALT flaps for lower limb coverage performed at our institution were screened. We excluded from the study flaps with less than 18 months of follow-up time, neurotized flaps, and those from patients who missed the last follow up. Sensory modalities that were evaluated included the two-point discrimination (2PD) test, measured in mm; and the Semmes-Weinstein monofilament (SWM) test, measured in gram. The sensory parameter results were compared and analyzed according to flap size (two groups; <160 cm2 vs. > 160 cm2), and post-op time of testing (two groups; <18-28 months vs. > 28 months). RESULTS Twenty-one ALT free flaps were finally retained by this study. Our findings showed that flaps of smaller surface area showed a significantly better return in sensory discrimination 2PD and in sensory cutaneous pressure perception SWM testing. CONCLUSION This work establishes for the first time some key quantitative data that can help predict free flap spontaneous reinnervation outcomes when using the same ALT flap. In our series, flaps surface remains the main discriminant value for a better sensory recovery.
Collapse
Affiliation(s)
- William Watfa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Department of Plastic and Reconstructive Surgery, Saint George University Hospital Medical Center, Beirut, Lebanon
| | - Gianluca Sapino
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Francesco Teatini
- Department of Neurology, Azienda Ospedaliera dell'Alto Adige, Bolzano, Italy
| | - Carlo M Oranges
- Department of Plastic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Mario Cherubino
- Department plastic reconstructive and hand surgery, University Hospital of Varese, Varese, Italy
| | - David Guiller
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Dijon, France
| | - Wassim Raffoul
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pietro G di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| |
Collapse
|
5
|
Oral Somatosensory Alterations in Head and Neck Cancer Patients-An Overview of the Evidence and Causes. Cancers (Basel) 2023; 15:cancers15030718. [PMID: 36765675 PMCID: PMC9913236 DOI: 10.3390/cancers15030718] [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: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Food-related sensory alterations are prevalent among cancer patients and negatively impact their relationship with food, quality of life, and overall health outcome. In addition to taste and smell, food perception is also influenced by somatosensation comprising tactile, thermal, and chemesthetic sensations; yet studies on oral somatosensory perception of cancer patients are lacking to provide patients with tailored nutritional solutions. The present review aimed to summarise findings on the oral somatosensory perception of head and neck cancer (HNC) patients and the potential aetiologies of somatosensory alterations among this population. Subjective assessments demonstrated alterations in oral somatosensory perception such as sensitivity to certain textures, spices, and temperatures. Physiological changes in oral somatosensation have been observed through objective assessments of sensory function, showing reduced localised tactile function and thermal sensitivity. Changes in whole-mouth tactile sensation assessed using texture discrimination and stereognosis ability seem to be less evident. Available evidence indicated oral somatosensory alterations among HNC patients, which may affect their eating behaviour, but more studies with larger sample sizes and standardised assessment methods are needed. Unlike other types of cancers, sensory alterations in HNC patients are not only caused by the treatments, but also by the cancer itself, although the exact mechanism is not fully understood. Prevalent oral complications, such as xerostomia, dysphagia, mucositis, and chemosensory alterations, further modify their oral condition and food perception. Oral somatosensory perception of cancer patients is an under-investigated topic, which constitutes an important avenue for future research due to its potential significance on eating behaviour and quality of life.
Collapse
|
6
|
Coverage of exposed ankle and foot with the conjoined lower abdomen and groin flaps. Injury 2022; 53:2893-2897. [PMID: 35690488 DOI: 10.1016/j.injury.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/09/2022] [Accepted: 06/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive soft-tissue defects around the ankle and foot pose a difficult challenge to surgeons. Considering that natural contour, the ideal solution should match a thin and pliable skin flap to allow shoe fitting and provide a functional move. As the conjoined flaps were increasingly utilized in covering various defects, we present our experience using the bipedicle conjoined flap on the lower abdomen and groin site. METHODS From May 2018 to September 2020, 36 patients (27 male and 9 female) with a mean age of 32 years (ranged, 21-54 years) underwent the one-stage coverage of ankle and foot defects with the bipedicle conjoined flap. A suitable "Y" bifurcation was dissected to enlarge vessel size or participated in intra-flap anastomosis. The mean dimension of the defect was 30 × 12 cm2 (ranged, 20 × 8 cm2 to 38 × 16 cm2). Primary donor-site closure was accomplished in all patients. RESULTS Thirty-six flaps survived completely without significant complications, and mild venous congestion was observed in one flap. The average flap size was 35 × 15 cm2 (ranged, 22 × 10 cm2 to 42 × 18 cm2). All flaps were available for a mean follow-up of 18 months (ranged, 12 to 24 months). Natural shape and walking function were successfully achieved with restored protective sensation. CONCLUSIONS Bipedicle conjoined flap harvested from the lower abdomen and groin is a great alternative, in selected patients seeking one-stage coverage for the exposed ankle and foot. Compared to single-pedicle flaps, the increased skin allows the wider coverage for the large defect with less morbidity and better outcomes.
