1
|
Piette E, Sounthakith V, Picard A, Couloigner V, Drabent P, Honart JF, Cordero C, Orbach D. Latissimus dorsi free flap reconstruction of a temporal defect following pediatric oncologic surgery: Case report + literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 125:101704. [PMID: 38030124 DOI: 10.1016/j.jormas.2023.101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children and adolescents. Around 35 % of pediatric sarcomas occur in the head and neck region. Consequently, RMS is considered the most common type of childhood malignancy diagnosed in this region. OBSERVATION We report the clinical case of a 6 years old patient, who presented a large temporal hollowing following oncological excision surgery for temporal rhabdomyosarcoma. He underwent surgical reconstruction to fill the right temporalis fossa using a latissimus dorsi muscle free flap micro-anastomosed to the lingual vessels. DISCUSSION This clinical case highlights the value of plastic surgery in oncological reconstruction, which, combined with a multidisciplinary and collective approach, enables a holistic approach and facilitates socio-psychological integration after oncological surgery in the pediatric population.
Collapse
Affiliation(s)
- Estelle Piette
- Maxillo-Facial and Plastic Surgery Department, Necker Children Hospital, AP-HP, 149, rue de Sèvres, Paris 75015, France.
| | - Vincent Sounthakith
- Maxillo-Facial and Plastic Surgery Department, Necker Children Hospital, AP-HP, 149, rue de Sèvres, Paris 75015, France; Medicine School, Paris-Cité University, France
| | - Arnaud Picard
- Maxillo-Facial and Plastic Surgery Department, Necker Children Hospital, AP-HP, 149, rue de Sèvres, Paris 75015, France; Medicine School, Paris-Cité University, France
| | - Vincent Couloigner
- Medicine School, Paris-Cité University, France; Head and Necker Surgery Department, Necker Children Hospital, AP-HP, Paris, France
| | - Philippe Drabent
- Medicine School, Paris-Cité University, France; Department of Pathology, Necker Children Hospital, AP-HP, Paris, France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery, Institut Gustave Roussy, Paris, France
| | - Camille Cordero
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France
| |
Collapse
|
2
|
Outcomes in Pediatric Maxillofacial Reconstruction With Vascularized Fibular Flaps: A Systematic Review. J Craniofac Surg 2022; 33:1346-1351. [PMID: 35184106 DOI: 10.1097/scs.0000000000008511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the complications and outcomes after maxillofacial reconstruction using the free fibular flap in the pediatric population. METHODS A systematic review and descriptive analysis were conducted using data variables, including study characteristics; patient characteristics; postoperative complications (major and minor); surgical revision; and dental rehabilitation. RESULTS The systematic review resulted in 1622 articles, 55 of which met inclusion criteria for this study. The 55 articles consisted of 17 case series and 38 case reports with level III/IV and level V of evidence, respectively. Of the 155 identified pediatric patients, the rate of major complications was 13.5% and minor complications was 24.5%. The most common complication was mild growth distortion (n = 7) at the recipient site. Complications at the donor site were less common. During follow-up, 29 patients (18.7%) underwent or awaited surgical revision, and 43 patients (27.7%) underwent or awaited dental rehabilitation. CONCLUSIONS Our study suggests that the free fibular flap for pediatric maxillofacial reconstruction is safe and reliable. Additionally, surgical revision to correct the functional impairments resulting from primary reconstruction using the free fibular flap is relatively common.
