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Neal TW, Williams FC, Jelmini J, Spresser W, Schwitzer D, Kim RY. Immediate Teeth in Fibulas Versus Standard Fibula Free Flap: A Comparison of Donor Surgical Site Infections. J Oral Maxillofac Surg 2024; 82:494-500. [PMID: 38272445 DOI: 10.1016/j.joms.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Immediate placement of dental implants with dental restoration at the leg donor site requires implant components and prosthetic materials that are not packaged sterile. PURPOSE This study aimed to determine if there was a difference in donor surgical site infection between patients that received a fibula free flap with dental implants and immediate teeth (ITFFF: immediate teeth fibula free flap) before flap transfer to the defect site when compared to standard fibula free flaps (SFFFs) without dental implant placement. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was designed and implemented. The study population was composed of patients who underwent free fibula flap transfer for the treatment of benign or malignant conditions of the head and neck from 2015 to 2022. Patients who received immediate dental implants without teeth were excluded, since those implants are sterile and buried under soft tissue. PREDICTOR VARIABLE The surgical treatment with either ITFFF or SFFF was treated as the primary predictor variable. MAIN OUTCOME VARIABLE The primary outcome variable was postoperative donor surgical site infection. COVARIATES There were 12 covariate variables including age, sex, diabetes diagnosis, immunosuppression/prior chemotherapy treatment, body mass index, smoking status, pack year history, pathology treated, technique for fibula donor site closure, skin paddle harvest, skin paddle area (cm2), and negative pressure wound therapy. ANALYSES For the effect of the covariates on the primary predictor variable, χ2 analyses and t-tests were used. The effect of the primary predictor variable on the primary outcome was evaluated using χ2 analysis. A P value of < 0.05 was considered statistically significant. RESULTS There were 37 patients in the ITFFF group and 47 in the SFFF group. The donor site infection rate for the entire study population was 2.38%. In the ITFFF group, there was 1 donor surgical site infection (2.70%), and in the SFFF group there was also 1 donor surgical site infection (2.13%). There was no significant difference in donor surgical site infection between the groups (P = .86). CONCLUSION AND RELEVANCE This study found no difference in donor surgical site infection rates between patients who received ITFFF versus SFFF. The overall donor surgical site infection rate following fibula free flap is low.
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Affiliation(s)
- Timothy W Neal
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX.
| | - Fayette C Williams
- Director, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital Health Network, Fort Worth, TX
| | - Jonathan Jelmini
- Fellow, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Health Network, Fort Worth, TX
| | - Wyatt Spresser
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - David Schwitzer
- Fellow, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Health Network, Fort Worth, TX
| | - Roderick Y Kim
- Vice Director, Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital Health Network, Fort Worth, TX
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Xu MS, D'Elia A, Hadzimustafic N, Adil A, Karoubi G, Waddell TK, Haykal S. Bioengineering of vascularized porcine flaps using perfusion-recellularization. Sci Rep 2024; 14:7590. [PMID: 38555385 PMCID: PMC10981729 DOI: 10.1038/s41598-024-58095-7] [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: 04/24/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
Large volume soft tissue defects greatly impact patient quality of life and function while suitable repair options remain a challenge in reconstructive surgery. Engineered flaps could represent a clinically translatable option that may circumvent issues related to donor site morbidity and tissue availability. Herein, we describe the regeneration of vascularized porcine flaps, specifically of the omentum and tensor fascia lata (TFL) flaps, using a tissue engineering perfusion-decellularization and recellularization approach. Flaps were decellularized using a low concentration sodium dodecyl sulfate (SDS) detergent perfusion to generate an acellular scaffold with retained extracellular matrix (ECM) components while removing underlying cellular and nuclear contents. A perfusion-recellularization strategy allowed for seeding of acellular flaps with a co-culture of human umbilical vein endothelial cell (HUVEC) and mesenchymal stromal cells (MSC) onto the decellularized omentum and TFL flaps. Our recellularization technique demonstrated evidence of intravascular cell attachment, as well as markers of endothelial and mesenchymal phenotype. Altogether, our findings support the potential of using bioengineered porcine flaps as a novel, clinically-translatable strategy for future application in reconstructive surgery.
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Affiliation(s)
- Michael S Xu
- Latner Thoracic Surgery Research Laboratories, University Health Network, 200 Elizabeth Street 8N-869, Toronto, ON, M5G 2C4, Canada
| | - Andrew D'Elia
- Latner Thoracic Surgery Research Laboratories, University Health Network, 200 Elizabeth Street 8N-869, Toronto, ON, M5G 2C4, Canada
| | - Nina Hadzimustafic
- Latner Thoracic Surgery Research Laboratories, University Health Network, 200 Elizabeth Street 8N-869, Toronto, ON, M5G 2C4, Canada
| | - Aisha Adil
- Latner Thoracic Surgery Research Laboratories, University Health Network, 200 Elizabeth Street 8N-869, Toronto, ON, M5G 2C4, Canada
| | - Golnaz Karoubi
- Latner Thoracic Surgery Research Laboratories, University Health Network, 200 Elizabeth Street 8N-869, Toronto, ON, M5G 2C4, Canada
| | - Thomas K Waddell
- Latner Thoracic Surgery Research Laboratories, University Health Network, 200 Elizabeth Street 8N-869, Toronto, ON, M5G 2C4, Canada
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Siba Haykal
- Latner Thoracic Surgery Research Laboratories, University Health Network, 200 Elizabeth Street 8N-869, Toronto, ON, M5G 2C4, Canada.
- Plastic and Reconstructive Surgery, Smilow Cancer Hospital, Yale New Haven Health, New Haven, CT, USA.
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Lupon E, Acun A, Taveau CB, Oganesyan R, Lancia HH, Andrews AR, Randolph MA, Cetrulo CL, Lellouch AG, Uygun BE. Optimized Decellularization of a Porcine Fasciocutaneaous Flap. Bioengineering (Basel) 2024; 11:321. [PMID: 38671744 PMCID: PMC11047669 DOI: 10.3390/bioengineering11040321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Reconstructive techniques to repair severe tissue defects include the use of autologous fasciocutaneous flaps, which may be limited due to donor site availability or lead to complications such as donor site morbidity. A number of synthetic or natural dermal substitutes are in use clinically, but none have the architectural complexity needed to reconstruct deep tissue defects. The perfusion decellularization of fasciocutaneous flaps is an emerging technique that yields a scaffold with the necessary composition and vascular microarchitecture and serves as an alternative to autologous flaps. In this study, we show the perfusion decellularization of porcine fasciocutaneous flaps using sodium dodecyl sulfate (SDS) at three different concentrations, and identify that 0.2% SDS results in a decellularized flap that is efficiently cleared of its cellular material at 86%, has maintained its collagen and glycosaminoglycan content, and preserved its microvasculature architecture. We further demonstrate that the decellularized graft has the porous structure and growth factors that would facilitate repopulation with cells. Finally, we show the biocompatibility of the decellularized flap using human dermal fibroblasts, with cells migrating as deep as 150 µm into the tissue over a 7-day culture period. Overall, our results demonstrate the promise of decellularized porcine flaps as an interesting alternative for reconstructing complex soft tissue defects, circumventing the limitations of autologous skin flaps.