Collapse
|
7
|
Feng SM, Zhao JJ, Migliorini F, Maffulli N, Xu W. First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes. J Orthop Surg Res 2021; 16:685. [PMID: 34794478 PMCID: PMC8600886 DOI: 10.1186/s13018-021-02838-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Shi-Ming Feng
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China.,Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Jia-Ju Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire, ST4 7QB, England.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China.
| |
Collapse
|
8
|
Aberrant Superficial Branch of the Radial Nerve-Radial Forearm Free Flap Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2191. [PMID: 31624666 PMCID: PMC6635202 DOI: 10.1097/gox.0000000000002191] [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: 12/01/2018] [Accepted: 01/30/2019] [Indexed: 11/25/2022]
Abstract
The superficial branch of the radial nerve (SBRN) is encountered and must be preserved during the harvest of a radial forearm free flap (RFFF). An abnormal course of the SBRN was encountered during the harvest of an RFFF. The nerve had an abnormal course with two branches—in the proximal forearm, one branch was anterior and the second branch was posterior to the brachioradialis muscle and in the distal forearm, both of these nerves merged together. A review of the literature was performed, with no such documented aberrant course of the SBRN being described previously. Knowledge of the SBRN anatomy and its variations is important to note during the RFFF harvest.
Collapse
|
9
|
Knackstedt R, Grobmyer S, Djohan R. Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy. Breast J 2019; 25:1187-1191. [DOI: 10.1111/tbj.13420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Risal Djohan
- Department of Plastic Surgery Cleveland Clinic Cleveland Ohio
| |
Collapse
|
10
|
Anatomic Targets for Breast Reconstruction Neurotization: Past Results and Future Possibilities. Ann Plast Surg 2019; 82:207-212. [PMID: 30628934 DOI: 10.1097/sap.0000000000001733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of providing neurotized autologous breast reconstruction is not novel, but the introduction of cadaveric nerve grafts has allowed for the development of new techniques and a resurgence in academic interest. There has been a surge in the number of publications regarding neurotized autologous breast reconstruction. However, recent articles and reviews have focused mainly on autologous, abdominal-based reconstruction. The sensory innervation of the most commonly used autologous tissues has been well described, allowing surgeons to perform accurate and reproducible dissections. However, there are numerous options for autologous breast reconstruction, and not all patients are candidates for abdominally based reconstruction. As more patients inquire to their possible reconstruction options, plastic surgeons will have to be well versed in the different neurotized options and appreciate the technical aspects associated with reconstructive success. In this review, we aim to discuss both established anatomic targets for autologous flap neurotization and future directions.
Collapse
|
11
|
Rothenberger J, Ramms EM, Medved F, Kolbenschlag J, Daigeler A, Held M. Comparison of spontaneous sensory recovery of noninnervated anteromedial thigh flap, latissimus dorsi flap, and gracilis muscle flap in lower extremity reconstruction: A prospective comparative study. Microsurgery 2018; 39:297-303. [DOI: 10.1002/micr.30385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Jens Rothenberger
- Department of Hand, Plastic, Reconstructive and Burn SurgeryBG Trauma Center Tuebingen, University Tuebingen Tuebingen Germany
| | - Eva Maria Ramms
- Department of Hand, Plastic, Reconstructive and Burn SurgeryBG Trauma Center Tuebingen, University Tuebingen Tuebingen Germany
| | - Fabian Medved
- Department of Hand, Plastic, Reconstructive and Burn SurgeryBG Trauma Center Tuebingen, University Tuebingen Tuebingen Germany
| | - Jonas Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn SurgeryBG Trauma Center Tuebingen, University Tuebingen Tuebingen Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn SurgeryBG Trauma Center Tuebingen, University Tuebingen Tuebingen Germany
| | - Manuel Held
- Department of Hand, Plastic, Reconstructive and Burn SurgeryBG Trauma Center Tuebingen, University Tuebingen Tuebingen Germany
| |
Collapse
|
12
|
Computed Tomographic Angiography Used for Localization of the Cutaneous Perforators and Selection of Anterolateral Thigh Flap "Bail-Out" Branches. Ann Plast Surg 2018; 81:87-95. [PMID: 29746278 DOI: 10.1097/sap.0000000000001433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the territory supplied by the lateral circumflex femoral artery for the consistency of a proximal perforator that could be used as an alternative pedicle for the anterolateral thigh flap if a tedious intramuscular course is encountered during elevation of the perforator used to develop the initial surgical plan. It is hypothesized that a consistent "bail-out" perforator supplying the proximal thigh would facilitate a simpler anterolateral thigh flap harvest, with minimal modification to flap design. METHODS Computed tomographic images of 9 fresh cadavers were imported using Materialize's Interactive Medical Imaging Control System software to create surface-rendered 3-dimensional reconstructions of 15 lower limbs. Perforators emerging proximally and laterally to a 3-cm radius circle drawn at the midpoint of the anterior superior iliac spine and superolateral patella were considered potential bail-out perforators and evaluated for their number emerging diameter, length, course, and location relative to the anterior superior iliac spine. RESULTS An average of 2.9 ± 1.8 perforators per limb were identified. Mean pedicle length was 111 ± 20 mm, measured from the origin in the lateral circumflex femoral artery to where the perforators emerged through the deep fascia directly overlying the thigh muscles. Average diameter at origin in the lateral circumflex femoral artery was 2.8 ± 0.8 mm, and that at emergence through the deep fascia was 1.1 ± 0.3 mm. Vessel course was predominantly musculocutaneous (90%). CONCLUSIONS A significant bail-out perforator routinely supplies the proximal anterolateral thigh and may be used as an alternative vascular pedicle for an anterolateral thigh flap if a tedious intramuscular course is encountered during elevation of a perforator identified within the conventional landmarks (3-cm radius circle at the midpoint of the anterior superior iliac spine and superolateral patella).
