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Smith B, Rosko A, VanKoevering KK, Heft Neal M, Ellsperman S, Fenberg RB, Cho J, Vita A, Feng AL, Contrera KJ, Sridharan SS, Spector ME. 3D modeling of anterior 2/3rds glossectomy reconstruction: A volume based donor site evaluation. Oral Oncol 2024; 157:106960. [PMID: 39068767 DOI: 10.1016/j.oraloncology.2024.106960] [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: 05/20/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Anterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location. We sought to correlate flap thickness at different donor sites with patient BMI to determine optimal donor site selection. METHODS Patients with CT scans of the oral cavity, thorax and lower extremity were identified and included. The volumes of the anterior 2/3rds of the tongue were measured and recorded using computed tomography-generated modeling. Pre-muscular tissue thicknesses at anterolateral thigh (ALT), deep inferior epigastric artery (DIEP), latissimus dorsi, and parascapular donor sites were measured. The donor site adequency was defined as reconstructing the tongue volume within 10% of the ideal volume required and stratified based on patient BMI. RESULTS In 144 patients, the average anterior 2/3rds glossectomy defect was 100.3 cm3. Glossectomy defect size was highly correlated with BMI (p < 0.001). The DIEP flap had the largest volume (155.4 cm3), followed by latissimus (105.6 cm3), parascapula (97.8 cm3), and ALT (60.5 cm3). For patients with BMI ≤ 30, the DIEP flap best reconstructed native tongue volume (up to 113 % of native tongue volume). In patients with BMI > 30.1, native tongue volumes were approximated by the latissimus flap (89-92 % of native tongue) and parascapular flap (85-95 % of native tongue volume). In BMI > 30.1 the DIEP flap provided excess tissue bulk (129-135 % of native tongue volume). CONCLUSION The DIEP flap more closely approximates the volume needed to reconstruct anterior two-thirds tongue defects for BMIs ≤ 30. The subscapular system flaps provided the best volume match for BMIs > 30 and the DIEP flap provided excess tissue bulk which could be adjusted in the reconstruction process.
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Affiliation(s)
- Brandon Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA
| | - Andrew Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Molly Heft Neal
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Susan Ellsperman
- Department of Otolaryngology - Head and Neck Surgery, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Joshua Cho
- Kresge Hearing Research Institute, University of Michigan, USA
| | - Alex Vita
- Department of Internal Medicine, University of Michigan, USA
| | - Allen L Feng
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Kevin J Contrera
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA.
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Choi JW, Kim YC. Functional Perspectives in Tongue Reconstruction Based on Perforator Free Flap. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00052-9. [PMID: 39217088 DOI: 10.1016/j.coms.2024.07.011] [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: 09/04/2024]
Abstract
This article explores advancements in functional tongue reconstruction after cancer ablation, focusing on the importance of flap selection, positioning, and volume adjustment to restore speech and swallowing function. It highlights advancements such as the perforator flap concept for customized reconstructions and the transition to dynamic techniques with motor-innervated free flaps, aiming to accurately replicate the tongue's inherent functions. The effectiveness of dynamic techniques in improving swallowing efficiency and speech clarity underscores their significant potential in enhancing postoperative rehabilitation, representing a significant progress in the realm of functional tongue reconstruction.
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Affiliation(s)
- Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, SongPa-Gu, Seoul 05505, Korea.
| | - Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, SongPa-Gu, Seoul 05505, Korea
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Speck NE, Haumer A, Pfister P, Muller L, Gahl B, Burger M, Largo RD, Schaefer DJ, Ismail T. Neurotized profunda artery perforator flap for subtotal tongue reconstruction - Prospective case series. J Plast Reconstr Aesthet Surg 2024; 95:35-42. [PMID: 38875869 DOI: 10.1016/j.bjps.2024.05.028] [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: 03/15/2024] [Revised: 05/05/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Total or subtotal glossectomy defects cause significant functional deficits in swallowing and speech and subsequently impair patients' quality of life (QOL). Recently, the profunda artery perforator (PAP) flap has emerged as a potential alternative for reconstructing extensive glossectomy defects. While previous studies assessing recovery of neurotized anterolateral thigh (ALT) flaps in head and neck reconstruction reported superior sensory recovery, improved swallow function, and improved overall patient satisfaction in patients with neurotized flaps vs. non-neurotized ALT flap reconstruction, PAP flap neurotization has not been described and systematically assessed in head and neck patients. METHODS Six patients underwent subtotal tongue reconstruction with neurotized PAP flaps at the authors' institution from May 2022 until August 2023. A branch of the posterior femoral cutaneous nerve of the PAP flap was coaptated to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament, pain, and temperature assessments were conducted at 3, 6, and 12 months postoperatively on the neo-tongue. The MD Anderson speech and deglutition scales and the EORTC-QLQ-H&N35 were used to record functional outcomes and QOL. RESULTS The mean age was 69 ± 4 years, and the mean body mass index was 25 ± 7 kg/m2. Neo-tongue median 2-point discrimination at the tip improved from >10 mm at 3 months to 6 mm at 12 months. All patients had protective pain and temperature perception at the neo-tongue tip at the 6-month follow-up. Speech and swallowing functions were similar at the 12-month follow-up to data on neurotized ALT flaps from literature. No neuropathic pain was reported at the donor site at the 6-month follow-up. CONCLUSIONS This is the first case series of PAP flap neurotization in head and neck patients, suggesting potential functional advantages with minimal donor-site morbidity. LEVEL OF EVIDENCE V Case Series.
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Affiliation(s)
- Nicole E Speck
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Alexander Haumer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Pablo Pfister
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Laurent Muller
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Basel, Switzerland
| | - Brigitta Gahl
- Surgical Outcome Research Center, University Hospital, Basel, Switzerland
| | - Maximilian Burger
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland; Faculty of Medicine, University of Basel, Switzerland
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland.
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Accorona R, Di Furia D, Cremasco A, Gazzini L, Mevio N, Pilolli F, Achena A, Iftikhar H, Awny S, Ormellese GL, Dragonetti AG, De Virgilio A. Oral Reconstruction with Locoregional Flaps after Cancer Ablation: A Systematic Review of the Literature. J Clin Med 2024; 13:4181. [PMID: 39064220 PMCID: PMC11278209 DOI: 10.3390/jcm13144181] [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: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction: The planning of oral reconstruction after tumor resection is a pivotal point for head and neck surgeons. It is mandatory to consider two aspects: the size of the surgical defect and the complexity of the oral cavity as an anatomical region. We offer a review of the literature that focuses on four types of locoregional flaps that can be profitably used for such reconstruction: infrahyoid (IF), nasolabial (NF), platysma (PF), and submental (SF). Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review was carried out according to the PICOS acronym through a comprehensive electronic search on PubMed/MEDLINE, Cochrane Library, and Google Scholar databases. For each selected article, we extrapolated eight main parameters, of which all mean values were compared through an ANOVA test. The dimensions of the oral defects were referred to as "small" (<7 cm2), "medium" (7-50 cm2), or "large" (>50 cm2). Results: A total of 139 articles were selected with a total of 5898 patients. The mean ages for each type of flap were not statistically significant (p = 0.30, p > 0.05). Seven sublocations of oral defects were reported: The most common was the tongue (2003 [34.0%] patients), followed by the floor of the mouth (1786 [30.4%]), buccal mucosa (981 [16.6%]), cheek (422 [7.2%]), hard palate (302 [5.1%]), alveolar ridge (217 [3.7%]), and retromolar trigone (187 [3.2%]). The defects were mainly medium-sized (4507 [76.4%] patients), and fewer were small-sized (1056 [17.9%]) or large-sized (335 [5.7%]). Complications were noted, the most frequent of which was flap necrosis, seen in 0.57% of cases. The functional and esthetical results were mainly positive. Conclusions: Locoregional flaps represent a good alternative in medium-sized defects as well as a fairly good alternative in small- and large-sized defects when other options are ruled out.