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Affiliation(s)
- Elise Lupon
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d’Azur, 06300 Nice, France;
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (C.B.T.); (H.H.L.); (A.R.A.); (M.A.R.); (C.L.C.J.); (A.G.L.)
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
| | - Aylin Acun
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Biomedical Engineering, Widener University, Chester, PA 19013, USA
| | - Corentin B. Taveau
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (C.B.T.); (H.H.L.); (A.R.A.); (M.A.R.); (C.L.C.J.); (A.G.L.)
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
| | - Ruben Oganesyan
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Hyshem H. Lancia
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (C.B.T.); (H.H.L.); (A.R.A.); (M.A.R.); (C.L.C.J.); (A.G.L.)
- University of Grenoble Alpes, CNRS, TIMC UMR 5525, EPSP, 38000 Grenoble, France
| | - Alec R. Andrews
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (C.B.T.); (H.H.L.); (A.R.A.); (M.A.R.); (C.L.C.J.); (A.G.L.)
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
| | - Mark A. Randolph
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (C.B.T.); (H.H.L.); (A.R.A.); (M.A.R.); (C.L.C.J.); (A.G.L.)
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
| | - Curtis L. Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (C.B.T.); (H.H.L.); (A.R.A.); (M.A.R.); (C.L.C.J.); (A.G.L.)
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alexandre G. Lellouch
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (C.B.T.); (H.H.L.); (A.R.A.); (M.A.R.); (C.L.C.J.); (A.G.L.)
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, 75015 Paris, France
| | - Basak E. Uygun
- Shriners Children’s Boston, Boston, MA 02114, USA; (A.A.); (R.O.)
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Chul Lee D, Hyung Lee H, Hoon Koh S, Soo Kim J, Young Roh S, Jin Lee K. Donor-Site Morbidity Analysis of Thenar and Hypothenar Flap. Arch Plast Surg 2024; 51:94-101. [PMID: 38425867 PMCID: PMC10901602 DOI: 10.1055/a-2168-4771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/01/2023] [Indexed: 03/02/2024] Open
Abstract
Background For the small glabrous skin defect, Thenar and Hypothenar skin are useful donors and they have been used as a free flap. Because of similar skin characteristics, both flaps have same indications. We will conduct comparative study for the donor morbidity of the Free thenar flap and Hypothenar free flap. Methods From January 2011 to December 2021, demographic data, characteristics of each flap, and complications using retrospective chart review were obtained. Donor outcomes of the patient, who had been followed up for more than 6 months, were measured using photographic analysis and physical examination. General pain was assessed by Numeric Rating Scale (NRS) score, neuropathic pain was assessed by Douleur Neuropathique 4 Questions (DN4) score, scar appearance was assessed by modified Vancouver Scar Scale (mVSS), and patient satisfaction was assessed on a 3-point scale. Statistical analysis was performed on the outcomes. Results Out of the 39 survey respondents, 17 patients received Free thenar flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher NRS, DN4, and mVSS ( p < 0.05). The average scores for the Thenar and Hypothenar groups were 1.35 and 0.27 for NRS, 2.41 and 0.55 for DN4, and 3.12 and 1.59 for mVSS, respectively. Despite the Hypothenar group showing greater satisfaction on the 3-point scale (1.82) compared with the Thenar group (1.47), the difference was not significant ( p = 0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures. Conclusion Despite the limited number of participants, higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared with the Hypothenar free flap. However, no difference in overall patient satisfaction was found between the two groups.
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Affiliation(s)
- Dong Chul Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Ho Hyung Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Sung Hoon Koh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Jin Soo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Si Young Roh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Kyung Jin Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
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Cortina LE, Moverman DJ, Zhao Y, Goss D, Zenga J, Puram SV, Varvares MA. Functional considerations between flap and non-flap reconstruction in oral tongue cancer: A systematic review. Oral Oncol 2023; 147:106596. [PMID: 37839153 DOI: 10.1016/j.oraloncology.2023.106596] [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: 06/06/2023] [Revised: 09/15/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
This systematic review aims to provide insight into the ideal reconstructive approach of the oral tongue in oral tongue cancer (OTC) by investigating the relationship between functional outcomes and the extent of tongue resection. A structured search was performed in Ovid MEDLINE, EMBASE, and Web of Science. Studies comparing patient-reported and objective measurements of the oral tongue function between flap vs. non-flap reconstruction were included. Functional outcomes of interest were speech production, deglutition efficiency, tongue mobility, overall quality of life, and postoperative complications. A total of nine studies were retrieved and critically appraised. Patients with 20 % or less of oral tongue resected had superior swallowing efficiency and speech intelligibility with a non-flap reconstruction while patients with a tongue defect of 40-50 % self-reported or demonstrated better swallowing function with a flap repair. The data in intermediate tongue defects (20-40 % tongue resected) was inconclusive, with several studies reporting comparable functional outcomes between approaches. A longitudinal multi-institutional prospective study that rigidly controls the extent of tongue resected and subsites involved is needed to determine the percentage of tongue resected at which a flap reconstruction yields a superior functional result in OTC.
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Affiliation(s)
- Luis E Cortina
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Daniel J Moverman
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Yinge Zhao
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Deborah Goss
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.
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Ranganath K, Miller LE, Goss D, Lin DT, Faden DL, Deschler DG, Emerick KS, Richmon JD, Varvares MA, Feng AL. Comparison of patient-reported upper extremity disability following free flaps in head and neck reconstruction: A systematic review and meta-analysis. Head Neck 2023. [PMID: 37129003 DOI: 10.1002/hed.27375] [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: 09/14/2022] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Comparisons of patient-reported donor site morbidity based on the Disabilities in Arm, Shoulder, and Hand (DASH) instrument across upper trunk free flaps in head and neck surgery, including radial forearm (RFFF), osteocutaneous radial forearm (OCRFF), scapular tip (STFF), and serratus anterior (SAFF) free flaps, may help inform donor tissue selection. METHODS In this meta-analysis, 12 studies were included and the primary outcome was average DASH score. RESULTS The pooled DASH scores were 12.14 (95% CI: 7.40-16.88) for RFFF (5 studies), 17.99 (11.87-24.12) for OCRFF (2 studies), 12.19 (8.74-15.64) for STFF (3 studies), and 16.49 (5.92-27.05) for SAFF (2 studies) and were not significantly different. CONCLUSIONS Results suggest that patients generally function well, with minimal to mild donor site morbidity, when assessed at an average of 20 months after flap harvest. These results are based on few effects from primarily retrospective studies of fair quality, and further research is needed.