Collapse
|
13
|
Vaira LA, Massarelli O, Gobbi R, Biglio A, De Riu G. Tactile recovery assessment with shortened Semmes-Weinstein monofilaments in patients with buccinator myomucosal flap oral cavity reconstructions. Oral Maxillofac Surg 2018; 22:151-156. [PMID: 29396784 DOI: 10.1007/s10006-018-0682-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The sensitive restoration is a primary aim of oral reconstructive surgery. The Semmes-Weinstein monofilament test is the "Gold Standard" to assess the threshold of tactile sensitivity on the skin but its use in the oral cavity is limited due to the size of the tools. We adopted half-cut Semmes-Weinstein monofilaments to evaluate the threshold of tactile sensitivity in oral reconstructions with buccinator myomucosal flaps. MATERIALS AND METHODS Monofilaments were half-cut and recalibrated. Fifty-seven oral reconstructions were considered at 4-year minimum follow-up. Test was conducted both on the reconstructive flap and on the non-operated contralateral side. RESULTS All of the considered flaps (100%) showed a recovery of tactile sensitivity. The overall average tactile threshold value assessed on this sample was 0.76 ± 1.58 g/mm2 overall. CONCLUSIONS Shortened monofilaments allow easily assessment of tactile sensitivity in all the oral cavity areas, even in operated patients which often present lockjaw or microstomia.
Collapse
Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy.
| | - Olindo Massarelli
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Roberta Gobbi
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Andrea Biglio
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| |
Collapse
|
14
|
Massarelli O, Vaira LA, Biglio A, Gobbi R, Dell'aversana Orabona G, De Riu G. Sensory recovery of myomucosal flap oral cavity reconstructions. Head Neck 2017; 40:467-474. [PMID: 29130554 DOI: 10.1002/hed.25000] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 07/24/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sensory restoration of the oral cavity is a primary aim of reconstructive surgery in posttraumatic or postablative defects. Sensitivity plays a key role in oral function, whose impairment strongly affects the patient's quality of life. Cheek myomucosal flaps provide a reliable and tissue-like reconstruction of these regions but their sensitive recovery, which we still know little about, deserves thorough assessment. METHODS In this retrospective study, the myomucosal cheek flaps were tested for different aspects of sensory recovery: touch; 2-point discrimination; pain; sharp/smooth discrimination; ability to feel hot/cold stimulus; stereognosis; and taste. RESULTS Fifty-two myomucosal flap reconstructions were investigated. All sensitivity tests showed positive results. When comparison was possible, sensitivity seemed significantly close to the contralateral healthy side. Sensory recovery proved to be even better than that reported on reinnervated microvascular free flap reconstructions of the oral cavity. CONCLUSION Myomucosal flap reconstruction demonstrated a high degree of sensory recovery.
Collapse
Affiliation(s)
- Olindo Massarelli
- Operative Unit of Maxillofacial Surgery, University of Sassari Hospital, Sassari, Italy
| | - Luigi Angelo Vaira
- Operative Unit of Maxillofacial Surgery, University of Sassari Hospital, Sassari, Italy
| | - Andrea Biglio
- Operative Unit of Maxillofacial Surgery, University of Sassari Hospital, Sassari, Italy
| | - Roberta Gobbi
- Operative Unit of Maxillofacial Surgery, University of Sassari Hospital, Sassari, Italy
| | | | - Giacomo De Riu
- Operative Unit of Maxillofacial Surgery, University of Sassari Hospital, Sassari, Italy
| |
Collapse
|
15
|
Zhu L, Zhang J, Song X, Hou W, Wu S, Chen W, Svensson P, Wang K. Sensory recovery of non-innervated free flaps and nasolabial island flaps used for tongue reconstruction of oncological defects. J Oral Rehabil 2017; 44:736-748. [PMID: 28370156 DOI: 10.1111/joor.12510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 11/26/2022]
Affiliation(s)
- L. Zhu
- Orofacial Pain & TMD Research Unit; Institute of Stomatology; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
- Institute of Stomatology & Department of Orthodontics; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
- Department of Stomatology; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - J. Zhang
- Orofacial Pain & TMD Research Unit; Institute of Stomatology; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
| | - X. Song
- Institute of Stomatology & Department of Oral and Maxillofacial Surgery; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
| | - W. Hou
- Orofacial Pain & TMD Research Unit; Institute of Stomatology; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
- Institute of Stomatology & Department of Orthodontics; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
| | - S. Wu
- Orofacial Pain & TMD Research Unit; Institute of Stomatology; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
- Institute of Stomatology & Department of Orthodontics; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
| | - W. Chen
- Orofacial Pain & TMD Research Unit; Institute of Stomatology; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
- Institute of Stomatology & Department of Orthodontics; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
| | - P. Svensson
- Section of Orofacial Pain and Jaw Function; School of Dentistry and Oral Health; Aarhus University; Aarhus Denmark
- Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
| | - K. Wang
- Orofacial Pain & TMD Research Unit; Institute of Stomatology; Affiliated Hospital of Stomatology; Nanjing Medical University; Nanjing China
- Center for Sensory-Motor Interaction (SMI) Aalborg University; Aalborg Denmark
| |
Collapse
|
16
|
Vaira LA, Massarelli O, Gobbi R, Soma D, Dell’aversana Orabona G, Piombino P, De Riu G. Evaluation of discriminative sensibility recovery in patients with buccinator myomucosal flap oral cavity reconstructions. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1277-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Maruccia M, Orfaniotis G, Ciudad P, Nicoli F, Cigna E, Giudice G, Kiranantawat K, Ribuffo D, Chen HC. Application of extended bi-pedicle anterolateral thigh free flaps for reconstruction of large defects: A case series. Microsurgery 2016; 38:26-33. [PMID: 27991695 DOI: 10.1002/micr.30141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/27/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Michele Maruccia
