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Kalle F, Stadler VP, Brach JK, Grote VF, Pohl C, Schulz K, Seidenstuecker M, Jonitz-Heincke A, Bader R, Mlynski R, Strüder D. High hydrostatic pressure treatment for advanced tissue grafts in reconstructive head and neck surgery. J Biomed Mater Res A 2024. [PMID: 39295278 DOI: 10.1002/jbm.a.37791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/21/2024]
Abstract
The increasing importance of regenerative medicine has resulted in a growing need for advanced tissue replacement materials in head and neck surgery. Allo- and xenogenic graft processing is often time-consuming and can deteriorate the extracellular matrix (ECM). High hydrostatic pressure (HHP)-treatment could allow specific devitalization while retaining the essential properties of the ECM. Porcine connective tissue and cartilage were HHP-treated at 100-400 MPa for 10 min. Structural modifications following HHP-exposure were examined using electron microscopy, while devitalization was assessed through metabolism and cell death analyses. Furthermore, ECM alterations and decellularization were evaluated by histology, biomechanical testing, and DNA content analysis. Additionally, the inflammatory potential of HHP-treated tissue was evaluated in vivo using a dorsal skinfold chamber in a mouse model. The devitalization effects of HHP were dose-dependent, with a threshold identified at 200 MPa for fibroblasts and chondrocytes. At this pressure level, HHP induced structural alterations in cells, with a shift toward late-stage apoptosis. HHP-treatment preserved ECM structure and biomechanical properties, but did not remove cell debris from the tissue. This study observed a pressure-dependent increase of markers suggesting the occurrence of immunogenic cell death. In vivo investigations revealed an absence of inflammatory responses to HHP-treated tissue, indicating a favorable biological response to HHP. In conclusion, application of HHP devitalizes fibroblasts and chondrocytes at 200 MPa while retaining the essential properties of the ECM. Prospectively, HHP may simplify the preparation of allo- and xenogenic tissue replacement materials and increase the availability of grafts in head and neck surgery.
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Affiliation(s)
- Friederike Kalle
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Rostock, Germany
| | - Valentin Paul Stadler
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Rostock, Germany
| | - Julia Kristin Brach
- Department of Otorhinolaryngology - Head and Neck Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Vivica Freiin Grote
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Christopher Pohl
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, University Medical Center Greifswald, Greifswald, Germany
| | - Karoline Schulz
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Rostock, Germany
| | - Michael Seidenstuecker
- G.E.R.N. Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Anika Jonitz-Heincke
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Rostock, Germany
| | - Daniel Strüder
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Rostock, Germany
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Cîrstea AI, Berteșteanu ȘVG, Vrînceanu D, Dumitru M, Bejenaru PL, Simion-Antonie CB, Schipor-Diaconu TE, Taher PB, Rujan SA, Grigore R. Perspectives in Using Multiple Flaps Reconstructions for Advanced Head and Neck Tumors (Scoping Review). MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1340. [PMID: 39202621 PMCID: PMC11355972 DOI: 10.3390/medicina60081340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/06/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Patients with advanced head and neck tumors require salvage surgery as a last resort. These extensive surgeries pose the challenge of complex reconstructions. The head and neck surgeon undertaking such complex cases needs to master different flaps. The team managing these patients needs input from various specialists, along with otorhinolaryngologists, plastic surgeons, maxillofacial surgeons, vascular surgeons, experienced radiologists, dedicated pathologists, oncologists and radiation therapists. We focus on the optimum solution between oncologic resections and the future quality of life of patients and overall survival. Each complex case requires a personalized medicine approach. This scoping review aims to assess the efficacy and outcomes of complex reconstructions using various flaps for head and neck tumors, with a focus on free flaps and emerging techniques. Materials and Methods: A systematic search of the literature was conducted following PRISMA guidelines, resulting in the inclusion of 44 articles that met the predefined criteria in the last 10 years. Results: The included studies encompassed diverse patient populations and evaluated various surgical techniques, outcomes, complications, and advancements in head and neck reconstruction. The review identified a variety of flaps utilized in head and neck tumor reconstruction, including free flaps such as the radial forearm, anterolateral thigh, scapular tip, and myocutaneous flaps, among others. The success rates for free flap reconstructions ranged from 85% to 100%, with notable variations attributed to patient selection, tumor characteristics, and surgical expertise. Conclusions: Complications such as flap necrosis, infection, hematoma, and donor site morbidity were documented across studies, highlighting the importance of meticulous surgical planning and postoperative care. Furthermore, the review revealed emerging techniques such as computer-aided design, virtual surgery, stereolithographic models, customized implants, tissue engineering, and allotransplants, offering promising reconstructive armamentarium. Advances in surgical techniques and emerging technologies hold promise for further enhancing reconstructive outcomes, minimizing morbidity, and improving patient quality of life.