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Affiliation(s)
- Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Domenico Di Furia
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Alice Cremasco
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Luca Gazzini
- Division of Otorhinolaryngology—Head and Neck Surgery, “San Maurizio” Hospital, 39100 Bolzano, Italy;
| | - Niccolò Mevio
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Francesco Pilolli
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Andrea Achena
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Haissan Iftikhar
- Department of Otorhinolaryngology, University Hospitals Birmingham, Birmingham B75 7RR, UK;
| | - Shadi Awny
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura 35516, Egypt;
| | - Giorgio Luigi Ormellese
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Alberto Giulio Dragonetti
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (R.A.); (D.D.F.); (A.C.); (N.M.); (F.P.); (A.A.); (G.L.O.); (A.G.D.)
| | - Armando De Virgilio
- Department of Organ of Sense, Sapienza University of Rome, 00185 Rome, Italy
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Huang RS, Benour A, Wong Riff KWY. Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta-analysis. Microsurgery 2024; 44:e31200. [PMID: 38828556 DOI: 10.1002/micr.31200] [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: 02/10/2024] [Revised: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Vascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its efficacy in pediatric patients persists due to its infrequent presentation. The aim of this study is to systematically consolidate the survival and infection rates of free flaps in pediatric mandibular reconstruction. METHODS A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer-reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (<18 years). We performed a random-effects meta-analysis with the inverse-variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by I2, and publication bias was examined using Egger's test. RESULTS A total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7 years, were included in our study. Most free flaps originated from the fibula (n = 392/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (n = 179/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93-97, I2 = 0%), and recipient-site infections were estimated to occur in 9% (95% CI: 6-13, I2 = 0%) of cases. The most common reported complications within the study timeframe were early malocclusion (n = 28/123, 21.4%) and bite abnormalities (18/131, 13.7%). CONCLUSION Free tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ali Benour
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland
| | - Karen W Y Wong Riff
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Pu JJ, Choi WS, Wong MCM, Wu S, Leung PH, Yang WF, Su YX. Long-term stability of jaw reconstruction with microvascular bone flaps: A prospective longitudinal study. Oral Oncol 2024; 152:106780. [PMID: 38555752 DOI: 10.1016/j.oraloncology.2024.106780] [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: 12/30/2023] [Revised: 03/01/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Microvascular bone flap jaw reconstruction has achieved satisfactory clinical outcomes. However, little is known about the long-term stability of the reconstructed jaw. This prospective longitudinal study aimed to investigate the long-term stability of jaw reconstruction and factors that were associated with it. METHODS Patients with successful computer-assisted osseous free-flap jaw reconstruction in the Department of Oral and Maxillofacial Surgery, Queen Mary Hospital, Hong Kong were recruited for this prospective longitudinal study. The three-dimensional jaw models at the pre-operative plan, post-operative 1-month, and 2 years were aligned and compared. RESULTS A total of 69 patients were recruited, among which 48 patients were available for the long-term analysis. Compared to 1-month after surgery, further deviation from the pre-operative plan was observed at post-operative 2 years. Lack of accuracy in surgery, segmental mandible resection especially with the involvement of mandible angles, and post-operative radiation therapy were identified as the significant factors affecting the positional stability of the reconstructed jaw (p < 0.05). Stable reconstruction was observed in the subgroup analysis of patients without post-operative radiation therapy. CONCLUSION Up to the best of our knowledge, this is the first prospective longitudinal study reporting the long-term stability of jaw reconstruction and its affecting factors. Our data demonstrated that the reconstructed jaw position lacked stability over the postoperative period. How to improve long-term stability of reconstructed jaw thus optimize the functional outcomes warrants further studies.
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Affiliation(s)
- Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | - Wing Shan Choi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - May C M Wong
- Division of Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Songying Wu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Pui Hang Leung
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Wei-Fa Yang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Wang Y, Ma D, Li Y, Zhang C, Yang Y, Wu W. Combined Use of Endoscopic Techniques and Virtual Surgical Planning for Intraoral Approach for Hemi-mandibular Resection and Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5644. [PMID: 38440367 PMCID: PMC10911526 DOI: 10.1097/gox.0000000000005644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/11/2024] [Indexed: 03/06/2024]
Abstract
Background The study aimed to describe our experience in using endoscopic procedures to aid hemi-mandibular reconstruction with bone flaps through transoral approach. Methods Five patients with huge benign mandibular tumors underwent transoral mandibulectomy and hemi-mandibular reconstruction, using endoscopy. Facial symmetry, occlusion, bone healing, and mandibular similarity were all evaluated postoperatively. The paired-samples t test was used to compare quantitative data, and a P value less than 0.05 was considered a significant difference. Results All five patients who received transoral mandibular surgery recovered in terms of TMJ functionality, facial symmetry, and aesthetic results. Endoscopy monitored and ensured that bone flaps were correctly connected and fixed. The accuracy of endoscopy-guided mandibular reconstruction was confirmed by quantitative examination for four cases, which revealed no statistically significant variations between postoperative CT analysis and preoperative virtual surgical planning data. Conclusions Endoscopy-assisted virtual surgery may resolve concerns with transoral hemi-mandibular reconstruction and broaden indications for mini-invasive mandibular reconstruction. However, only patients with benign mandibular tumors were included in our study, so surgeons should be very cautious if applying this technique to malignant lesions or bony tumors invading soft tissues.
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Affiliation(s)
- Yujiao Wang
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dan Ma
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yun Li
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chunyi Zhang
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yaowu Yang
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Wu
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
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Kouketsu A, Kaneuji T, Yamaguma Y, Yamauchi K, Sugiura T, Takahashi T, Ito H, Yamashita Y. Microvascular reconstruction for oral cancer in older adult patients: the impact of age on surgical outcomes. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:6-11. [PMID: 37612162 DOI: 10.1016/j.oooo.2023.06.010] [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: 03/23/2023] [Revised: 05/23/2023] [Accepted: 06/17/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Flap complications continue to be a challenge in microsurgical reconstruction for older adults. We aimed to evaluate the impact of age on surgical outcomes after microvascular reconstruction. STUDY DESIGN We retrospectively investigated 103 patients with oral squamous cell carcinoma who had undergone microvascular reconstruction surgery to compare microsurgical reconstruction, common postoperative complications, and flap success rates in geriatric (>75 years) and non-geriatric (<75 years) patients. We also evaluated differences based on the American Society of Anesthesiologists Physical Status score. RESULTS We found no significant differences between the geriatric and non-geriatric groups in peri-operative, postoperative, or general complications. Conversely, we found that delirium and aspiration pneumonia were significantly more likely to occur in geriatric patients and that multiple medical complications were significantly more likely to occur in geriatric patients with a high American Society of Anesthesiologists score. CONCLUSION Microvascular reconstruction can be performed effectively and without excessive complications in geriatric patients, and age should not be considered a contraindication for this procedure. Comorbidities play a stronger role in the prediction of adverse events.
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Affiliation(s)
- Atsumu Kouketsu
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; Division of Oral and Maxillofacial Oncology and Surgical Sciences, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan.
| | - Takeshi Kaneuji
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yu Yamaguma
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Tsuyoshi Sugiura
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan; Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Hiroshi Ito
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, Miyazaki, Japan
| | - Yoshihiro Yamashita
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Singh H, Kumar G, Jain A, Khazanchi RK. Dermal Template for Superficial Defects Related to Intra Oral Malignancy. Indian J Otolaryngol Head Neck Surg 2023; 75:3778-3785. [PMID: 37974864 PMCID: PMC10645704 DOI: 10.1007/s12070-023-04099-0] [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: 05/12/2023] [Accepted: 07/17/2023] [Indexed: 11/19/2023] Open
Abstract
Flaps are the workhorse reconstructive options for management of defects for oral malignancy. Superficial defects are traditionally managed with skin grafting or healing by secondary intention, each of which have its own problems. We would like to share our experience of use of dermal template for superficial intra oral defects related to oral malignancy. Patients with cancerous and pre-cancerous lesions which resulted in defects involving mucosa and superficial muscles were included in the study. All the patients were managed with Matriderm 2 mm dermal template without the use of skin graft/ flap. 7 patients in the period of 6 months with superficial defects were managed with Matriderm alone. Two patients had lesions on the tongue while five had it on Buccal mucosa. None of these patients had post operative pain, contracture or trismus. Speech and swallowing at 6 month average follow up is normal. Dermal Substitutes are effective method of management of superficial intra oral defects with no donor area morbidity.
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Affiliation(s)
- Hardeep Singh
- Medanta Division of Plastic, Reconstructive and Aesthetic Surgery, Medanta- The Medicity, Sector 38, Gurgaon, NCR 122001 India
| | - Gopal Kumar
- Department of Head and Neck Oncology, Medanta-The Medicity, Sector 38, Gurgaon, NCR 122001 India
| | - Ankit Jain
- Medanta Division of Plastic, Reconstructive and Aesthetic Surgery, Medanta- The Medicity, Sector 38, Gurgaon, NCR 122001 India
| | - Rakesh Kumar Khazanchi
- Medanta Division of Plastic, Reconstructive and Aesthetic Surgery, Medanta- The Medicity, Sector 38, Gurgaon, NCR 122001 India
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Gasteratos K, Vlachopoulos N, Kokosis G, Goverman J. Efficacy and Safety of Microsurgical Pharyngolaryngeal and Pharyngoesophageal Reconstruction: A Systematic Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4958. [PMID: 37124383 PMCID: PMC10146040 DOI: 10.1097/gox.0000000000004958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 05/02/2023]
Abstract
Restoration of function and complication management after pharyngolaryngectomy remains a challenging task. The aim of our study was to compare the functional and clinical outcomes of pharyngolaryngeal and pharyngoesophageal reconstruction using free flaps, namely jejunal (FJF), anterolateral thigh, and radial forearm, and describe a reconstructive approach for these defects following tumor resection. Methods We performed a systematic literature review on PubMed (Medline), Embase and Cochrane Library over the last two decades for articles reporting the surgical reconstructive modalities available after total or partial pharyngeal and/or laryngeal resection using a structured search strategy and strict inclusion and elimination criteria. Results Our search identified a total of 677 articles, 112 full texts were fully reviewed for eligibility, and 39 met the inclusion criteria. The use of both FJF and fasciocutaneous flaps is safe. The FJF has optimal swallowing outcomes and a low incidence of major recipient-site complications. Nevertheless, free fasciocutaneous flaps exhibit comparable functional results, while they seem linked with fewer cases of perioperative mortality and flap failure. However, none of the currently available techniques can combine all potential benefits. Conclusions Despite these procedures being mainly palliative in nature, the advent of microvascular techniques and utilization of fasciocutaneous free flaps has allowed optimal restoration of function combined with a reduced rate of perioperative and longterm complications. Both FJF and fasciocutaneous flaps can be viable treatment options, depending on the expertise of the surgeon and patient selection, to ensure the best outcomes.