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Affiliation(s)
- Kushi Ranganath
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren E Miller
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah Goss
- Howe Library, Mass Eye and Ear, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin S Emerick
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Archibald H, Stanek J, Hamlar D. Free Flap Donor-Site Complications and Management. Semin Plast Surg 2023; 37:26-30. [PMID: 36776806 PMCID: PMC9911222 DOI: 10.1055/s-0042-1759795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Free flap harvest will occasionally result in donor-site complications and morbidity. Most of these complications are managed simply without producing lingering effects on activities of daily living. However, some patients will sustain limb weakness, gait issues, chronic pain, and nonhealing wounds. Frank preoperative discussion between surgeon and patient is essential to maximize postoperative outcome and manage expectations. Fastidious surgical technique will help minimize the risks of hematoma, seroma, and infection, while newer techniques can help prevent some issues with wound healing, limb weakness, and sensory changes. In this article, we describe the rates of common and rare complications at free flap donor sites, as well as techniques to prevent and manage them.
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Affiliation(s)
- Hunter Archibald
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Joel Stanek
- Department of Otolaryngology, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Otolaryngology, Regions Hospital, St. Paul, Minnesota
| | - David Hamlar
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota
- Department of Otolaryngology, Regions Hospital, St. Paul, Minnesota
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8
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Kaleem A, Patel N, Schubert E, Stanbouly D, Shanti R, Tursun R. Comparison of propeller flaps versus skin grafts for coverage of osteocutaneous fibula free flap donor site defects. Head Neck 2023; 45:135-146. [PMID: 36256590 DOI: 10.1002/hed.27217] [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: 02/05/2022] [Revised: 09/18/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Authors compare use of propeller flaps versus skin grafts in defect coverage after fibula flap harvest. MATERIALS AND METHODS Retrospective review of patients who received either PFPF or STSG. Primary predictor variable was technique, and secondary predictor variables were comorbidities. Primary outcome variable was flap/graft healing, and secondary outcome variables were cosmesis, adverse events, effect on activities of daily living (ADLs), pain, additional procedures, and cost. Statistical analysis performed via independent sample t tests, ANOVA, and χ2 tests. Logistic regression analysis was performed. RESULTS Study sample was 50 patients. PFPFs showed higher rates of success, while STSG showed increased complications and adverse events. Pain and ADLs significantly affected in STSG group. Cosmesis was better in the PFPF group, and overall cost was significantly higher in STSG group. CONCLUSION PFPFs show greater success rates, fewer complications, improved cosmesis, less pain, reduced cost compared to STSG for wound coverage after fibula flap harvest.
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Affiliation(s)
- Arshad Kaleem
- Head and Neck Surgical Oncology & Microvascular Reconstructive Surgery, High Desert Oral and Facial Surgery, El Paso, Texas, USA
| | - Neel Patel
- Head and Neck Oncology & Reconstructive Surgery, HCA Florida, Miami, Florida, USA
| | - Enrique Schubert
- Head and Neck Surgical Oncology & Microvascular Reconstructive Surgery, High Desert Oral and Facial Surgery, El Paso, Texas, USA
| | - Dani Stanbouly
- College of Dental Medicine, Columbia University, New York, New York, USA
| | - Rabie Shanti
- Oral and Maxillofacial Surgery, Head and Neck Oncology & Microvascular Surgery, Rutgers University, New Brunswick, New Jersey, USA
| | - Ramzey Tursun
- Oral and Maxillofacial Surgery, Head and Neck Oncology & Microvascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
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Donor-Site Morbidity after Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Stair Climbing Asymmetry and Functional Outcome. Symmetry (Basel) 2022. [DOI: 10.3390/sym14091888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The autologous vascularised free fibula flap is currently considered the best option for facial reconstruction after oncological surgery, but its donor-site morbidity has not been fully examined. The purpose was to evaluate donor-site changes in temporal and spatial kinematic gait parameters during stair climbing, as well as the gait symmetry. Fourteen patients (48 ± 16 years) were evaluated before and six months after harvest of a vascularised free fibula flap. Temporal gait variables for both the ascent and descent phases did not change after surgery (2-way ANOVA, p > 0.05). During stair ascent, ankle flexion (healthy side, increased; donor side, reduced; low effect size) had a significant time × side interaction. During stair descent, hip flexion was significantly larger on the donor side (medium effect size). Significant time × side interactions were observed for ankle inversion (healthy side, reduced; donor side, increased; and low effect size) and knee flexion (healthy side, increased; donor side, unchanged; and low effect size). Medium effect sizes were found for hip flexion side differences (significant). No relevant spatio-temporal nor kinematic asymmetry emerged apart from ankle joint kinematics. Overall, only the side effect of hip flexion during descent was both statistically significant and practically meaningful. Considering the slight modifications of the gait variables, no major functional limitations were found following vascularised free fibula flap reconstruction during stair climbing and descent.
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10
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Wu H, Mao J, Zhai Z, Wang Z, Guo Z, Liu Y, Han J, Zhang C, Liu J. Analysis of related factors of long-term complications after vascularized fibular transplantation. Clin Oral Investig 2022; 26:6961-6971. [DOI: 10.1007/s00784-022-04650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/16/2022] [Indexed: 11/24/2022]
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11
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Hughes KR, Fong A, Rozen WM, Leong JCS. The arterialised saphenous venous flow-through flap for managing the radial forearm free flap donor site. Microsurgery 2022; 42:333-340. [PMID: 35297112 PMCID: PMC9315149 DOI: 10.1002/micr.30883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site. METHOD A cohort study of six patients (five male, one female; mean age 59 [range 19-90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra-flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap. RESULTS In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6-15 cm (mean 11.5 cm) and widths of 4-6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24-90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow-up of 6 months (4-24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15. CONCLUSION The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.
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Affiliation(s)
- Kimberley R Hughes
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Alisha Fong
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Warren M Rozen
- Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - James C S Leong
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia
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12
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Weiss RO, Wong PE, Reddy LV. Immediate reconstruction of segmental mandibular defects via tissue engineering. Proc AMIA Symp 2022; 35:391-393. [DOI: 10.1080/08998280.2022.2035162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Robert O. Weiss
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of Dentistry, Dallas, Texas
| | - Patrick E. Wong
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of Dentistry, Dallas, Texas
| | - Likith V. Reddy
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of Dentistry, Dallas, Texas
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13
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Xu Q, Chen PL, Liu YH, Wang SM, Xu ZF, Feng CJ. Comparing donor site morbidity between radial and ulnar forearm free flaps: a meta-analysis. Br J Oral Maxillofac Surg 2021; 60:547-553. [DOI: 10.1016/j.bjoms.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022]
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14
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A Novel Approach to Virtual Surgical Planning for Mandibular and Midfacial Reconstruction With a Fibula Free Flap. J Craniofac Surg 2021; 33:759-763. [PMID: 34560742 DOI: 10.1097/scs.0000000000008169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The fibula free flap is a major workhorse in facial reconstruction. To decrease operative times, virtual surgical planning (VSP) has been implemented. Traditional VSP is costly and may delay operative planning. In this study, the authors present a novel algorithm using readily accessible software packages to perform VSP in a manner that is quick and cost-effective. METHODS A 6-part survey was administered to physicians with prior training in facial reconstruction. Fourteen physicians participated regarding outcomes on 10 patients who underwent mandibular or midfacial fibula free flap reconstruction. Participants were asked to match the true postoperative and VSP models and rate the similarity of the models using the Likert scale (0-10). The goal was to determine whether the VSP models accurately depicted the actual reconstruction, and whether they would use VSP in future clinical practice. RESULTS The physicians surveyed were able to match the models correctly 93.6% of the time. The mean score for the similarity between virtual and actual models ranged between 7.60 and 8.80. Most participants (90.9%) who answered stated they would use our VSP algorithm if they were trained in the protocol. CONCLUSIONS AND RELEVANCE Virtual surgical planning models were created utilizing our novel algorithm. Participants matched the preoperative VSP plan with the postoperative model most of the time and rated the similarity well. Participants in our study are interested in learning more about physician performed VSP. The authors believe this model may be financially and clinically relevant and serve as an excellent educational tool.