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
- Department of Plastic and Reconstructive Surgery; “Sapienza” University; Rome 00161 Italy
- Department of Emergency and Organ Transplantation; University of Bari “Aldo Moro,” Plastic and Reconstructive Surgery and Burns Unit, Bari, Italy
| | - Georgios Orfaniotis
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Pedro Ciudad
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Fabio Nicoli
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Emanuele Cigna
- Department of Plastic and Reconstructive Surgery; “Sapienza” University; Rome 00161 Italy
| | - Giuseppe Giudice
- Department of Emergency and Organ Transplantation; University of Bari “Aldo Moro,” Plastic and Reconstructive Surgery and Burns Unit, Bari, Italy
| | - Kidakorn Kiranantawat
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Diego Ribuffo
- Department of Plastic and Reconstructive Surgery; “Sapienza” University; Rome 00161 Italy
| | - Hung-Chi Chen
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| |
Collapse
|
18
|
Lee SH, An SJ, Kim NR, Kim UJ, Kim JI. Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap. Clin Orthop Surg 2016; 8:444-451. [PMID: 27904728 PMCID: PMC5114258 DOI: 10.4055/cios.2016.8.4.444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/03/2016] [Indexed: 11/06/2022] Open
Abstract
Background Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap. Methods Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years. Results All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results. Conclusions The ALT flap may be considered ideal for the treatment of severe forefoot deformity.
Collapse
Affiliation(s)
- Sang Hyun Lee
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung Jin An
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nu Ri Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Um Ji Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeung Il Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
19
|
|
20
|
Wu CW, Valerio IL, Huang JJ, Chang KP, Cheng MH. Refinement of the myocutaneous anterolateral thigh flap for reconstruction of frontonasal fistula defects. Head Neck 2015; 38 Suppl 1:E552-8. [PMID: 25800364 DOI: 10.1002/hed.24038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Frontonasal fistulas can lead to life-threatening intracranial infections. Our refinement of the myocutaneous anterolateral thigh (ALT) flap for treating these fistulas is described. METHODS A retrospective review of the microsurgical treatment of frontonasal fistulas is presented. Demographics, etiologies, outcomes, and complications were evaluated. RESULTS Ten myocutaneous ALT flaps were used to reconstruct frontonasal fistula. The mean follow-up was 35 ± 2.5 months. Nine fistulas were secondary to oncologic resections, and one was due to a traumatic origin. Complications included a recurrent abscess in 1 case (10%); there were no cases of cerebrospinal fluid (CSF) leak or flap loss. Preoperative intracranial infections were present in 7 cases, with 6 successfully resolving their infection after surgical intervention and flap obliteration of their fistulas. CONCLUSION Refinements in the myocutaneous ALT flap design have been illustrated to provide robust dead-space obliteration with vascularized muscle and reliable simultaneous scalp coverage in the treatment of frontonasal fistulas. © 2015 Wiley Periodicals, Inc. Head Neck 38: E552-E558, 2016.
Collapse
Affiliation(s)
- Chih-Wei Wu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ian L Valerio
- Department of Plastic Surgery, Division of Burn, Wound, and Trauma, Wexner Medical Center at the Ohio State University, Columbus, Ohio.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
21
|
Baas M, Duraku LS, Corten EML, Mureau MAM. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits? J Plast Reconstr Aesthet Surg 2015; 68:1025-35. [PMID: 26044088 DOI: 10.1016/j.bjps.2015.04.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tongue reconstruction after (hemi)glossectomy including sensory recovery is challenging. Although sensory recovery could improve functional outcome, no consensus on the need for reinnervation of the neo-tongue exists. Therefore, a systematic review was performed to determine if sensory reinnervation of free flaps in tongue reconstruction is better than no sensory reinnervation. The secondary study aim was to assess the effect of sensory reinnervation on overall functional outcome, such as speech and deglutition. METHODS Seven databases (Embase, Medline, Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar) were searched. Studies that reported the effect of sensory reinnervation on overall functional outcome were identified. RESULTS Fourteen articles were included in the systematic review, concerning a total of 271 tongue reconstructions. Free flaps that were used were the radial forearm (RF) flap (n = 137), the anterolateral thigh (ALT) flap (n = 65), the rectus abdominis (RA) flap (n = 20), and the tensor fascia latae (TFL) flap (n = 5). Seven out of seven articles directly comparing sensory reinnervation with no sensory reinnervation revealed superior sensibility in the reinnervated group. Moreover, the innervated RF and ALT flaps showed superior recovery of sensibility compared to other flaps used for the reconstruction of hemiglossectomy as well as total glossectomy defects. There are indications that sensory reinnervation may have a beneficial effect on overall tongue function. Age, smoking, and sex did not affect sensory recovery. Four out of five articles showed that postoperative radiotherapy does not have a long-term adverse effect on sensory recovery. CONCLUSIONS Sensory reinnervation of free flaps in the reconstruction of (hemi)glossectomy defects improves sensory recovery; however, evidence for beneficial effects on function is poor.