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Affiliation(s)
| | | | - George Kokosis
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill
| | - Jeremy Goverman
- Sumner M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, Mass
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Reece MK, Langenfeld TL, Pak KY, Wax MK, Tan K, Slijepcevic A, Petrisor D, Alwani M, Johnson RM, Ducic Y, Kadakia SP. Impact of smoking on donor site following rectus flap harvest for head and neck reconstruction. Am J Otolaryngol 2023; 44:103847. [PMID: 36989752 DOI: 10.1016/j.amjoto.2023.103847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVES The rectus abdominis myocutaneous free flap has been widely used as a reconstructive option in head and neck reconstruction with great success. Challenging the popular assumption, this study sought to examine the effects of smoking on donor site complications in this population. METHODS Multi-institution retrospective study of 103 patients (50 active smokers, 28 former and 25 never smoked). RESULTS Overall complication rate was 14.5 %. Hernia rate 4.8 %, evisceration 0 %, dehiscence 2.9 %, infection 6.7 %. Smoking history did not significantlly influence complication rates (chi square test, p = 0.33). Abdominal wall closure technique also did not influence the complication rate (chi square test, p = 0.58). CONCLUSIONS The rectus abdomonis myocutaneous free flap has an acceptable complication rate that does not appear to be influenced by smoking history. While patients should be counseled regarding smoking cessation, smoking habits should not delay treatment nor obviate consideration of rectus flap utilization.
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Affiliation(s)
- Mac Kenzie Reece
- Wright State University Boonshoft School of Medicine, Department of Surgery, Dayton, OH, United States of America.
| | - Tyler L Langenfeld
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America.
| | - Kaitlynne Y Pak
- Cedars Sinai Medical Center, Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, United States of America
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Science University, Portland, OR, United States of America.
| | - Kenneth Tan
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Science University, Portland, OR, United States of America.
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston Salem, NC, United States of America.
| | - Dan Petrisor
- Department of Oral Maxillo Facial Surgery, Oregon Health Science University, Portland, OR, United States of America.
| | - Mohamedkazim Alwani
- Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, United States of America
| | - R Michael Johnson
- Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, United States of America
| | - Yadranko Ducic
- Otolarygology and Facial Plastic Surgery Assoc., Forth Worth, TX, United States of America
| | - Sameep P Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, 30 E Apple St, Suite 2200, 45409, Dayton, OH, United States of America.
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13
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Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, Agrawal A, Old MO, Seim NB, Carrau RL, Rocco JW, VanKoevering KK. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol 2022; 132:105976. [PMID: 35809506 DOI: 10.1016/j.oraloncology.2022.105976] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023]
Abstract
Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Margaret Heller
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Natalia von Windheim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amelia Gingras
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Stephen Y Kang
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Enver Ozer
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amit Agrawal
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Nolan B Seim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Ricardo L Carrau
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - James W Rocco
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Kyle K VanKoevering
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States.
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Choi JW, Alshomer F, Kim YC. Current status and evolution of microsurgical tongue reconstructions, part I. Arch Craniofac Surg 2022; 23:139-151. [PMID: 36068689 PMCID: PMC9449093 DOI: 10.7181/acfs.2022.00654] [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: 05/10/2022] [Revised: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Reconstructive surgery in the management of head and neck cancer has evolved to include structure-specific approaches in which organ-specific treatment algorithms help optimize outcomes. Tongue cancer management and reconstruction are surgical challenges for which well-executed reconstructive plans should be completed promptly to avoid delaying any subsequently planned oncologic treatment. Crucial considerations in tongue cancer resection are the significant functional morbidity associated with surgical defects, particularly in terms of speech and swallowing, and the consequent negative impact on patients' quality of life. With the evolution of microsurgical techniques and the development of the perforator flap concept, flap options can be tailored to the characteristics of various tongue defects. This has allowed the implementation of pliable flaps that can help restore tongue mobility and yield subsequent functional outcomes. Using an evolutional framework, we present this series of reviews related to tongue reconstruction. The first part of the review summarizes flap options and flap-related factors, such as volume and tissue characteristics. Related functional aspects are also presented, including tongue mobility, speech, and swallowing, as well as ways to evaluate and optimize these outcomes.
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Affiliation(s)
- Jong-Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Feras Alshomer
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Chul Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Cho MJ, Hanasono MM. Virtual Surgical Planning in Free Tissue Transfer for Orbito-Maxillary Reconstruction. Semin Plast Surg 2022; 36:183-191. [PMID: 36506272 PMCID: PMC9729062 DOI: 10.1055/s-0042-1754386] [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: 12/15/2022]
Abstract
Since its introduction, virtual surgical planning (VSP) has been rapidly adopted as a part of reconstructive surgeon's armamentarium. VSP allows reconstructive surgeons to simulate resection, plan osteotomies, and design custom plates. These unique advantages have been especially beneficial for head and neck reconstructive surgeons as there is small room for error and high technical demand in head and neck reconstruction. Despite its popularity, most surgeons have limited experience in using VSP for orbito-maxillary reconstruction as tumors that involve the midface are relatively rare compared with other head and neck oncologic defects. In our institution, we routinely use VSP for orbito-maxillary reconstruction using free fibula flap to provide support for orbit, to restore normal dental occlusion, and to restore midface projection. In this chapter, we will discuss the role of virtual surgical planning and our algorithmic approach of performing orbito-maxillary reconstruction using free tissue transfer.
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Affiliation(s)
- Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew M. Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston Texas
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16
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Current Concepts for Reconstruction of Oral Tissues Following Ablative Surgery: A Comprehensive Approach. J Maxillofac Oral Surg 2022; 21:358-368. [DOI: 10.1007/s12663-022-01704-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
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17
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Pu JJ, Choi WS, Yang WF, Zhu WY, Su YX. Unexpected Change of Surgical Plans and Contingency Strategies in Computer-Assisted Free Flap Jaw Reconstruction: Lessons Learned From 98 Consecutive Cases. Front Oncol 2022; 12:746952. [PMID: 35186723 PMCID: PMC8854356 DOI: 10.3389/fonc.2022.746952] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022] Open
Abstract
BackgroundComputer-assisted surgeries (CAS) are increasingly being adopted as the treatment of choice for jaw reconstructions with osseous free flaps. Although unexpected change of surgical plans remains a major concern of CAS, there are few studies focusing on this unfavorable clinical scenario. The aim of the present study was to investigate the rate of unexpected change of surgical plans and potential influential parameters, and to discuss the contingency strategies.MethodsA retrospective study was performed to evaluate all the patients who underwent computer-assisted jaw resections and osseous free flap reconstructions. The postoperative radiographs were reviewed and compared with the preoperative surgical plans. Operating records were examined to analyze the reasons for unexpected change of surgical plans and the management. The potential influential parameters for the change of surgical plans were analyzed using Fisher-exact test. The difference was regarded as statistically significant for a p-value less than 5%.ResultsFrom Nov 2014 to Oct 2021, a total of 98 consecutive computer-assisted free flap jaw reconstruction cases with osseous free flaps were included in this study. Our experience showed that 5.1% of the patients (five cases) needed intra-operative change of the surgical plans. We summarized the unexpected change of surgical plans and the contingency strategies as four clinical scenarios, including extended resection and reconstruction, shortened resection and reconstruction, modified resection without changing reconstruction, and modified reconstruction without changed resection. None of the potential influential parameters was identified as significant in relation to unexpected change of surgical plans intraoperatively.ConclusionOur experience shows that with the comprehensive methodology for computer-assisted free flap jaw reconstruction surgery planning, we can minimize the possibility of unexpected change of surgical plans during surgery. The lessons learned from our 98 consecutive cases can help beginners prevent unexpected change of surgical plans and rationalize contingency strategies in computer-assisted free flap jaw reconstruction.