Collapse
|
3
|
Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3243. [PMID: 33299708 PMCID: PMC7722618 DOI: 10.1097/gox.0000000000003243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
Background: The etiology and treatment of complex mandibular defects in children differ markedly from those of adults, although treatment with free bone flaps is historical in both groups. While adult outcomes and complication rates are well known, few pediatric data exist, especially for patients with congenital deficiencies. This study reports early and late outcomes from a cohort of young, primarily syndromic patients undergoing microvascular mandibular reconstruction. Methods: This is a retrospective case series of patients who underwent microvascular mandibular reconstruction between 1995 and 2016. Results: Thirteen patients received a total of 13 fibula transfers and 1 medial femoral condyle transfer. Most patients carried a congenital diagnosis (77%), and the average age during surgery was 11.7 ± 5.7 years. The median (interquartile range) [IQR] length of follow-up was 6.3 (5.7) years. There was a 100% flap survival rate, although 86% of all patients experienced at least one complication. Half of all procedures resulted in an early complication. Nine patients (69%) developed late complications, of which temporal mandibular joint ankylosis was the most common (n = 5; 38%). Conclusions: This study is one of few detailing outcomes following mandibular reconstruction by free flap transfer in pediatric patients. These patients were primarily syndromic with appreciable complication rates higher than in other adult and pediatric studies. Some complications are manageable or self-resolving, but others lead to functional problems that may require late operative interventions to correct. Microsurgical treatment should be reserved for children with large, complex mandibular defects when other options are unavailable or have been exhausted.
Collapse
|
4
|
One-Step Lower Leg Reconstruction with Vascularized Functional Vastus Lateralis Muscle Flap in the Treatment of Embryonal Rhabdomyosarcoma for a Six-Month-Old Boy: A Case Report. ACTA ACUST UNITED AC 2020; 56:medicina56070362. [PMID: 32708209 PMCID: PMC7404637 DOI: 10.3390/medicina56070362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
Rhabdomyosarcoma (RMS) is a common soft tissue sarcoma in childhood, however, it is very rare in the neonatal period (0.4-2% of cases). This case depicts a boy, who presented with RMS at two weeks of age, but officially diagnosed at the age of three months. MRI and scintigraphy determined a soft tissue tumor in the soleus muscle, while biopsy confirmed embryonal RMS with high mitotic activity (Ki67 (monoclonal antibodies) ~80%). CWS (Cooperative Weichteilsarkom Studiengruppe)-2012 with I2VA (ifosfamide, vincristine, actinomycin) chemotherapy regimen was administered per protocol. Surgical treatment was performed at age of six months and 18 days. The operation consisted of radical tumor resection and total triceps surae with partial fibula resection. Immediate reconstruction of triceps muscle was accomplished using a vascularized functional musculocutaneous vastus lateralis flap. Functional outcome was measured using the Lower Extremity Functional Scale (LEFS) and the Foot and Ankle Outcome Score (FAOS) with the results of 92.5% and 99% respectively.
Collapse
|
5
|
Askerov ED, Topolnitsky OZ, Zayratyants OV. Anatomical features of the extensor digitorum brevis muscle as a plastic material in reconstructive surgery of facial paralysis. Pediatr Dent 2020. [DOI: 10.33925/1683-3031-2020-20-2-84-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Relevance. Facial paralysis is a common neurological illnesses of the maxillofacial region. Gold standard of dynamic correction of permanent facial paralysis is gracilis muscle transfer. However, using this flap is impractical or impossible in some cases. There are few domestic and international publications about extensor digitorum brevis muscle for facial reanimation surgery.Purpose. Assessment of muscle variability on the dorsum of the foot; analysis of blood supply and innervation of the extensor digitorum brevis muscle.Materials and methods. Operations performed on 10 unclaimed corpses: dissection of the extensor digitorum brevis muscle, as well as the blood vessels and nerves of the dorsum of the foot. The legal and ethical requirements for such studies were observed planning the design of the study and during work.Results. As a result, in 80% of cases, was found a typical anatomy of muscles, blood vessels, and nerves in the dorsum of the foot. In 10% was found a typical anatomy of muscles and nerves, but there was no lateral tarsal artery – the branch of the dorsal artery of the foot. Blood supply to the extensor digitorum brevis muscle performed by perforating branches of the peroneal artery. In 10% was found subtotal atrophy and fibrous degeneration of the extensor digitorum brevis muscle.Conclusions. The use of the extensor digitorum brevis muscle is a perspective method for the treatment of facial paralysis. Harvesting of this flap is complicated.