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15
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Benbassat B, Chantalat E, Chabrillac E, Roumiguie M, De Bonnecaze G, Vairel B, Sarini J, Vergez S, Dupret-Bories A. The external pudendal artery free flap in women: Anatomical study of a novel flap for buccopharyngeal reconstruction. Ann Anat 2021; 239:151828. [PMID: 34474125 DOI: 10.1016/j.aanat.2021.151828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Because of the widespread and high reliability of free flaps in head and neck reconstruction, the challenge today is to reduce donor site morbidity. The external pudendal artery (EPA) free flap has been described in men and provides a minimal functional and cosmetic impact. This study aimed to assess the feasibility of the EPA free flap in women for buccopharyngeal reconstruction. METHODS A dissection of the inguinal region was performed bilaterally on fresh female cadavers. The anatomy of the EPA and its angiosome were described, along with the design of the EPA free flap. A computed tomography angiographic study of the flap perfusion was performed. RESULTS Fourteen cadavers were dissected. The EPA was constant. Its diameter ranged from 1.12 to 2.96 mm (median 2.0 mm). The mean area of its angiosome was 167.3 ± 38.5 cm2. An axial fasciocutaneous flap was designed with a horizontal skin paddle measuring on average 9.2 × 6 cm and a pedicle length of 8.4 ± 1.9 cm. The mean flap thickness was 11.7 ± 6.8 mm and depended on individual factors. A primary closure was achieved in all cases with a scar hidden in the underwear. CONCLUSIONS This anatomical study demonstrates that the EPA seems constant despite variations in its origin pattern. Its diameter and angiosome allow the design of an EPA free flap in women. A clinical study should confirm that this flap is suitable for the repair of buccopharyngeal defects and could be added to the armamentarium of the head and neck reconstructive surgeon.
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Affiliation(s)
- Bastien Benbassat
- Department of Otorhinolaryngology and Head and Neck surgery, Toulouse University Hospital, Hôpital Larrey, 24 chemin de Pouvourville, 31400 Toulouse, France
| | - Elodie Chantalat
- Department of Anatomy, Toulouse University Hospital, 133 route de Narbonne, 31400 Toulouse, France
| | - Emilien Chabrillac
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Claudius Regaud, University Cancer Institute Toulouse - Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Mathieu Roumiguie
- Department of Urology, Toulouse University Hospital, Hôpital Rangueil, 1 avenue du Professeur Jean Poulhès, 31400 Toulouse, France
| | - Guillaume De Bonnecaze
- Department of Anatomy, Toulouse University Hospital, 133 route de Narbonne, 31400 Toulouse, France
| | - Benjamin Vairel
- Department of Otorhinolaryngology and Head and Neck surgery, Toulouse University Hospital, Hôpital Larrey, 24 chemin de Pouvourville, 31400 Toulouse, France
| | - Jérôme Sarini
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Claudius Regaud, University Cancer Institute Toulouse - Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Sébastien Vergez
- Department of Otorhinolaryngology and Head and Neck surgery, Toulouse University Hospital, Hôpital Larrey, 24 chemin de Pouvourville, 31400 Toulouse, France
| | - Agnès Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Claudius Regaud, University Cancer Institute Toulouse - Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France.
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16
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A Novel Design of V-shaped Radial Forearm Free Flap Facilitates the Direct Closure of Donor Site Wound. J Craniofac Surg 2021; 32:1136-1139. [PMID: 33181617 DOI: 10.1097/scs.0000000000007211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The radial forearm free flap (RFFF) is one of the commonly used flaps in the repair of head and neck soft tissue defects, especially small and medium-sized defects. The free skin grafts from abdomen are usually used to repair the RFFF donor site wound. This study aims to design a novel V-shaped RFFF, hoping that it might facilitate the direct closure of the forearm donor site wound. From August to December in 2019, 20 patients with oral cancers received radical surgeries, and V-shaped RFFFs were designed to repair the soft defects and the forearm donor site wound was directly closed. The patients were followed up for 6 months to assess the final outcome of repair. The results showed that the pre-designed V-shaped RFFF met the needs of soft tissue defect repair, with the size ranging from 24 cm2 to 30 cm2. Fifteen patients with tongue cancers and four with buccal cancers had satisfactory repair results, and only one patient with buccal cancer had mild limitation of mouth opening. There were 3 patients with a small area of ischemia. The mean postoperative hospital stay was 13.85 ± 1.09 days. In 5 patients, wrist tilt motility decreased compared with that before surgery. The postoperative influence score of wrist exercise on daily life was 2.75 ± 0.44 points. In conclusion, the V-shaped RFFF can meet the needs of small and medium-sized defect repair. This novel design can directly close the forearm donor site wound, which avoids surgical trauma to secondary donor site, and significantly reduces related complications.
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17
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Goey R, van Drunen B, van der Linden E, van Merkesteyn JR. Fracture of the tibia after a fibula graft for mandibular reconstruction: A rare complication, report of a case. Clin Case Rep 2021; 9:e03987. [PMID: 34084479 PMCID: PMC8142795 DOI: 10.1002/ccr3.3987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 12/03/2022] Open
Abstract
A tibia fracture after a fibula harvest is a rare and serious condition; however, when treated adequately, it has a good outcome. The possibility of a fracture should be kept in mind and other pathology and/or metastasis should be ruled out.
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Affiliation(s)
- Ru‐shan Goey
- Department of Oral and Maxillofacial SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Bert van Drunen
- Department of Plastic SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Enrike van der Linden
- Department of Orthopedic SurgeryLeiden University Medical CentreLeidenThe Netherlands
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18
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Roof S, Ferrandino R, Eden C, Khelemsky Y, Teng M, Genden E, DeMaria S, Miles BA. Local infusion of ropivacaine for pain control after osseous free flaps: Randomized controlled trial. Head Neck 2021; 43:1063-1072. [PMID: 33619855 DOI: 10.1002/hed.26562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/04/2020] [Accepted: 11/18/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Donor site pain after osteocutaneous free flap surgery contributes to postoperative morbidity and impairs recovery. We evaluated the efficacy of local infusion of ropivacaine for treating donor-site pain after surgery. METHODS We conducted a randomized, double-blind, placebo-controlled trial of patients undergoing osteocutaneous fibula or scapular tip free flaps for head and neck reconstruction at Mount Sinai Hospital. Patients were randomized to receive local infusion of ropivacaine or saline. We compared Visual Analog Scale pain scores for donor-site specific pain 48 hours after surgery. RESULTS There were 8 fibular free flap and 10 scapular free flap reconstructions. Average donor-site pain scores were 29 ± 22 and 31 ± 28 mm (P = .88) for placebo and ropivacaine arms, respectively. The trial was stopped after the planned interim analysis for futility of the intervention. CONCLUSIONS Local infusion of ropivacaine did not affect donor-site specific pain scores in this population. ClinicalTrials.gov Identifier: NCT03349034.