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18
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Pu JJ, Choi WS, Yeung WK, Yang WF, Zhu WY, Su YX. A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction. Front Oncol 2022; 11:743389. [PMID: 35070962 PMCID: PMC8767155 DOI: 10.3389/fonc.2021.743389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/07/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Although computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy. METHODS In this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas in the control group, without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared. RESULTS Twenty patients were recruited, with 10 in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5 to 4.1 mm and 25.3° to 8.7°. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2 to 1.3 mm), apex locations (from 3.8 to 1.5 mm), and angles (from 11.3° to 4.6°). No significant difference was detected in the accuracy of fibula reconstruction segments. CONCLUSIONS We developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.
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Affiliation(s)
- Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wing Shan Choi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai Kan Yeung
- Division of Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wei-Fa Yang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wang-Yong Zhu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Marttila E, Salli M, Mesimäki K, Kainulainen S, Snäll J, Wilkman T. The combined anterolateral thigh-Partial iliac crest minihybrid free flap for mandibular reconstruction. Microsurgery 2021; 42:312-318. [PMID: 34967042 DOI: 10.1002/micr.30854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/29/2021] [Accepted: 11/29/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS Tumors of the oral cavity often require extensive resections leading to significant hard and soft tissue defects. Microvascular free flaps, consisting of both hard and soft tissue, are often required in reconstructions. Hybrid flaps, composed of two different joint free flaps, offer potential alternatives for head and neck reconstruction. This report presents our results with a modified hybrid ALT/DCIA, that is, minihybrid free flap (MH-flap) composed of the anterolateral thigh (ALT) and a partial inner lamina iliac crest only (partial DCIA) for reconstruction of the mandibular region. PATIENTS AND METHODS Eight patients underwent oral cancer reconstruction of the mandible with the MH-flap. The MH-flap was harvested sparing the outer crest and lamina of crista, and its pedicle was combined to the distal pedicle of ALT. Clinical data and postoperative complications were analyzed. RESULTS The mean length of the osseous graft was 64 mm (range 54-78 mm). None of the patients had complications requiring surgical intervention. No donor site complications were observed. The overall survival rate was 100%. The mean length of follow-up was 16 months (range 7-30 months). CONCLUSIONS According to our results, the ALT-partial DCIA MH-flap has postoperative outcomes comparable to those of the fibular flap. The flap is a good option with excellent bone properties for reconstruction of limited mandibular defects not suitable for fibular or scapular reconstruction.
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Affiliation(s)
- Emilia Marttila
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Malla Salli
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Karri Mesimäki
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Satu Kainulainen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
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20
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Virtual Surgical Planning for Oncologic Mandibular and Maxillary Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3672. [PMID: 34548995 PMCID: PMC8448079 DOI: 10.1097/gox.0000000000003672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 05/14/2021] [Indexed: 11/25/2022]
Abstract
Virtual surgical planning (VSP) with computer-aided design and computer-aided modeling (CAD/CAM) enables the opportunity to provide personalized medicine in complex head and neck reconstruction. This innovative technology allows ablative and reconstructive surgeons to virtually create and manipulate three-dimensional anatomic models to plan both the resection and reconstruction of complicated maxillofacial defects. Studies demonstrate improvements in preoperative planning, operative efficiency and accuracy, and postoperative outcomes. VSP facilitates immediate dental implantation in selected patients, which can improve the likelihood of achieving dental restoration. This article outlines strategies for technique optimization as well as the applications, advantages and disadvantages of VSP in complex oncologic head and neck reconstruction.
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21
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Başaran B, Ünsaler S, Kesimli MC, Aslan İ. Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists. Turk Arch Otorhinolaryngol 2021; 59:103-110. [PMID: 34386796 PMCID: PMC8329401 DOI: 10.4274/tao.2021.2021-1-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/18/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine flap success rate and complications in patients who underwent microvascular free tissue reconstruction after major head and neck ablative surgery and to report the improvement in the results. Methods: Medical records of 124 patients who were operated on in 2012 to 2019 were retrospectively reviewed. Indications for different free flap types, success rates and re-exploration rates, donor site morbidities, and reasons for flap loss were analyzed. Patients were divided into two groups to identify the effects of the anticoagulant and the antiaggregant treatments on postoperative results. Results: There were 127 flaps in 124 patients, including two different free flaps each in three patients that were harvested and used in the same surgical session. Of the total 127 flaps, 82 (64.6%) were radial forearm flaps, 39 (30.7%) were fibula flaps, and 6 (4.7) were rectus abdominis flaps. Four patients were re-explored for flap perfusion problems, and 18 patients were re-explored for hematoma drainage (n=22/124, %17.3). The rate of hematoma and re-exploration was higher in patients who received anticoagulant and antiaggregant treatments synchronously (p=0.02). Three flaps were lost, and the overall success rate was 97.6%. Two patients died from perioperative complications. No major complications were observed at the donor site; minor complications were observed in 30 patients. Conclusion: The success rate for the 127 flaps in 124 patients were found comparable to those reported in the literature. These results show that successful outcomes can be achieved with experience and a head and neck team dedicated to improving the results in microsurgical reconstruction, and flap failure rarely occurs if perioperative care of the patients is given meticulously.
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Affiliation(s)
- Bora Başaran
- Department of Otolaryngology Head and Neck Surgery, İstanbul University-İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Selin Ünsaler
- Department of Otolaryngology Head and Neck Surgery, Koç University School of Medicine, İstanbul, Turkey
| | - Mustafa Caner Kesimli
- Department of Otolaryngology Head and Neck Surgery, İstinye University Faculty of Medicine, İstanbul, Turkey
| | - İsmet Aslan
- Department of Otolaryngology Head and Neck Surgery, İstanbul University-İstanbul Faculty of Medicine, İstanbul, Turkey
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22
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Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:1035-1044. [PMID: 34292310 DOI: 10.1001/jamaoto.2021.1563] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Aesthetic outcomes are key determinants of psychosocial functioning among surgically treated patients with head and neck cancer (HNC); however, long-term aesthetic outcomes after microvascular free tissue transfer (MFTT) are not well described. Objective To examine risk factors for impaired long-term aesthetic satisfaction and appearance-related psychosocial functioning after HNC ablation with MFTT. Design, Setting, and Participants A cross-sectional, web-based survey was conducted at an academic tertiary care center. A total of 228 individuals who underwent MFTT between January 1, 2015, and December 31, 2019, for treatment of HNC were included. The study was conducted from November 1, 2020, through January 15, 2021. Exposures Head and neck cancer ablation with MFTT. Main Outcomes and Measures Patient-reported outcomes were assessed via Aesthetic FACE-Q scales. The primary objective was aesthetic satisfaction determined by the Satisfaction With Facial Appearance scale. Secondarily, the Appearance-Related Psychosocial Distress, Psychological Function, and Social Function scales were used to assess appearance-related psychosocial functioning. Patients were stratified by demographic, disease, surgical, and postoperative characteristics. Survey scores on a 100-point scale were compared and subjected to univariable and multivariable linear regression. Results A total of 124 of 228 patients (54.4%) completed surveys a median of 34.4 months after MFTT (interquartile range, 22.6-48.8). Most responders (79 [63.7%]) were men with advanced cancer of the oral cavity or skin, reconstructed with anterolateral thigh or osteocutaneous fibula free flaps. Nonresponders had no significant differences in baseline characteristics. The Satisfaction With Facial Appearance score was independently lower among patients who received osteocutaneous flaps (regression coefficient, -10.6 points, 95% CI, -20.4 to -0.8 points) and/or adjuvant (chemo)radiotherapy (regression coefficient, -6.9 points; 95% CI, -13.8 to -0.1 points). Impaired appearance-related psychosocial functioning was independently associated with female sex, a history of anxiety or depression, osteocutaneous flaps, prolonged tube feeding requirements, and any recurrent or persistent disease. After adjustment for covariates, each 1-point increase in the Satisfaction With Facial Appearance score independently estimated improved appearance-related psychosocial functioning as determined by the Appearance-Related Psychosocial Distress scale (regression coefficient, -0.5 points; 95% CI, -0.7 to -0.4 points), Psychological Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.5 points), and Social Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.6 points). Conclusions and Relevance The findings of this cross-sectional, web-based survey study suggest that osteocutaneous reconstruction and adjuvant therapy independently increase the risk of poor patient-reported long-term aesthetic satisfaction, which correlated with impaired appearance-related psychosocial functioning. Aesthetic outcomes appear to be a priority to address in patients with HNC undergoing MFTT.