Collapse
Affiliation(s)
- Martijn Baas
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Liron S Duraku
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eveline M L Corten
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
22
|
Chang EI, Yu P, Skoracki RJ, Liu J, Hanasono MM. Comprehensive analysis of functional outcomes and survival after microvascular reconstruction of glossectomy defects. Ann Surg Oncol 2015; 22:3061-9. [PMID: 25634781 DOI: 10.1245/s10434-015-4386-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few studies on tongue reconstruction provide a comprehensive, multidisciplinary analysis examining defect size, flap selection, function, and long-term survival. This report presents the largest study in the literature evaluating free flap reconstruction after glossectomy. METHODS A retrospective review of patients undergoing free flap glossectomy reconstruction from 2000 to 2012 was performed. RESULTS In this review, 268 patients were identified. Resections involving the tongue only included 59 partial glossectomies, 86 hemiglossectomies, 28 subtotal glossectomies, and 24 total glossectomies. Glossectomies performed with mandibulectomies were analyzed independently for speech and swallowing function (32 partial glossectomies, 18 hemiglossectomies, 8 subtotal glossectomies, and 13 total glossectomies with mandibulectomy). A total of 299 free flaps were performed, with 30 patients receiving two free flaps. Multivariate analysis demonstrating smoking (p = 0.018), composite resections (p < 0.001), and larger resections (total and subtotal glossectomies; p < 0.001) were associated with significantly worse speech results. Advanced age (p = 0.002), radiation (p = 0.003), and larger or composite resections had significantly worse swallowing function (p < 0.001). Patients with a persistent tracheostomy had significantly worse speech and swallowing function (p < 0.001), whereas innervated flaps were associated with superior speech (p = 0.049) and better swallowing function (p = 0.004). The surgical complication rate was 23.5 %, with only one total flap loss. Tumor stage (p = 0.003), positive margins (p < 0.001), lymphovascular invasion (p = 0.023), and chemotherapy (p < 0.001) were associated with significantly worse overall survival. The median overall survival time was 50.5 months (range 39-79 months). CONCLUSIONS Although comorbidities and the extent of resection impair both speech and swallowing, reconstruction, particularly with innervated free flaps, still affords the majority of patients' reasonable function.
Collapse
Affiliation(s)
- Edward I Chang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
| | | | | | | | | |
Collapse
|
23
|
Sirimahachaiyakul P, Orfaniotis G, Gesakis K, Kiranantawat K, Ciudad P, Nicoli F, Maruccia M, Sacak B, Chen HC. Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel. Microsurgery 2015; 35:356-63. [PMID: 25597746 DOI: 10.1002/micr.22377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Pornthep Sirimahachaiyakul
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Division of Plastic Surgery; Department of Surgery; Faculty of Medicine Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kanellos Gesakis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Maxillofacial Surgery; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; Sapienza University; Rome Italy
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| |
Collapse
|
24
|
Luenam S, Prugsawan K, Kosiyatrakul A, Chotanaphuti T, Sriya P. Neural Anatomy of the Anterolateral Thigh Flap. J Hand Microsurg 2015; 7:49-54. [PMID: 26078503 DOI: 10.1007/s12593-014-0167-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 12/26/2014] [Indexed: 11/26/2022] Open
Abstract
The anterolateral thigh (ALT) flap is one of the commonly used sensate flaps for intra-oral, hand, and foot reconstruction. The objective of this study was to describe the anatomic location of the sensory nerves supplying the ALT flap in relation to the surface landmarks and with the vascular pedicles. The dissections were carried out in 28 embalmed specimens. An axial line from the anterior superior iliac spine to the superolateral border of the patella and two circles with radii of 5 and 10 cm centered on the midpoint of the former line were used for the surface landmarks. At the intersection point of the axial line and the 10-cm circle, the main lateral femoral cutaneous nerve (LFCN) and its anterior branch were located within 1 and 2.4 cm, respectively. At the intersection point of the axial line and the 5-cm circle, the anterior branch of the LFCN was located within 2.8 cm. The anterior branch of the LFCN can be detected within 3 cm from the central perforator pedicle in all specimens. The posterior branch of the LFCN, superior perforator nerve, and median perforator nerve were found in more variable locations. The findings from our study provide additional information for clinical use in the planning of sensate ALT flap harvest.