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Affiliation(s)
- Scott Roof
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Rocco Ferrandino
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Caroline Eden
- Department of Anesthesiology, Columbia University Medical Center, New York City, New York, USA
| | - Yury Khelemsky
- Department of Anesthesiology, Mount Sinai Hospital, New York City, New York, USA
| | - Marita Teng
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Eric Genden
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Mount Sinai Hospital, New York City, New York, USA
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
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19
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Kaleem A, Patel N, Schubert E, Tursun R. Use of soleus musculocutaneous perforator-based propeller flap for lower extremity wound coverage after osteocutaneous fibula free flap harvest. Microsurgery 2020; 41:233-239. [PMID: 33325593 DOI: 10.1002/micr.30692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Osteocutaneous fibula free flap (OCFFF) donor sites are often covered with skin grafts, with an additional donor site, more postoperative care, and increased cost. The authors examine posterior tibial artery (PTA) based pedicled propeller flaps (PPF) as an alternative for OCFFF donor site coverage. PATIENTS AND METHODS Retrospective review of 16 consecutive patients from 30 to 79 years old, who underwent OCFFF reconstruction of head and neck defects (11 mandibular, 5 maxillary), with the closure of donor site with PPF based on a perforator from PTA. Mean donor site defect measured 12.9 × 5.1 cm, PPF was an elliptical design, and rotated 180 degrees in a propeller fashion, to cover donor site defect. Visual analog scale (VAS) was used to assess esthetic results, functional outcomes assessed using mobility and range of motion (ROM), and secondary complications including infections, hematomas, and seromas were recorded. Follow-up period was noted in months postoperatively. Other information collected included underlying head and neck pathology. RESULTS Average dimension of PPF measured 13.9 × 4.1 cm. Successful closure of donor site defects in 14 of 16 patients, with two flaps having partial necrosis, one requiring a secondary skin graft. Follow-up was 6 to 10 months, esthetic results with mean VAS 8.8 of 10, full ROM, and mobility noted. No secondary complications were observed. The most common pathology noted was squamous cell carcinoma (6 of 16 patients). CONCLUSION PPFs based on the soleus branch of the PTA represent an excellent alternative to skin grafts for the closure of OCFFF donor site defects.
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Affiliation(s)
- Arshad Kaleem
- DeWitt Daughtry Family Department of Surgery, Division of Oral and Maxillofacial Surgery, Section of Head and Neck Surgical Oncology/Microvascular Reconstructive Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Miami, Florida, USA
| | - Neel Patel
- DeWitt Daughtry Family Department of Surgery, Division of Oral and Maxillofacial Surgery, Section of Head and Neck Surgical Oncology/Microvascular Reconstructive Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Miami, Florida, USA
| | - Enrique Schubert
- DeWitt Daughtry Family Department of Surgery, Division of Oral and Maxillofacial Surgery, Section of Head and Neck Surgical Oncology/Microvascular Reconstructive Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Miami, Florida, USA
| | - Ramzey Tursun
- DeWitt Daughtry Family Department of Surgery, Division of Oral and Maxillofacial Surgery, Section of Head and Neck Surgical Oncology/Microvascular Reconstructive Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Miami, Florida, USA
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20
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Harris BN, Ghazizadeh S, Bayon R, Kejner AE, Cannady SB, Greene BJ, Huang AT, Curry J, Blackwell KE, Ducic Y, Wax MK. Safety of fibula free flap in patients following total knee replacement. Head Neck 2020; 43:585-589. [PMID: 33089587 DOI: 10.1002/hed.26519] [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: 04/29/2020] [Revised: 07/21/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total knee arthroplasty [TKA]). METHODS Multi-institutional review of outcomes following FFF in patients who had prior TKA. RESULTS Ten surgeons reported successful FFF in 53 patients with prior TKA. The most common preoperative imaging was a CT angiogram of the bilateral lower extremities. There was no evidence of intraoperative vascular abnormality. Physical therapy began between postoperative day 1 to postoperative day 3. At 1 month postoperatively, 40% of patients were using a cane or walker to ambulate, but by 3 months all had returned to baseline ambulatory status. At >1 year, there were no gait complications. CONCLUSION FFF appears safe in patients with prior knee replacement without an increased risk of complications compared to baseline.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology - Head and Neck Surgery, Scripps Health, San Diego, California, USA
| | - Shabnam Ghazizadeh
- Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rodrigo Bayon
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Alexandra E Kejner
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Steven B Cannady
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin J Greene
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama, Birmingham, Alabama, USA
| | - Andrew T Huang
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Curry
- Department of Otolaryngology - Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Keith E Blackwell
- Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| | - Mark K Wax
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
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21
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Calotta NA, Chandawarkar A, Desai SC, Dellon AL. An Algorithm for the Prevention and Treatment of Pain Complications of the Radial Forearm Free Flap Donor Site. J Reconstr Microsurg 2020; 36:680-685. [PMID: 32726818 DOI: 10.1055/s-0040-1714149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The radial forearm free flap (RFFF) is a staple of microsurgical reconstruction. Significant attention has been paid to donor-site morbidity, particularly vascular and aesthetic consequences. Relatively few authors have discussed peripheral nerve morbidity such as persistent hypoesthesia, hyperesthesia, or allodynia in the hand and wrist or neuroma formation in the wrist and forearm. Here, we present a diagnostic and therapeutic algorithm for painful neurologic complications of the RFFF donor site. MATERIALS AND METHODS The peripheral nerves that can be involved with the RFFF are reviewed with respect to the manner in which they may be involved in postoperative pain manifestations. A method for prevention and for treatment of each of these possibilities is also presented. RESULTS Nerves from the forearm that can be harvested with the RFFF will have the most likelihood for injury and these include the lateral antebrachial cutaneous nerve, the radial sensory nerve, and the medial antebrachial cutaneous nerve. A nerve that may be injured at the distal juncture of the skin graft to the forearm is the palmar cutaneous branch of the median nerve. The "prevention" portion of the algorithm suggests that each nerve divided to become a recipient nerve should have its proximal end implanted into a muscle to prevent painful neuroma. The "treatment" portion of the algorithm suggests that if a neuroma does form, it should be resected, not neurolysed, and the proximal portion should be implanted into an adjacent muscle. The diagnostic role of nerve block is emphasized. CONCLUSION Neurological complications following RFFF can be prevented by an appropriate algorithm as described by devoting attention to the proximal end of recipient nerves. Neurological complications, once present, can be difficult to diagnose accurately. Nerve blocks are critical in this regard and are employed in the treatment algorithm presented.