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Affiliation(s)
- Aaron L Zebolsky
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Neil Patel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco
| | - Chase M Heaton
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Andrea M 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
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Comparison of the surgical outcomes of free flap reconstruction for primary and recurrent head and neck cancers: a case-controlled propensity score-matched study of 1,791 free flap reconstructions. Sci Rep 2021; 11:2350. [PMID: 33504947 PMCID: PMC7840944 DOI: 10.1038/s41598-021-82034-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
This study was designed to compare the outcome and analyze the operation-related risk factors in free flap reconstruction for patients with primary and recurrent head and neck cancers. A 1:1 propensity score-matched analysis of the microsurgery registry database of the hospital. The primary outcome of the free flap reconstruction had a higher failure rate in the recurrent group than the primary group (5.1% vs. 3.1%, p = 0.037). Among the 345 pairs in the matched study population, there were no significant differences between the primary and recurrent groups regarding the rate of total flap loss (3.5% vs. 5.5%, p = 0.27) and secondary outcomes. This study revealed that free flap reconstruction had a higher failure rate in the recurrent group than the primary group, but such a difference may be attributed by the different patient characteristics.
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Tankersley A, Velasco Martinez I, Medina A. Use of cervicothoracic rotation flap and osteocutaneous radial forearm free flap for a complex multilayered cheek defect reconstruction. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2020; 7:98-104. [PMID: 32939364 PMCID: PMC7470103 DOI: 10.1080/23320885.2020.1806070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the combination of osteocutaneous radial forearm free flap and extensive cervicothoracic flap to reconstruct a large through-and-through cheek and mandibular defect. In patients with difficult clinical settings, this approach reduces operative time and complications without compromising the functional and cosmetic outcomes.
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Affiliation(s)
- Ashley Tankersley
- Department of Oral Maxillofacial Surgery and Pathology, School of Dentistry, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ignacio Velasco Martinez
- Department of Oral Maxillofacial Surgery and Pathology, School of Dentistry, University of Mississippi Medical Center, Jackson, MS, USA
| | - Abelardo Medina
- Division of Plastic Surgery, Department of Surgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Lu J, Chen Y, Xia RH, Shen Y, Zheng Z, Sun J. Modification of the anterior-posterior tongue rotation flap for oral tongue reconstruction. Head Neck 2020; 42:3769-3775. [PMID: 32767540 DOI: 10.1002/hed.26409] [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: 11/04/2019] [Revised: 05/05/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022] Open
Abstract
The aim of this study is to evaluate the efficacy and long-term outcome of a modification of the anterior-posterior tongue rotation flap used for reconstruction of tongue following cancer ablation. From April 2016 to September 2017, 21 consecutive patients with tumor classification (T2), lymph node classification (N0) tongue cancer on the anterior and middle one-third portion were selected for this study. A modification of the anterior-posterior tongue rotation flap was selected for tongue reconstruction after the cancer resection. Patient's scorings of swallowing, chewing, speech and taste were recorded. Patient after tongue flap reconstruction acquired satisfied tongue movement that allows normal functional outcomes for swallowing, chewing, speech and taste. Local tumor recurrence was not observed during the follow-up examination (range, 12-24 months). The modification of the anterior-posterior tongue rotation flap was a safe and reliable treatment for medium-size tongue cancer (T2N0), especially suitable to patients who cannot endure prolonged surgery.
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Affiliation(s)
- Junqin Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yahong Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong-Hui Xia
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yi Shen
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhiwei Zheng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jian Sun
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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Crystal DT, Curiel DA, Abdul-Hamed S, Blankensteijn LL, Ibrahim AMS, Lee BT, Lin SJ. Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction. Microsurgery 2020; 40:731-740. [PMID: 32729977 DOI: 10.1002/micr.30634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/14/2020] [Accepted: 06/29/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical resection of head and neck (H&N) neoplasms requiring osseous reconstruction have underdefined complication profiles. This study aimed to characterize postoperative outcomes of patients with H&N neoplasia undergoing osteocutaneous flap (OCF) or bare bone flap (BBF) reconstructions. MATERIALS AND METHODS Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2005-2017 databases. Queried for diagnosis and procedural codes extracted patients with H&N neoplasms undergoing BBF or OCF reconstruction. Postoperative complications were evaluated. Multivariable regression generated adjusted odds ratios. RESULTS A cohort of 746 patients were identified. Of reconstructions, 24.9% (n = 186/746) were BBFs while 75.1% (n = 560/746) were OCFs. 58.1% of the BBF cohort and 59.9% of the OCF cohort experienced an all-cause complication (p = .654). Sub-stratified, 24.2% of BBF and 17.5% of OCF patients experienced a wound complication (p = .045). Regression analysis demonstrated no difference in risk for medical complications between cohorts. However, patients receiving OCFs had a decreased likelihood of developing a wound complication (OR 0.652; 95%CI 0.430-0.989; p = .044) compared to patients receiving BBFs. CONCLUSION The incidence of complications following osseous reconstruction of the H&N is considerable. Although several complication outcomes do not seem to differ between BBF or OCF reconstructions, OCFs is associated with a decreased likelihood of wound complications.
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Affiliation(s)
- Dustin T Crystal
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Curiel
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Senan Abdul-Hamed
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise L Blankensteijn
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed M S Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Hemi-tongue Allograft Transplantation in Dogs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2767. [PMID: 32440434 PMCID: PMC7209899 DOI: 10.1097/gox.0000000000002767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 02/19/2020] [Indexed: 12/16/2022]
Abstract
Background When complete recovery of tongue function following tumor excision is desired, reestablishment of the complex movements of the tongue is necessary. However, currently available methods for recovery of tongue function, such as flap surgery or prosthesis insertion, are inadequate. In the current study, we investigated the effects of transplantations of tongue allografts. Methods Hemi-tongue allotransplantation procedures were performed with 8 pairs of sex-blind and unrelated beagle dogs. In each donor, the right side of the tongue, including the lingual and hypoglossal nerves, extrinsic muscles of the tongue, mucous membrane of the oral floor, lingual artery, and vein were exposed. A vascularized transplantation method was used with manual anastomosis of the blood vessels and nerves. Results Survival of the grafted tongue was only noted in 1 dog that died 5 days after transplantation. We suspected that the death was due to nutritional deficiency or dehydration, rather than hyperacute rejection of the transplant or technical failure of the microsurgical anastomosis. The grafted tongue was partially connected to the side of the recipient tongue, and lymphocyte infiltration was observed in this dog. Conclusions Postoperative management is difficult in dogs. Even if tongue allograft including nerves and extrinsic muscles is performed, it seems to take a long time before the tongue recovers its functions. Furthermore, expansive tongue allograft was too invasive a treatment for animals. If we want to adapt this procedure to humans, the first trial in a human will be done without animal experiments, as was the case with face transplantations.
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Lian C, Li XL, Liu XJ. Modified Supratrochlear Artery Forehead Island Flap: A Novel Approach for 1-Stage Reconstruction of Nasal Defects. EAR, NOSE & THROAT JOURNAL 2020; 100:788S-789S. [PMID: 32133890 DOI: 10.1177/0145561319900389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Chao Lian
- Department of Plastic and Reconstructive Surgery, Changzhi People's Hospital, Shanxi Medical University, Changzhi, Shanxi, People's Republic of China
| | - Xue-Lei Li
- Department of Plastic and Reconstructive Surgery, Changzhi People's Hospital, Shanxi Medical University, Changzhi, Shanxi, People's Republic of China
| | - Xiao-Jun Liu
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, 198153Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Mavrogenis AF, Igoumenou VG, Ignatiadis I, Mourouzis K, Rallis G, Spyridonos SG. Microsurgical reconstruction of complex oromandibular defects: An update. Injury 2019; 50 Suppl 5:S117-S122. [PMID: 31732121 DOI: 10.1016/j.injury.2019.10.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Free flaps are the gold standard for reconstruction of the mandible, tongue and floor of the mouth. Free fibular flaps are the most preferable option for reconstruction of complex mandibular defects, as well as for tongue and mouth floor reconstruction, since they are harvested easily, present excellent sculptability and good functional outcomes. Alternative options for bone reconstruction include the fibular and iliac crest free flap, and for soft tissue reconstruction include the anterolateral thigh, the radial forearm free flap, and the nasolabial island flap. The principles of the surgical approach include resection of the mandibular segment, intraoperative evaluation of the defect, and various surgical manipulations of the flap on site to reconstruct the defect. Advances in computerized preoperative planning have allowed virtual simulation of the defect and fabrication of an individualized stereolithic mandibular model. This short review discusses the current trends of bone and soft tissue flaps for complex oromandibular reconstructions aiming to present a comprehensive review that the readers would find interesting and informative.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasilios G Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - George Rallis
- Department of Maxillofacial Surgery, KAT Hospital, Athens, Greece
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Torabi SJ, Chouairi F, Dinis J, Alperovich M. Head and Neck Reconstructive Surgery: Characterization of the One-Team and Two-Team Approaches. J Oral Maxillofac Surg 2019; 78:295-304. [PMID: 31622570 DOI: 10.1016/j.joms.2019.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To the best of our knowledge, no studies have compared the patient profiles for 1- versus 2-team surgery within head and neck oncosurgery. PATIENTS AND METHODS A retrospective study of the data from 2968 patients who had undergone concurrent head and neck extirpative and reconstructive surgery in the National Surgical Quality Improvement Program (2010 to 2017) was conducted. Patients were stratified into 1- and 2-team surgery groups, and the demographic data were compared. Univariate analyses of the outcomes before and after propensity score matching were conducted. RESULTS Most ablative and reconstructive head and neck procedures (68.5%) were performed using a 1-team approach. The patients who had undergone 2-team surgery were more likely to have a higher American Society of Anesthesiologists classification (P < .001), to require mandibulectomy (P < .001) or glossectomy (P < .001), and to receive a microvascular free flap (P < .001) but were less likely to require parotidectomy (P < .001) or to receive a rotational flap (P < .001). Before propensity score matching, the patients undergoing 2-team surgery had longer operative times (P < .001), longer postoperative stays (P < .001), greater rates of a return to the operating room (P = .001), and an increased rate of complications (P < .001). After propensity score matching, the 2-team approach continued to have longer operative times (P < .001) and an increased incidence of complications (P < .001) but no significant differences in the length of stay or rate of return to the operating room after Bonferroni's correction. CONCLUSIONS Nationally, most head and neck ablative and reconstructive surgeries were completed by 1 team. More complicated reconstructive procedures involving microvascular free flaps have been more commonly performed by 2 teams, resulting in slightly longer operative times and greater associated complication rates.