Collapse
Affiliation(s)
- Suriya Luenam
- Department of Orthopaedics, Phramongkutklao Hospital, 315 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Krit Prugsawan
- Department of Orthopaedics, Phramongkutklao Hospital, 315 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Arkaphat Kosiyatrakul
- Department of Orthopaedics, Phramongkutklao Hospital, 315 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Thanainit Chotanaphuti
- Department of Orthopaedics, Phramongkutklao Hospital, 315 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Piyanee Sriya
- Department of Anatomy, Phramongkutklao College of Medicine, Bangkok, Thailand
| |
Collapse
|
25
|
|
26
|
|
27
|
Abstract
Vascularized composite allotransplantation (VCA) is a novel therapeutic option for treatment of patients suffering from limb loss or severe facial disfigurement. To date, 72 hand and 19 facial transplantations have been performed worldwide. VCA in hand and facial transplantation is a complex procedure requiring a multidisciplinary team approach and extensive surgical planning. Despite good functional outcome, courses after hand and facial transplantation have been complicated by skin rejection. Long-term immunosuppression remains a necessity in VCA for allograft survival. To widen the scope of these quality-of-life-improving procedures, minimization of immunosuppression to limit risks and side effects is needed.
Collapse
|
28
|
Reconstruction of Large Facial Defects Using a Sensate Superficial Circumflex Iliac Perforator Flap Based on the Lateral Cutaneous Branches of the Intercostal Nerves. Ann Plast Surg 2014; 72:328-31. [DOI: 10.1097/sap.0b013e318264fc7d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Matsuda K, Kikuchi M, Murase T, Hosokawa K, Shibata M. Free flap transfer for complex regional pain syndrome type II. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2014; 1:1-4. [PMID: 27252946 PMCID: PMC4627105 DOI: 10.3109/23320885.2014.966106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/20/2014] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Abstract
A patient with complex regional pain syndrome type II was successfully treated using free anterolateral thigh flap transfer with digital nerve coaptation to the cutaneous nerve of the flap. Release of the scarred tissue and soft tissue coverage with targeted sensory nerve coaptation were useful in relieving severe pain.
Collapse
Affiliation(s)
- Ken Matsuda
- Division of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medicine , Niigata, Japan
| | - Mamoru Kikuchi
- Department of Plastic and Reconstructive Surgery, Saga University Hospital , Saga, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedics, Osaka University Graduate School of Medicine , Suita, Osaka, Japan
| | - Ko Hosokawa
- Department of Plastic and Reconstructive Surgery, Osaka University Graduate School of Medicine , Suita, Osaka, Japan
| | - Minoru Shibata
- Division of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medicine , Niigata, Japan
| |
Collapse
|
30
|
Abstract
The field of head and neck surgery has gone through numerous changes in the past two decades. Microvascular free flap reconstructions largely replaced other techniques. More importantly, there has been a paradigm shift toward seeking not only to achieve reliable wound closure to protect vital structures, but also to reestablish normal function and appearance. The present paper will present an algorithmic approach to head and neck reconstruction of various subsites, using an evidence-based approach wherever possible.
Collapse
|
31
|
Loupatatzi A, Stavrianos SD, Karantonis FF, Machairas A, Rapidis AD, Kokkalis G, Papadopoulos O. Are Females Predisposed to Complications in Head and Neck Cancer Free Flap Reconstruction? J Oral Maxillofac Surg 2014; 72:178-85. [DOI: 10.1016/j.joms.2013.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
|
32
|
Ayhan Oral M, Zeynep Sevim K, Görgü M, Yücel Öztan H. Sensory recovery with innervated and noninnervated flaps after total lower lip reconstruction: a comparative study. PLASTIC SURGERY INTERNATIONAL 2013; 2013:643061. [PMID: 24381755 PMCID: PMC3871915 DOI: 10.1155/2013/643061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022]
Abstract
This study compares sensory recovery after total lower lip reconstruction in a wide variety of flaps including bilateral depressor anguli oris flap, submental island flap, bilateral fan flaps, radial forearm flap, and pectoralis major myocutaneous flaps in a large number of patients. Spontaneous return of flap sensation was documented by clinical testing in the majority (3%) of patients who underwent total lower lip reconstruction. Sensory recovery occurred more often in patients with fasciocutaneous free flaps than in those with musculocutaneous flaps. Flap sensation to touch, two-point discrimination, and temperature perception was correlated with age, smoking, and radiation treated patients. We conclude that reasonable sensory recovery may be expected in noninnervated flaps, provided that the major regional sensorial nerve has not been sacrificed, and also provided that the patients age is relatively young and that enough surface contact area of the recipient bed is present without marked scarring. This trial was regestered with Chinese Clinical Trial Registry (Chi CTR) with ChiCTR-ONC-13003656.