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Affiliation(s)
- Nicholas A Calotta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Akash Chandawarkar
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shaun C Desai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Dellon Institutes for Peripheral Nerve Surgery, Baltimore, Maryland
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Eldenburg E, Pfaffenberger M, Gabriel A. Closure of a Complex Lower Extremity Wound With the Use of Multiple Negative Pressure Therapy Modalities. Cureus 2020; 12:e9247. [PMID: 32821593 PMCID: PMC7430689 DOI: 10.7759/cureus.9247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Complex lower extremity wounds can present challenges in healing due to the cause of injury or previous surgery, presence of infection or tissue necrosis, patient comorbidities, or a combination of these factors. Negative pressure wound therapy (NPWT) modalities play a major role in the perioperative management of patients with complex wounds and their adjunctive use continues to evolve with time. In this case study, we discuss the use of adjunctive NPWT with instillation and dwell time (NPWTi-d) and closed incision negative pressure therapy (ciNPT) to assist with the management of a complex lower extremity wound. The patient was a 25-year-old female who presented with an actively draining Morel-Lavallée lesion of the left lateral thigh that she had previously sustained after being struck by a motor vehicle as a pedestrian. She was initially evaluated and admitted for the avulsion injury approximately two weeks prior to this and had a drain placed at that time. However, due to issues with compliance, she had not been re-evaluated. She now presented with a suspected infection of her left lower extremity, and was thus admitted, placed on intravenous cefazolin and underwent several rounds of excisional debridement and irrigation. The patient was then managed operatively by the plastic surgery service. This care included three rounds of tissue advancement, followed by a seven-day course of NPWTi-d. Cycles consisted of normal saline instillation with a one-second dwell time, followed by six hours of continuous negative pressure at −125 mm Hg. The patient was then taken back for a final round of reconstruction with tissue advancement. A split-thickness skin graft was used at that time to cover the remaining area of the wound that the advancement could not close. A seven-day course of ciNPT (PREVENA RESTOR BELLA•FORM™ System; 3M + KCI, San Antonio, TX) was then applied to manage the incisions and bolster the graft. This was followed by simple dressing changes several times weekly for four weeks. In this case, we demonstrate how the adjunctive use of multiple NPWT modalities resulted in a completely healed wound within two months, without any major complications.
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Successful Salvage of a Lower Extremity Local Flap Using Multiple Negative Pressure Modalities. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2801. [PMID: 32766028 PMCID: PMC7339255 DOI: 10.1097/gox.0000000000002801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/04/2020] [Indexed: 12/28/2022]
Abstract
Wounds from orthopedic limb reconstruction are often difficult to heal due to the surgery, patient comorbidities, or a combination of these factors. The role of negative pressure wound therapy (NPWT) modalities in the perioperative management of patients with complex lower extremity wounds is evolving. Here, we present a case study using adjunctive NPWT with instillation and a dwell time, standard NPWT, and closed-incision negative pressure therapy (ciNPT) to manage a complex lower extremity wound. The patient was a 51-year-old man who presented with severe scarring of the lower extremity and infection following plate osteosynthesis of a tibial shaft fracture. Following lower extremity reconstruction, the patient received 5 days of NPWT with instillation and a dwell time with cycles that consisted of instilling normal saline with a 1-second dwell time, followed by 2 hours of continuous negative pressure at −125 mm Hg. The wound is then covered with an adjacent local tissue flap, which showed signs of vascular complication. ciNPT is applied over the flap incision for 7 days, which resulted in restored normal coloration; ciNPT is continued for another 7 days. A skin substitute is applied over the flap donor site, followed by NPWT using a silver foam dressing. Dressing changes are performed weekly for 4 weeks. At 8 weeks postsurgery, a skin graft is applied over the donor site. In this case, adjunctive use of multiple NPWT modalities resulted in a completely healed wound within 12 months with no complications.
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Sallent A, Soza D, Duarri G, Busquets R. Checkrein deformity: a case report of two patients with hallux deformity and pain following mandibular reconstruction in oral cancer treatment. Oral Maxillofac Surg 2020; 24:359-362. [PMID: 32500381 DOI: 10.1007/s10006-020-00852-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Checkrein deformity is an uncommon disease with a well-described etiology. It is characterized by a dynamic deformity of the hallux or great toe. We report two cases of checkrein deformity due a fibular graft harvesting in two patients with a mandibular bone defect secondary to an oral cancer treatment. CASE REPORT We report two young patients with mandibular cancers that had been treated several years before our visit and were currently free of disease. The patients had a mandibular bone defect due to the maxillofacial treatment, solved with a free fibular graft. The current complaint was a great toe deformity that caused pain and made them walk with difficulties. Diagnosis was a checkrein deformity, and after a surgical release of the flexor hallucis longus tendon, both cases returned to normal activities with no walking limitations. CONCLUSION Our cases highlight that an accurate patient examination is warranted following these reconstructions as many of them can be misdiagnosed, and a relatively simple surgery can improve the patients' limitations.
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Affiliation(s)
- Andrea Sallent
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain.
| | - Diego Soza
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
| | - Gemma Duarri
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
| | - Rosa Busquets
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
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25
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David AP, Heaton C, Park A, Seth R, Knott PD, Markey JD. Association of Bolster Duration With Uptake Rates of Fibula Donor Site Skin Grafts. JAMA Otolaryngol Head Neck Surg 2020; 146:537-542. [PMID: 32297916 DOI: 10.1001/jamaoto.2020.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The fibula free flap donor site is associated with both short-term and long-term morbidity. Split-thickness skin graft (STSG) loss can lead to long delays in donor site healing and is associated with significant adverse sequelae. Patients may experience initial good STSG uptake after bolster removal but may have subsequent partial or total loss related to contact pressure or shearing. Objective To determine if increased duration of bolster use is associated with increased STSG uptake rates following fibula free flap reconstruction. Design, Setting, and Participants This retrospective cohort study included patients 18 years and older undergoing fibula free flap reconstruction following head and neck extirpative surgery at a tertiary care academic medical center from May 2013 to March 2019. The donor sites were photographed 4 weeks postoperatively, and areas of graft uptake were measured using image processing software. The baseline demographic, comorbidity, and operative characteristics were also collected. Interventions A fine mesh gauze with 3% bismuth tribromophenate and petrolatum blend bolster was sutured over leg STSGs placed on fibula free flap donor sites intraoperatively, and the ankle and lower leg were immobilized for 5 days in a plaster splint. Bolsters were either removed on postoperative day 5 or 14. Thereafter, the STSGs were covered with a petroleum and bismuth gauze and a cotton dressing. Main Outcomes and Measures Rates of donor site infection and STSG percentage uptake at 4 weeks. Results Of the 42 included patients, 31 (74%) were male, and the mean (SD) age was 62.1 (13.1) years. A total of 20 patients were included in the 5-day group, and 22 were included in the 14-day group. The 14-day bolster group had a higher mean percentage skin graft uptake rate compared with the 5-day bolster duration group (77.5% vs 59.9%), with an effect size of -0.632 (95% CI, -1.260 to -0.004). Patients with Adult Comorbidity Evalution-27 scores of 3 had poorer rates of STSG uptake compared with patients with Adult Comorbidity Evalution-27 scores of 0 to 2 (65.9% vs 82.9%), with an effect size of 0.599 (95% CI, -0.191 to 1.389). No donor site infections were noted in either group. Conclusions and Relevance Fourteen-day bolster application to the fibula free flap donor site was associated with better STSG uptake rates than 5-day bolster application.