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Affiliation(s)
- Sina J Torabi
- Medical Student, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Fouad Chouairi
- Medical Student, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Jacob Dinis
- Medical Student, Department of Surgery, Yale University School of Medicine, New Haven, CT; and Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT
| | - Michael Alperovich
- Assistant Professor, Section of Plastic and Reconstructive Surgery Department of Surgery, Yale University School of Medicine, New Haven, CT.
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Won HR, Seo C, Lee HY, Roh J, Kim CH, Jang JY, Shin YS. An Important Role of Macrophages for Wound Margin Regeneration in a Murine Flap Model. Tissue Eng Regen Med 2019; 16:667-674. [PMID: 31824828 DOI: 10.1007/s13770-019-00214-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background Macrophages have been known to have diverse roles either after tissue damage or during the wound healing process; however, their roles in flap wound healing are poorly understood. In this study, we aimed to evaluate how macrophages contribute to the flap wound regeneration. Methods A murine model of a pedicled flap was generated, and the time-course of the wound healing process was determined. Especially, the interface between the flap and the residual tissue was histopathologically evaluated. Using clodronate liposome, a macrophage-depleting agent, the functional role of macrophages in flap wound healing was investigated. Coculture of human keratinocyte cell line HaCaT and monocytic cell line THP-1 was performed to unveil relationship between the two cell types. Results Macrophage depletion significantly impaired flap wound healing process showing increased necrotic area after clodronate liposome administration. Interestingly, microscopic evaluation revealed that epithelial remodeling between the flap tissue and residual normal tissue did not occurred under the lack of macrophage infiltration. Coculture and scratch wound healing assays indicated that macrophages significantly affected the migration of keratinocytes. Conclusion Macrophages play a critical role in the flap wound regeneration. Especially, epithelial remodeling at the flap margin is dependent on proper macrophage infiltration. These results implicate to support the cellular mechanisms of impaired flap wound healing.
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Affiliation(s)
- Ho-Ryun Won
- 1Department of Otorhinolaryngology - Head and Neck Surgery, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015 Republic of Korea
| | - Chorong Seo
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Hye-Young Lee
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Jin Roh
- 3Department of Pathology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Chul-Ho Kim
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
- 4Department of Molecular Science and Technology, Ajou University, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Jeon Yeob Jang
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Yoo Seob Shin
- 2Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
- 4Department of Molecular Science and Technology, Ajou University, 164 Worldcup Street, Yeongtong-gu, Suwon, 16499 Republic of Korea
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Giordano L, Di Santo D, Bondi S, Marchi F, Occhini A, Bertino G, Grammatica A, Parrinello G, Peretti G, Benazzo M, Nicolai P, Bussi M. The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience. ACTA ACUST UNITED AC 2019; 38:497-503. [PMID: 30623895 PMCID: PMC6325652 DOI: 10.14639/0392-100x-1794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
The supraclavicular artery island flap (SCAIF) is a thin and pliable pedicled flap that is easy and quick to harvest. Thanks to its particular features and high reliability, it is best indicated for the elderly or most fragile patients. SCAIF is very versatile, as it can be used for reconstruction of oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. We began using this flap in four Italian tertiary referral centres, with several indications, both as first treatment and as salvage surgery. The aim of the study was to demonstrate the easy reproducibility of the flap among four different centres. A series of 28 patients underwent head and neck reconstructions with SCAIF with no recorded complications during flap harvesting. After the very first cases, harvesting time was approximately 45 minutes; 24 patients had successful flap integration at the recipient site, while the remaining 4 suffered from partial flap necrosis, two of whom needed revision surgery. Other minor complications were reported at the recipient site, always at the most distal and most delicate portion of the flap. Donor site was always closed primarily, with only three cases of partial suture dehiscence. We only selected the most fragile patients for SCAIF reconstruction, such as the elderly or those with one or more comorbidities; for this reason, we reported some serious systemic complications and one intraoperative death. SCAIF is an easy reproducible flap, with multiple possible indications. Its use as an alternative to free flaps in the head and neck region is nowadays under discussion. Its use should be encouraged among head and neck surgeons thanks to its various advantages.
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Affiliation(s)
- L Giordano
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - D Di Santo
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - S Bondi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - F Marchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - A Occhini
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - G Bertino
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - A Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - G Parrinello
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - G Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - P Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - M Bussi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Chen DW, Wang T, Shey-Sen Ni J, Sandulache VC, Graboyes EM, Worley M, Hornig JD, Skoner JM, Day TA, Huang AT. Prognostic factors associated with achieving total oral diet after glossectomy with microvascular free tissue transfer reconstruction. Oral Oncol 2019; 92:59-66. [PMID: 31010625 PMCID: PMC6510264 DOI: 10.1016/j.oraloncology.2019.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/02/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primary surgery followed by adjuvant therapy is the current standard of care in the multidisciplinary management of squamous cell carcinoma (SCC) of the oral tongue. Additionally, salvage glossectomy is used to treat recurrent base of tongue SCC. Microvascular free tissue transfer reconstruction (MVFTT) is utilized to maximize functional outcomes such as swallowing. We sought to identify prognostic factors related to achievement of a total oral diet in patients that underwent glossectomy with MVFTT. METHODS Retrospective review at a tertiary care center from 2010 to 2015. RESULTS 200 patients (69% male, mean age 60 years) met inclusion criteria. Extent of glossectomy was categorized as partial or hemiglossectomy (39%), tongue base resection with or without hemi-oral glossectomy (23%), composite resection with mandibulectomy (18%), and subtotal or total glossectomy (21%). Flap success rate was 96%. Median follow-up time was 14 months. A total oral diet was achieved by 49% of patients with median time to achievement of 31 days (IQR 9-209). Multivariate analysis identified body mass index < 25 kg/m2, prior radiation therapy, adjuvant chemoradiation, and resection requiring subtotal or total glossectomy or concurrent mandibulectomy as independent risk factors for worse total oral diet achievement. CONCLUSION Swallowing dysfunction represents a significant morbidity following glossectomy in the treatment of SCC. High BMI, smaller resection fields, and absence of prior radiation therapy or adjuvant chemoradiotherapy correlated with improved likelihood of obtaining a total oral diet. Patients should be appropriately counseled of this risk with emphasis placed on aggressive swallow rehabilitation in the post- treatment setting.
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Affiliation(s)
- Diane W Chen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Tao Wang
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Jonathan Shey-Sen Ni
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Mitchell Worley
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Joshua D Hornig
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Judith M Skoner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Terry A Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States.