Collapse
Affiliation(s)
- Meltem Ayhan Oral
- İzmir Katip Celebi University, Ataturk Research and Training Hospital, Department of Plastic and Reconstructive Surgery, 35360 Izmir, Turkey
| | - Kamuran Zeynep Sevim
- Sisli Hamidiye Etfal Research and Training Hospital, Department of Plastic and Reconstructive Surgery, 34371 Istanbul, Turkey
| | - Metin Görgü
- Abant İzzet Baysal University, Department of Plastic and Reconstructive Surgery, 14280 Bolu, Turkey
| | | |
Collapse
|
33
|
The sensate fibular osteoneurocutaneous flap in oromandibular reconstruction: Clinical outcomes in 31 cases. J Plast Reconstr Aesthet Surg 2013; 66:1695-701. [DOI: 10.1016/j.bjps.2013.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/02/2013] [Accepted: 07/07/2013] [Indexed: 11/19/2022]
|
34
|
|
35
|
Boyd JB, Caton AM, Mulholland RS, Tong L, Granzow JW. The sensate fibula osteocutaneous flap: neurosomal anatomy. J Plast Reconstr Aesthet Surg 2013; 66:1688-94. [PMID: 23906598 DOI: 10.1016/j.bjps.2013.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/02/2013] [Accepted: 07/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rapid return of oral sensation enhances quality of life following oromandibular reconstruction. For predictable reinnervation of flaps, a detailed knowledge of their nerve supply is required. This study was designed to investigate the cutaneous nerve supply of the fibula osteocutaneous flap. METHODS We dissected thirty-seven fresh cadaveric specimens to better understand the cutaneous innervation of the typical fibula flap that would be used in oromandibular reconstruction. In addition, ten volunteers were enlisted for nerve blocks testing the cutaneous innervation of the lateral aspect of the lower leg. RESULTS The lateral sural cutaneous nerve (LSCN) is generally considered to be sole cutaneous innervation to the lateral aspect of the lower leg; however, our analysis of the cadaveric specimens revealed dual innervation to this region. We identified a previously unnamed distal branch of the superficial peroneal nerve, which we have termed the recurrent superficial peroneal nerve (RSPN). Given the cadaveric findings, both the LSCN and the RSPN were tested using sequential nerve blocks in 10 volunteers. An overlapping pattern of innervation was demonstrated. CONCLUSIONS The lateral aspect of the lower leg has an overlapping innervation from the LSCN and the newly described RSPN. The overlap zone lies in the region of the skin paddle of the fibula flap. The exact position of the neurosomal overlap zone (N.O.Z.E.) may be an important factor in reestablishing sensation in the fibula's skin paddle following free tissue transfer.
Collapse
Affiliation(s)
- J Brian Boyd
- Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, USA.
| | | | | | | | | |
Collapse
|
36
|
Abstract
The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functional outcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functional assessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations.
Collapse
Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
| | | |
Collapse
|
37
|
|
38
|
George RK, Krishnamurthy A. Microsurgical free flaps: Controversies in maxillofacial reconstruction. Ann Maxillofac Surg 2013; 3:72-9. [PMID: 23662264 PMCID: PMC3645616 DOI: 10.4103/2231-0746.110059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps.
Collapse
Affiliation(s)
- Rinku K George
- Department of Head & Neck Oncology & Reconstructive Surgery, Cancer Institute (W.I.A), Adyar, Chennai, India
| | | |
Collapse
|
39
|
|
40
|
|
41
|
Lee JH, Chung DW, Han CS. Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type IIIB open tibial fractures. Microsurgery 2012; 32:431-7. [DOI: 10.1002/micr.21970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 01/11/2012] [Accepted: 01/27/2012] [Indexed: 11/06/2022]
|
42
|
López-Arcas JM, Arias J, Morán MJ, Navarro I, Pingarrón L, Chamorro M, Burgueño M. The Deep Inferior Epigastric Artery Perforator (DIEAP) Flap for Total Glossectomy Reconstruction. J Oral Maxillofac Surg 2012; 70:740-7. [DOI: 10.1016/j.joms.2011.02.098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 01/23/2011] [Accepted: 02/16/2011] [Indexed: 10/17/2022]
|
43
|
Rodriguez-Lorenzo A, Audolfsson T, Rozen S, Kildal M, Nowinski D. Supraorbitary to infraorbitary nerve transfer for restoration of midface sensation in face transplantation: Cadaver feasibility study. Microsurgery 2012; 32:309-13. [DOI: 10.1002/micr.21944] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/04/2011] [Accepted: 11/09/2011] [Indexed: 11/06/2022]
|
44
|
Wang ZX, Luo DL, Pan Y, Chen L, Li Z, Tao L, Dai X, Li YJ, Li XY, Li SR. Autologous nerve implantation into denervated monkey skin promotes regeneration of Meissner's corpuscle. Med Sci Monit 2011; 17:BR377-84. [PMID: 22129896 PMCID: PMC3628142 DOI: 10.12659/msm.882124] [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] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study was to observe the effects of autologous nerve implantation into the denervated finger flap on the regression and regeneration of sensory nerve endings and Meissner’s corpuscles. Material/Methods Bilateral nerves of fingers were separated: one was removed and the other was implanted into the denervated finger in the implantation group. In the non-implantation group, both nerves were removed. The ventral skin of fingers was collected for immunohistochemistry and electron microscopy 3, 6, 9 and 12 months after surgery. Results The nerve endings in the Meissner’s corpuscles began to degenerate 3 months after denervation. The elementary structure of Meissner’s corpuscles was not significantly altered. Nerve fibers were present around the Meissner’s corpuscles, accompanied by growing into its inward. The axons in the denervated nerve disappeared and the Meissner’s corpuscles began to atrophy at month 6. More regenerated nerve fibers were observed after nerve implantation, including intensive and thick fibers, accompanied by reinnervation of Meissner’s corpuscles. More nerve fibers and a higher proportion of myelinated nerve fibers were noted at month 9 in the implantation group, and the reinnervation was present in the majority of Meissner’s corpuscles. Naive myelinated nerve fibers appeared at the caudal end of Meissner’s corpuscles. The nerve fibers in the Meissner’s corpuscles increased to the normal level at 12 months after nerve implantation. Conclusions The implanted nerve regenerated a large amount of free nerve endings, which helped to regenerate simple Meissner’s corpuscles via governing previously degenerated corpuscles.