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Affiliation(s)
- Anca-Ionela Cîrstea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
- Department of ENT, Head and Neck Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Șerban Vifor Gabriel Berteșteanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
- Department of ENT, Head and Neck Surgery, Colţea Clinical Hospital, 030167 Bucharest, Romania
| | - Daniela Vrînceanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
- Department of ENT, Head and Neck Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Mihai Dumitru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
- Department of ENT, Head and Neck Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Paula Luiza Bejenaru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
| | - Catrinel Beatrice Simion-Antonie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
| | - Teodora Elena Schipor-Diaconu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
| | - Petra Bianca Taher
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
- Department of ENT, Head and Neck Surgery, Colţea Clinical Hospital, 030167 Bucharest, Romania
| | - Simona-Andreea Rujan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
- Department of ENT, Head and Neck Surgery, Colţea Clinical Hospital, 030167 Bucharest, Romania
| | - Raluca Grigore
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-I.C.); (M.D.); (P.L.B.); (C.B.S.-A.); (T.E.S.-D.); (P.B.T.); (S.-A.R.); (R.G.)
- Department of ENT, Head and Neck Surgery, Colţea Clinical Hospital, 030167 Bucharest, Romania
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Shetty D, Kumar N, Desai AK, Anehosur V. Single perforator-based anterolateral thigh flap, the workhorse flap, in oral cancer reconstruction: A tertiary care institution experience. J Cancer Res Ther 2023; 19:1255-1260. [PMID: 37787292 DOI: 10.4103/jcrt.jcrt_1761_21] [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: 10/04/2023]
Abstract
Background Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction. Materials and Methods All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study. Results Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration. Conclusion We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction.
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Affiliation(s)
- Deepthi Shetty
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Niranjan Kumar
- Department of Plastic and Reconstructive Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Anil Kumar Desai
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Venkatesh Anehosur
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
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Tensor fascia lata flow-through modification of the anterolateral thigh flap for the repair of through-and-through defects of the face. Int J Oral Maxillofac Surg 2022; 51:1157-1160. [PMID: 35339330 DOI: 10.1016/j.ijom.2022.02.010] [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: 11/16/2021] [Revised: 01/01/2022] [Accepted: 02/22/2022] [Indexed: 02/05/2023]
Abstract
The treatment of tumour recurrence or severe surgical complications in the head and neck region is often very complicated and limited. In particular, there is no suitable reconstruction strategy for patients whose necks are poor in blood vessels and whose anterolateral thigh (ALT) donor areas concurrently have only one available perforating branch. Therefore, a 'flow-through' technique was applied to fabricate chimeric ALT flaps for such patients. An ipsilateral tensor fascia lata flap was anastomosed to the distal end of the descending branch of the lateral circumflex femoral artery. Six patients were included in this study. All fabricated chimeric flaps were successfully prepared and remained viable. After follow-up (range 3-38 months), the patients were satisfied with their appearance and the incision lines had healed well. In patients with through-and-through defects of the face and with anatomical variations in the donor area, chimeric ALT flaps fabricated via the flow-through technique can provide double flaps and longer vascular pedicles, thereby enabling reconstruction.
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