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Affiliation(s)
- Abel P David
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Chase Heaton
- Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Andrea Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Jeffrey D Markey
- Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, New York
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Melville JC, Tran HQ, Bhatti AK, Manon V, Young S, Wong ME. Is Reconstruction of Large Mandibular Defects Using Bioengineering Materials Effective? J Oral Maxillofac Surg 2019; 78:661.e1-661.e29. [PMID: 31883442 DOI: 10.1016/j.joms.2019.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE Clinical tissue engineering has revolutionized surgery by improving surgical efficiency and decreasing the risks associated with traditional bone graft procurement techniques. Compared with autogenous bone grafts, composite tissue-engineered grafts fulfill the principles of osteoconduction, osteoinduction, and osteogenesis and provide adequate bone volume for maxillofacial reconstruction with less morbidity. The present study aimed to demonstrate the effectiveness, as defined by our success criteria, of a composite tissue-engineered bone graft in the reconstruction of mandibular defects. PATIENTS AND METHODS We implemented a retrospective case series and enrolled a sample of patients with mandibular defects that had been reconstructed using allogeneic bone combined with recombinant human bone morphogenic protein-2 and bone marrow aspirate concentrate at our institution during a 5-year period. The success criteria were as follows: 1) bone union, defined as a homogenous radiopaque pattern continuous with native bone without mandibular mobility; and 2) volume of grafted bone adequate for implant placement, defined as at least 1.0 cm (height) by 0.8 cm (width). Clinical examinations and computed tomography scans were performed at 6 months postoperatively. Descriptive statistics were computed for each variable. RESULTS From 2014 to 2019, tissue engineering reconstruction was used in 31 patients with and 3 patients without mandibular continuity defects, for a total of 34 patients. The median follow-up was 6 months. The mean length of the continuity defects was 5.5 cm (range, 1.0 to 12.5). Of the 30 patients with mandibular continuity defects, 27 achieved success according to our criteria, with an average gained height of 2.12 ± 0.64 cm and width of 1.53 ± 0.46 cm. Of the 34 patients, 1 was lost to follow-up, and treatment failed in 3 patients. CONCLUSIONS Although the use of autogenous graft remains the reference standard, the evolving science behind clinical tissue engineering has resulted in an effective treatment modality for complex head and neck defects with less morbidity and graft material equal to that of autogenous bone.
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Affiliation(s)
- James C Melville
- Associate Professor, Department of Oral, Head and Neck Oncology and Microvascular Reconstructive Surgery, and Internship Director, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, Houston, TX.
| | - Huy Q Tran
- Postgraduate Year 5 Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Arsalan K Bhatti
- Postgraduate Year 1 Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Victoria Manon
- Postgraduate Year 2 Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Simon Young
- Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Mark E Wong
- Professor and Bernard and Gloria P. Katz Chair, Department of Oral and Maxillofacial Surgery, and Director of Residency Training, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
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Potet P, De Bonnecaze G, Chabrillac E, Dupret-Bories A, Vergez S, Chaput B. Closure of radial forearm free flap donor site: A comparative study between keystone flap and skin graft. Head Neck 2019; 42:217-223. [PMID: 31621986 DOI: 10.1002/hed.25977] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim was to investigate the feasibility of radial forearm free flap (RFFF) donor site closure by keystone flap (KF) and compare its outcomes to those of skin graft (SG) closure. METHODS One hundred and one patients who underwent RFFF for head and neck reconstruction were included (35 KF closure and 65 SG closure). Duration of wound healing and donor site complications was collected. After a minimal follow-up of 1 year, patients were questioned about functional and esthetic impairment. RESULTS Coverage of donor site by KF was successful in all cases. The duration of wound healing was longer after SG than after KF (32 days vs 18 days, P < .001). Healing complications, esthetic and functional results were not statistically different. CONCLUSION Forearm donor site closure by KF is a feasible alternative to the traditional SG. Its main advantages are the reduced wound healing time and the avoidance of a second donor site.
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Affiliation(s)
- Pauline Potet
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
| | - Guillaune De Bonnecaze
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
| | - Emilien Chabrillac
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
| | - Agnès Dupret-Bories
- Department of surgery, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Sébastien Vergez
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France.,Department of surgery, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Benoit Chaput
- Department of Plastic and Aesthetic Surgery, Toulouse University Hospital, Hôpital Rangueil, Toulouse, France
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Liu M, Yang Y, Zhang Y, Yang X, Hu D. Surgical Reconstruction of Complex Distal Foot Defects With Vascularized Fascia Lata. Ann Plast Surg 2019; 84:525-528. [PMID: 31609252 PMCID: PMC7357543 DOI: 10.1097/sap.0000000000002115] [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: 11/25/2022]
Abstract
Reconstruction of distal foot defect remains a challenge in plastic surgery. The purpose of this report is to present a new procedure that repairs these defects in severe burn patients. Results of application and follow-up in 7 patients were presented.