Collapse
Affiliation(s)
- Zhen-Xiang Wang
- Department of Plastic Surgery, Southwest Hospital, 3rd Military Medical University, Chongqing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Abstract
Microsurgical free flaps are today considered state of the art in head and neck reconstruction after composite tumor resections. Free flaps provide superior functional and aesthetic restoration with less donor-site morbidity. This article details our approach to this challenging and complex procedure. Free tissue transfer can be viewed as consisting of 4 essential stages: (1) defect assessment, (2) preparation of recipient vessels, (3) flap selection and harvest, and (4) flap inset and microsurgical anastomoses. The essential details of each step are highlighted. Meticulous attention to each step is important because each plays a crucial role in the overall success of the procedure. Workhorse flaps in our practice are the anterolateral thigh, radial forearm, fibula, and jejunum flaps. Unique issues related to postoperative care and monitoring of head and neck free flaps are discussed. The management of complications, in particular those threatening flap survival, are reviewed in detail.
Collapse
Affiliation(s)
- Chin-Ho Wong
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
| | | |
Collapse
|
47
|
Dancey A, Blondeel PN. Technical tips for safe perforator vessel dissection applicable to all perforator flaps. Clin Plast Surg 2010; 37:593-606, xi-vi. [PMID: 20816515 DOI: 10.1016/j.cps.2010.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The introduction of perforator flaps by Koshima and Soeda in 1989 was met with much animosity in the surgical community. The flaps challenged conventional teaching and were often branded as being unsafe. Surgeries using perforator flaps are now routinely practiced all over the world, with increasing emphasis on minimizing donor site morbidity, and perforator flaps are becoming the current gold standard. The simple principles and techniques of perforator dissection can be applied to all perforator flaps, provided the surgeon has an intimate knowledge of the regional anatomy. Thus, virtually any piece of skin can be harvested as long as it incorporates a feeding vessel. This article highlights the essential techniques in planning and raising perforator flaps and the common pitfalls to be avoided.
Collapse
Affiliation(s)
- Anne Dancey
- Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent B-9000, Belgium
| | | |
Collapse
|
48
|
Ou KL, Tzeng YS, Yu CC, Chen TM. Resurfacing tophaceous gout in the foot with anterolateral thigh flap. Microsurgery 2009; 30:79-82. [DOI: 10.1002/micr.20693] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
49
|
Gideroglu K, Gunduz OH, Ofluoglu D, Akoz T. Sensorial donor site morbidity after saphenous neurocutaneous flap. ACTA ACUST UNITED AC 2009; 39:302-7. [PMID: 16243744 DOI: 10.1080/0284431051003556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neurocutaneous flaps based on the arterial network around the superficial sensory nerves are popular in soft tissue coverage of the lower extremities, and are usually preferred in reconstruction of the lower leg and foot. Although sacrifice of sensory cutaneous nerves is mentioned as one of their major disadvantages to our knowledge the morbidity in the foot and at the donor site has not been properly investigated. We investigated sensorial morbidity in the foot and at the donor site caused by raising a saphenous neurocutaneous flap in 14 patients by using static two-point discrimination test, Semmes-Weinstein monofilament test, vibration test, and by measuring somatosensory evoked potentials in the twelfth postoperative month. Our results suggest that sensory recovery is good and protective sensation is gained in most patients.
Collapse
Affiliation(s)
- Kaan Gideroglu
- Department of Plastic Surgery, Kartal Dr. Lütfü Kirdar Education and Research Hospital, Istanbul, Turkey.
| | | | | | | |
Collapse
|
50
|
Abstract
Free flaps are usually required rather than local flaps for large plantar defects, due to a lack of locally available tissue. The medial sural artery perforator free flap, recently introduced clinically by several authors, is a noticeable option for soft tissue coverage, but it has still not been widely used for the reconstruction of various large plantar defects. Between 2005 and 2007, medial sural artery perforator free flaps were used to reconstruct soft tissue defects in plantar areas in 11 patients at our institute. Patient ages ranged from 10 to 68 years (mean, 43 years), and follow-up periods ranged from 7 to 22 months (mean, 13 months). Flap sizes ranged from 10 to 14 cm in length and from 5 to 7 cm in width. Flaps survived in all patients. Marginal loss over the distal flap region was noted in 1 patient, and this was treated successfully with a subsequent split-thickness skin graft. In another one case, venous insufficiency developed, but salvage was successful with leech application. Long-term follow-up showed good flap durability with a protective sensation. The medial sural artery perforator flap provides sufficient durability for weight-bearing areas, even though it is a thin cutaneous flap. The authors recommend that this flap be considered as a reliable alternative for the reconstruction of large plantar defects.
Collapse
|