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Torabi SJ, Chouairi F, Dinis J, Alperovich M. Impact of advanced age on microvascular reconstruction of the lower facial third: An American College of Surgeons NSQIP study. Microsurgery 2019; 39:487-496. [DOI: 10.1002/micr.30455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/04/2019] [Accepted: 03/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Sina J. Torabi
- Department of Surgery (Section of Plastic and Reconstructive Surgery)Yale University School of Medicine New Haven Connecticut
| | - Fouad Chouairi
- Department of Surgery (Section of Plastic and Reconstructive Surgery)Yale University School of Medicine New Haven Connecticut
| | - Jacob Dinis
- Department of Surgery (Section of Plastic and Reconstructive Surgery)Yale University School of Medicine New Haven Connecticut
- Department of Medical School, Quinnipiac University, Frank H. Netter MD School of Medicine North Haven Connecticut
| | - Michael Alperovich
- Department of Surgery (Section of Plastic and Reconstructive Surgery)Yale University School of Medicine New Haven Connecticut
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35
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Sakakibara A, Kusumoto J, Sakakibara S, Hasegawa T, Akashi M, Minamikawa T, Furudoi S, Hashikawa K, Komori T. Effect of size difference between hemiglossectomy and reconstruction flap on oral functions: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2019; 72:1135-1141. [PMID: 30930123 DOI: 10.1016/j.bjps.2019.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/12/2019] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Forearm free flaps are used after hemiglossectomy. However, no investigation has been performed on whether oral functions are better preserved when sizes of the resection and reconstruction flap are exact matches, or whether the size of the resection should be changed. We aimed to retrospectively examine whether size differences between the resection and reconstruction flap affect speech and swallowing functions postoperatively, and to determine whether there are more favorable flap size ratios. METHODS This is a retrospective cohort study of patients undergoing hemiglossectomy using a forearm free flap between 2006 and 2016 at Kobe University Hospital, Japan. The effect of size difference between the resection and reconstruction flap on maintained oral function was assessed. Speech and swallowing functions were assessed, and their correlation with the ratio of the flap size to that of the resected area was determined. With these data, distribution maps of the relationship between the functional level and reconstructed dimension ratio were prepared. The more suitable reconstructed dimension ratio was examined and evaluated. The Fisher exact test, Kruskal-Wallis test, and Scheffe test were used in statistical analyses. RESULTS Eighty-eight patients underwent hemiglossectomy using a forearm free flap during a 10-year period. Of these cases, 66 patients were included in this study, while 22 were excluded. The ratio of the area of the reconstruction flap to that of the resection site was 0.59-2.79 (median: 1.61). Sixty patients had flaps greater than the resection area, whereas 6 had smaller flaps. Significant differences were found in speech intelligibility and swallowing function when the reconstructed dimension ratio was categorized as follows: ≤1.3, 1.3-1.8, and ≥1.8. CONCLUSION Our findings suggest that postoperative deterioration of oral functions after hemiglossectomy could be reduced if reconstruction is performed using a forearm free flap with a surface area 1.3 to 1.8 times greater than that of the resection area.
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Affiliation(s)
- Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Sweeny L, Rosenthal EL, Light T, Grayson J, Petrisor D, Troob SH, Greene BJ, Carroll WR, Wax MK. Outcomes and cost implications of microvascular reconstructions of the head and neck. Head Neck 2019; 41:930-939. [DOI: 10.1002/hed.25424] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/28/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Larissa Sweeny
- Department of Otolaryngology – Head and Neck SurgeryLouisiana State University Health Science Center – New Orleans New Orleans Louisiana
| | - Eben L. Rosenthal
- Department of Otolaryngology – Head and Neck SurgeryStanford University Stanford California
| | - Tyler Light
- Department of Otolaryngology – Head and Neck SurgeryOregon Health and Science University Portland Oregon
| | - Jessica Grayson
- Department of Otolaryngology – Head and Neck SurgeryLouisiana State University Health Science Center – New Orleans New Orleans Louisiana
| | - Daniel Petrisor
- Department of Otolaryngology – Head and Neck SurgeryOregon Health and Science University Portland Oregon
| | - Scott H. Troob
- Department of Otolaryngology – Head and Neck SurgeryOregon Health and Science University Portland Oregon
| | - Benjamin J. Greene
- Department of Otolaryngology – Head and Neck SurgeryLouisiana State University Health Science Center – New Orleans New Orleans Louisiana
| | - William R. Carroll
- Department of Otolaryngology – Head and Neck SurgeryLouisiana State University Health Science Center – New Orleans New Orleans Louisiana
| | - Mark K. Wax
- Department of Otolaryngology – Head and Neck SurgeryOregon Health and Science University Portland Oregon
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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Han AY, Kuan EC, Mallen-St Clair J, Badran KW, Palma Diaz MF, Blackwell KE, St John MA. Total Glossectomy With Free Flap Reconstruction: Twenty-Year Experience at a Tertiary Medical Center. Laryngoscope 2019; 129:1087-1092. [PMID: 30667056 DOI: 10.1002/lary.27579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize the demographics, clinicopathologic characteristics, and treatment and reconstructive outcomes of patients who underwent total glossectomy STUDY DESIGN: Retrospective chart review at an academic tertiary-care medical center. METHODS All patients who had undergone total glossectomy (as an individual procedure or as part of a more extensive resection) between January 1, 1995 and December 31, 2014 were included in the analysis. Patient characteristics and clinical outcomes were reviewed. RESULTS Forty-eight patients underwent total glossectomy for oral tongue and base of tongue cancer. The mean age of the patients was 56 (range, 29-92 years). History of tobacco and heavy alcohol use was found in 76% and 11% of patients, respectively. The majority of patients had advanced cancer (91.7% at stage IV), and 60.4% had salvage therapy for recurrent disease. T4 disease comprised 81% of patients. Sixty percent had clinical or radiographic evidence of nodal metastasis. Reconstruction of the defect was performed with free flaps from the rectus abdominus (40%), fibula (25%), anterolateral thigh (23%), and other donor tissues. One- and 5-year survival rates were 42% and 26%, with locoregional and distant recurrence reported at 36% and 25%, respectively. CONCLUSIONS Total glossectomy for oncologic control is most commonly performed in patients who have stage IV cancers. Despite high reconstructive success rates, the likelihood of locoregional and distance recurrence was high. Most patients can communicate intelligibly and achieve decannulation, but swallowing outcomes remain guarded, especially considering previous irradiation and resection of the base of tongue. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1087-1092, 2019.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, Los Angeles, California
| | - Edward C Kuan
- Department of Head and Neck Surgery, Los Angeles, California
| | - Jon Mallen-St Clair
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center, San Francisco, California, U.S.A
| | - Karam W Badran
- Department of Head and Neck Surgery, Los Angeles, California
| | | | - Keith E Blackwell
- Department of Head and Neck Surgery, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, Los Angeles, California.,Jonsson Comprehensive Cancer Center, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
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39
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Vastus lateralis myofascial free flap for tongue reconstruction and hypoglossal-femoral anastomosis: neurophysiological study. Neurol Sci 2019; 40:553-559. [DOI: 10.1007/s10072-018-3687-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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40
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Comini LV, Spinelli G, Mannelli G. Algorithm for the treatment of oral and peri-oral defects through local flaps. J Craniomaxillofac Surg 2018; 46:2127-2137. [DOI: 10.1016/j.jcms.2018.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/23/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023] Open
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41
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A Modification of an Established Method of Intercalary Extremity Bone Defect Reconstruction: The "Hemi-Capanna" Technique. Ann Plast Surg 2018; 81:240-243. [PMID: 29944534 DOI: 10.1097/sap.0000000000001554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skeletal reconstruction of segmental defects of the appendicular skeleton is among the most challenging tasks in reconstructive surgery. A popular method of reconstruction of large osseous defects is the combination of massive allografts and vascularized bone transfer. We present and discuss our experience with a modification of the traditional Capanna technique in which the allograft is split in half longitudinally to provide for more space for postoperative fibula hypertrophy. METHODS Patients who underwent reconstruction of segmental intercalary defects of the tibia using our modified technique were retrospectively identified. The following parameters were retrieved: patient age, race, sex, length of skeletal defect, recipient vessels, type of microsurgical anastomosis, union rate, complication rate, ambulation (yes/no), and follow-up (in months). RESULTS Two male patients underwent reconstruction of the tibia via the modified "hemi-Capanna" technique. The tibia defect measured 12 and 13 cm, respectively. No intraoperative or postoperative complications were encountered. Osseous union was obtained in both patients who are both ambulatory. CONCLUSION The hemi-Capanna technique not only leaves more room for hypertrophy of the vascularized fibula, but also simplifies the technique of combining an allograft with vascularized bone transfer in reconstructions of segmental skeletal defects of the appendicular skeleton.