Collapse
Affiliation(s)
- E. D. Askerov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | | |
Collapse
|
6
|
Zirk M, Zalesski A, Peters F, Kreppel M, Zinser M, Zöller JE. Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis. Clin Oral Investig 2019; 24:1599-1605. [PMID: 31643002 DOI: 10.1007/s00784-019-03078-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study was designed to assess the influence of peri/post-operative antibiotic prophylaxis (POABP) and the reconstructive graft itself on recipient sites infections in head and neck surgery. MATERIALS AND METHODS In this retrospective cohort study, 322 consecutive patients with reconstructive surgery were investigated. The primary objective was to analyze the differences of commonly applied reconstructive grafts on the occurrence of oral recipient site infections. Moreover, differences of POABP regimes (namely: ampicillin/sulbactam, 2nd generation cephalosporins, clindamycin) and antibiotic alternatives were investigated. In addition, patients' length of in-hospital stay was analyzed in regard to reconstructive graft and POABP regime. RESULTS The free radial forearm flap and split-thickness skin graft presented significantly less recipient site infections and shorter length of in-hospital stays (LOS) in comparison to further six reconstructive technique with pedicled tissue transfer or bone transfers. LOS was significantly shorter for patients with ampicillin/sulbactam than with 2nd generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2nd and 3rd generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin. CONCLUSION Smaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2nd and 3rd generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin. CLINICAL RELEVANCE A combination of 2nd and 3rd generation cephalosporins may be used to prevent recipient sites in head and neck surgery.
Collapse
Affiliation(s)
- Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
| | - Artjom Zalesski
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Franziska Peters
- Department of Dermatology, University of Cologne, Cologne, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Max Zinser
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| |
Collapse
|
7
|
Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis. Clin Oral Investig 2019. [PMID: 31643002 DOI: 10.1007/s00784‐019‐03078‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study was designed to assess the influence of peri/post-operative antibiotic prophylaxis (POABP) and the reconstructive graft itself on recipient sites infections in head and neck surgery. MATERIALS AND METHODS In this retrospective cohort study, 322 consecutive patients with reconstructive surgery were investigated. The primary objective was to analyze the differences of commonly applied reconstructive grafts on the occurrence of oral recipient site infections. Moreover, differences of POABP regimes (namely: ampicillin/sulbactam, 2nd generation cephalosporins, clindamycin) and antibiotic alternatives were investigated. In addition, patients' length of in-hospital stay was analyzed in regard to reconstructive graft and POABP regime. RESULTS The free radial forearm flap and split-thickness skin graft presented significantly less recipient site infections and shorter length of in-hospital stays (LOS) in comparison to further six reconstructive technique with pedicled tissue transfer or bone transfers. LOS was significantly shorter for patients with ampicillin/sulbactam than with 2nd generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2nd and 3rd generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin. CONCLUSION Smaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2nd and 3rd generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin. CLINICAL RELEVANCE A combination of 2nd and 3rd generation cephalosporins may be used to prevent recipient sites in head and neck surgery.
Collapse
|
8
|
Hopkins B, Dean K, Appachi S, Drake AF. Craniofacial Interventions in Children. Otolaryngol Clin North Am 2019; 52:903-922. [PMID: 31353139 DOI: 10.1016/j.otc.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child's life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients.
Collapse
Affiliation(s)
- Brandon Hopkins
- Pediatric Otolaryngology, Pediatric Center for Airway Voice and Swallowing, Cleveland Clinic, 9500 Euclid Avenue, 7th Floor Crile Building, Cleveland, OH 44195, USA.
| | - Kelly Dean
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, University of North Carolina, 170 Manning Drive, CB# 7070, Chapel Hill, NC 27599-7070, USA
| | - Swathi Appachi
- Cleveland Clinic Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, 7th Floor Crile Building, Cleveland, OH 44195, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, 170 Manning Drive, CB# 7070, Chapel Hill, NC 27599-7070, USA
| |
Collapse
|
9
|
Pediatric free flap reconstruction for head and neck defects. Curr Opin Otolaryngol Head Neck Surg 2018; 26:334-339. [DOI: 10.1097/moo.0000000000000473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|