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Affiliation(s)
- Mengdong Liu
- From the Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an
| | - Yunshu Yang
- From the Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an
| | - Yong Zhang
- Department of Burns Surgery, The Second People's Hospital of Xinxiang, Henan, China
| | - Xuekang Yang
- From the Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an
| | - Dahai Hu
- From the Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an
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Morgan PF, Hornig JD, Momin SR, Albergotti WG, Brody RM, Graboyes EM. Perforator‐based propeller flap for fibula free flap donor site repair: A novel surgical technique. Laryngoscope 2019; 130:1233-1235. [DOI: 10.1002/lary.28232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Patrick F. Morgan
- Department of Otolaryngology–Head & Neck SurgeryMedical University of South Carolina Charleston South Carolina
| | - Joshua D. Hornig
- Department of Otolaryngology–Head & Neck SurgeryMedical University of South Carolina Charleston South Carolina
| | - Suhael R. Momin
- Department of Otolaryngology–Head and Neck SurgeryHenry Ford Health System Detroit Michigan
| | - William G. Albergotti
- Department of Otolaryngology–Head and Neck SurgeryMedical College of Georgia at Augusta University Augusta Georgia
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of Pennsylvania Philadelphia Pennsylvania United States
| | - Evan M. Graboyes
- Department of Otolaryngology–Head & Neck SurgeryMedical University of South Carolina Charleston South Carolina
- Hollings Cancer CenterMedical University of South Carolina Charleston South Carolina
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Fang H, Liu F, Sun C, Pang P. Impact of wound closure on fibular donor-site morbidity: a meta-analysis. BMC Surg 2019; 19:81. [PMID: 31277627 PMCID: PMC6612155 DOI: 10.1186/s12893-019-0545-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Vascularized free fibular flaps have been the “workhorses” for reconstruction of many kinds of bone defects. Nevertheless, there is no consensus regarding the optimal wound closure method for fibular donor sites. This study aimed to compare prognostic outcomes of primarily closures (PC) and skin grafts (SG) for fibular donor sites. Methods Studies regarding donor-site outcomes of PC versus SG in patients undergoing free fibular flap procedures were included. Two authors individually searched PubMed, Web of Science, EMBASE, Cochrane Library and clinicaltrials.gov up to February 2019, extracted the data and assessed quality of each selected article. Ultimately, The incidences of donor-site morbidities were evaluated. Results Five studies with a total of 119 patients were included in our analysis. No significant differences were found with respect to the rates of donor-site problems between the PC and SG groups. Conclusions Fibular flap patients undergoing PC and SG wound closures may have similar donor-site outcomes. Additional large-scale studies are necessary to draw a solid conclusion. Electronic supplementary material The online version of this article (10.1186/s12893-019-0545-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui Fang
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China
| | - Fayu Liu
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China
| | - Changfu Sun
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Pai Pang
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China.
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Clark JM, Rychlik S, Harris J, Seikaly H, Biron VL, O'Connell DA. Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy. J Otolaryngol Head Neck Surg 2019; 48:21. [PMID: 31113481 PMCID: PMC6528371 DOI: 10.1186/s40463-019-0344-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background Donor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD. Methods Adult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications. Results Twenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively (P = 0.016). Flexion at seven days was improved in NPD group (P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation. Conclusions In the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.
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Affiliation(s)
- Jessica M Clark
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada
| | - Shannon Rychlik
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Daniel A O'Connell
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada. .,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada.
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Longo B, Sorotos M, Laporta R, Santanelli di Pompeo F. Aesthetic improvements of radial forearm flap donor site by autologous fat transplantation. J Plast Surg Hand Surg 2018; 53:51-55. [PMID: 30442054 DOI: 10.1080/2000656x.2018.1537977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite its reliability, radial forearm (RF) flap is still affected by high donor site morbidity with poor cosmetic and functional outcomes after coverage with skin grafts. Having fat grafting demonstrated promising and effective filling and rejuvenating properties, we considered and tested it as a valuable alternative to dermal substitutes for the aesthetic improvement of RF flap donor site. Thirty-three patients with previous RF free flap reconstruction and poor donor site outcomes after full-thickness skin grafting to RF region were evaluated for secondary fat injection to improve outcomes. Objective and subjective assessments of results with standardized ultrasonographic soft tissue thickness measurements, cutaneous sensibility tests with the pressure-specified sensory device and scar assessment scale (POSAS) have been performed. Bivariate statistical analyses were performed comparing outcomes with contralateral healthy forearm. All cases showed significant improvement in soft tissue thickness (p< 0.031), cutaneous sensibility and scar appearance, with improved patient's and observers' scar assessment scores (<0.001). In conclusion, fat transplantation is an effective procedure that provided us with an adjunctive autologous layer in-between skin graft and underlying fascia, as well as a rejuvenating effect on skin and scars.
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Affiliation(s)
- Benedetto Longo
- a Plastic Surgery Unit , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy
| | - Michail Sorotos
- a Plastic Surgery Unit , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy
| | - Rosaria Laporta
- a Plastic Surgery Unit , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy
| | - Fabio Santanelli di Pompeo
- a Plastic Surgery Unit , Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome , Rome , Italy
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Di Giuli R, Zago M, Beltramini GA, Pallotta ML, Bolzoni A, Baj A, Giannì AB, Sforza C. Donor-Site Morbidity After Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Gait Performance. J Oral Maxillofac Surg 2018; 77:648-657. [PMID: 30481496 DOI: 10.1016/j.joms.2018.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose was to evaluate donor-site clinical morbidity and changes in kinematic gait parameters after the harvest of a vascularized free fibula flap for facial reconstruction. MATERIALS AND METHODS We enrolled 14 patients (aged 50 ± 15 years) in a longitudinal study. Every patient underwent a double evaluation in which a presurgical assessment and 6-month postsurgical assessment were performed. Subjective donor-site evaluation was carried out through unstructured clinical questioning about pain, paresthesia, walking ability, and restrictions in activity. Further subjective evaluations were assessed through the Western Ontario and McMaster Universities Osteoarthritis Index and the Point Evaluation System for Lower Extremity Fibulectomy. A clinical evaluation of the donor site assessed muscular deficits, sensibility disturbance, and wound healing. Temporal and spatial kinematic parameters were measured through gait analysis during overground walking at a comfortable speed. RESULTS Postsurgical clinical examinations detected 1 patient affected by a neurologic disorder and 3 patients with donor-site pain, whereas 10 patients (71%) declared no residual alterations in the operated leg. On average, the Western Ontario and McMaster Universities Osteoarthritis Index score was 367 of 2,400, and the Point Evaluation System for Lower Extremity Fibulectomy score was 19 of 24. Presurgical versus postsurgical gait analysis comparison showed no significant differences in gait parameters except for a 6% reduction in the double-support phase. Stance values were higher for the operated limb in both evaluations (+1.3% before surgery, +1.8% after surgery). No alterations were detected in the range of motion of the lower-limb joints. CONCLUSIONS Considering the slight modification of the gait pattern, which is not usually perceived by patients, vascularized free fibula flap harvest was generally associated with successful functional and subjective outcomes of the donor site.
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Affiliation(s)
- Riccardo Di Giuli
- Resident, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Matteo Zago
- Postdoctoral Student, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giada A Beltramini
- Research Associate, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maria Ludovica Pallotta
- Resident, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandro Bolzoni
- Research Associate, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Baj
- Adjunct Professor, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Aldo Bruno Giannì
- Professor and Unit Head, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; and Director, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Chiarella Sforza
- Professor, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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Morbidity of donor flaps from the lower limbs. Br J Oral Maxillofac Surg 2018; 56:766-768. [DOI: 10.1016/j.bjoms.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
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35
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Zirk M, Zalesski A, Peters F, Dreiseidler T, Buller J, Kreppel M, Zöller JE, Zinser M. Prevention and management of bacterial infections of the donor site of flaps raised for reconstruction in head and neck surgery. J Craniomaxillofac Surg 2018; 46:1669-1673. [DOI: 10.1016/j.jcms.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/01/2022] Open
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Pabst A, Werkmeister R, Steegmann J, Hölzle F, Bartella A. Is there an ideal way to close the donor site of radial forearm free flaps? Br J Oral Maxillofac Surg 2018; 56:444-452. [DOI: 10.1016/j.bjoms.2018.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/15/2018] [Indexed: 10/16/2022]
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