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42
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Lin YS, Liu WC, Wang KY, Lin YS, Yang KC. Obliquely-arranged double skin paddles: A novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap. Microsurgery 2018; 39:108-114. [DOI: 10.1002/micr.30322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Ying-Sheng Lin
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Division of Plastic and Reconstructive Surgery; National Taiwan University Hospital Yulin Branch; Yulin County Taiwan
| | - Wen-Chung Liu
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
- National Defense Medical Center; Taipei Taiwan
| | - Kuan-Ying Wang
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Yaoh-Shiang Lin
- National Defense Medical Center; Taipei Taiwan
- Department of Otolaryngology Head and Neck; Kaohsiung Veterans General Hospital; Taiwan
| | - Kuo-Chung Yang
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
- National Defense Medical Center; Taipei Taiwan
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43
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Barton BM, Riley CA, Fitzpatrick JC, Hasney CP, Moore BA, McCoul ED. Postoperative anticoagulation after free flap reconstruction for head and neck cancer: A systematic review. Laryngoscope 2017; 128:412-421. [PMID: 28581030 DOI: 10.1002/lary.26703] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Postoperative use of anticoagulation after free tissue transfer in head and neck ablative procedures is common practice, but a clear protocol has not been well established. The outcome measures including total flap failure, thrombosis, and hematoma formation for different anticoagulation regimens in free tissue transfer in the head and neck were reviewed. DATA SOURCES PubMed, Ovid, and Cochrane databases were examined for patients who underwent free tissue transfer following head and neck ablative procedures. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting anticoagulation regimens following free tissue transfer in head and neck ablative procedures. Outcomes included total flap failure, thrombosis, and hematoma formation. Two independent reviewers assessed the quality of the articles by using the Methodological Index for Non-Randomized Studies. RESULTS A total of 368 articles were identified. An additional 36 articles were identified through screening of reference lists. Twenty-one of these studies met final inclusion criteria for qualitative analysis. Outcome data on total flap failure, thrombosis, and hematoma formation were extracted and analyzed for comparison against all anticoagulation regimens. Total flap failure, thrombosis, and hematoma formation rates were 4.4%, 4.5%, and 2.2%, respectively. Individual study rates ranged from 0.0% to 10.7%, 0.0% to 10.4%, and 0.6% to 7.2%, respectively. CONCLUSIONS There is not adequate evidence to develop a standardized anticoagulation protocol for head and neck free flap procedures. Comparable flap complications were reported between all the employed anticoagulation methods studied, though significant variability in study design among articles existed. Prospective, randomized studies are warranted to determine the optimal postoperative anticoagulation regimen following free tissue transfer of the head and neck. Laryngoscope, 128:412-421, 2018.
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Affiliation(s)
- Blair M Barton
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Christian P Hasney
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
| | - Brian A Moore
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
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44
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Chang EI, Yu P. Prospective series of reconstruction of complex composite mandibulectomy defects with double island free fibula flap. J Surg Oncol 2017; 116:258-262. [DOI: 10.1002/jso.24647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/18/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Edward I. Chang
- Department of Plastic Surgery; MD Anderson Cancer Center; Houston Texas
| | - Peirong Yu
- Department of Plastic Surgery; MD Anderson Cancer Center; Houston Texas
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45
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Song D, Li Z, Zhou X, Zhang Y, Xie S, Peng X, Zhou B, Lü C, Yang L, Peng W. [Clinical application of free thoracoacromial artery perforator flap in reconstruction of tongue and mouth floor defects after resection of tongue carcinoma]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:222-226. [PMID: 29786257 DOI: 10.7507/1002-1892.201609090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the clinical outcome of free thoracoacromial artery perforator (TAAP) flap in the reconstruction of tongue and mouth floor defects after radical resection of tongue carcinoma. Methods Between May 2010 and February 2015, 11 cases of tongue carcinoma underwent radical resection and reconstruction of tongue and mouth floor defects with free TAAP flaps. The locations of tongue carcinoma were the lingual margin in 7 cases, the ventral tongue in 2 cases, and the mouth floor in 2 cases. According to Union for International Cancer Control (UICC) TNM stage, 3 cases were classified as T 4N 0M 0, 3 cases as T 4N lM 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, and 1 case as T 3N 0M 0. The disease duration ranged from 3 to 28 months, 10.6 months on average. The tumor size ranged from 6.0 cm×3 cm to 10 cm×5 cm. The TAAP flap ranged from 7.0 cm×4.0 cm to 11.0 cm×5.5 cm in size, and 0.6-1.2 cm (0.8 cm on average) in thickness, with a pedicle length of 6.8-9.9 cm (7.2 cm on average). Results All 11 flaps survived, the donor site was closed directly and healed primarily in all cases. The patients were followed up 12-24 months (17.2 months on average). The reconstructed tongue had satisfactory appearance and good functions of swallowing and language. No local recurrence was observed during follow-up. Only linear scar was left at the donor site, and the function of pectoralis major muscle was normal. Conclusion The TAAP flap is an ideal choice in the reconstruction of tongue defect after resection of tongue carcinoma, which has good texture, appearance, and function results.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008,
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, 200011, P.R.China
| | - Songlin Xie
- Department of Hand and Foot Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang Hunan, 421000, P.R.China
| | - Xiaowei Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Lichang Yang
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Wen Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
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46
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Reconstructive considerations in head and neck surgical oncology: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S191-S197. [PMID: 27841135 PMCID: PMC4873910 DOI: 10.1017/s0022215116000621] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The reconstructive needs following ablative surgery for head and neck cancer are unique and require close attention to both form and function. The vast experience accrued with microvascular reconstructive surgery has meant a significant expansion in the options available. This paper discusses the options for reconstruction available following ablative surgery for head and neck cancer and offers recommendations for reconstruction in the various settings.
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47
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Gao LL, Basta M, Kanchwala SK, Serletti JM, Low DW, Wu LC. Cost‐effectiveness of microsurgical reconstruction for head and neck defects after oncologic resection. Head Neck 2016; 39:541-547. [DOI: 10.1002/hed.24644] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/21/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lin Lin Gao
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - Marten Basta
- Department of Plastic and Reconstructive SurgeryBrown UniversityProvidence Rhode Island
| | - Suhail K. Kanchwala
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - Joseph M. Serletti
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - David W. Low
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
| | - Liza C. Wu
- Department of Plastic and Reconstructive SurgeryUniversity of Pennsylvania Health SystemPhiladelphia Pennsylvania
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Cherubino M, Turri-Zanoni M, Battaglia P, Giudice M, Pellegatta I, Tamborini F, Maggiulli F, Guzzetti L, Di Giovanna D, Bignami M, Calati C, Castelnuovo P, Valdatta L. Chimeric anterolateral thigh free flap for reconstruction of complex cranio-orbito-facial defects after skull base cancers resection. J Craniomaxillofac Surg 2016; 45:87-92. [PMID: 27919596 DOI: 10.1016/j.jcms.2016.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 09/26/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022] Open
Abstract
Complex cranio-orbito-facial defects after skull base cancers resection entail a functional and esthetic reconstruction. The introduction of endoscopic assisted techniques for excision surgery with the advances in reconstructive surgery and anesthesiology allowed to improve the management of such critical patients. We report a series of chimeric anterolateral thigh (ALT) flaps used to reconstruct complex cranio-orbital-facial defects after skull base surgery. A retrospective review of patients that underwent cranio-orbito-facial reconstruction using a chimeric ALT flap from March 2013 to October 2015 at a single tertiary care referral Institute was performed. All patients were affected by locally-advanced malignant tumor and the resulting defects involved the skull base in all cases. The ALT flaps were perforator-based flaps with different components: fascia, skin and muscle. The different flap territories had independent vascular supply and were independent of any physical interconnection except where linked by a common source vessel. Ten patients were included in the study. Three patients underwent adjuvant radiotherapy and to chemotherapy. The mean hospitalization time was 21 days (range, 8-24 days). One failure was observed. After a mean follow-up of 12.4 months, 3 patients died of the disease, 2 are alive with disease, while 5 patients (50%) are currently alive without evidence of disease. Chimeric ALT flap is a reliable and versatile reconstructive option for complex cranio-orbito-facial defects resulting from skull base surgery. The chimeric flap composed of different territories proved to be adequate for a patient-tailored three-dimensional reconstruction of the defects as well as able to resist to the postoperative adjuvant treatments.
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Affiliation(s)
- Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy.
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Marco Giudice
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Igor Pellegatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Federico Tamborini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Francesca Maggiulli
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Luca Guzzetti
- Division of Anaesthesia, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy.
| | - Danilo Di Giovanna
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Carolina Calati
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology Head & Neck Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, Varese, 21100 VA, Italy
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Allensworth JJ, Troob SH, Weaver TS, Gonzalez JD, Petrisor D, Wax MK. Secondary free-flap reconstruction following ablation for acute invasive fungal sinusitis. Laryngoscope 2016; 127:815-819. [PMID: 27730655 DOI: 10.1002/lary.26298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/12/2016] [Accepted: 07/21/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Acute invasive fungal sinusitis (AIFS) is a frequently fatal infection for which extensive and debilitating surgical debridement is a mainstay of therapy. Resulting defects are often composite in nature, mandating free tissue-transfer reconstruction. Outcomes data for free flap reconstruction are limited. The purpose of this study was to examine surgical outcomes and survival in patients undergoing free flap transfer following invasive fungal sinusitis. STUDY DESIGN Retrospective case series. METHODS Between 1995 and 2015, patients undergoing operative debridement for AIFS were identified. Surgical records were used to identify survivors of acute infection who subsequently underwent free flap reconstructive surgery. Patient demographics, cause of immune compromise, defect description, flap type, perioperative complications, indications for revision surgery, functional outcomes, and long-term survival were reviewed. RESULTS Forty-four patients were treated for AIFS, of those, 30 (68%) survived acute infection. Ten patients underwent maxillectomy, six with orbital exenteration, and were designated candidates for reconstruction. Eight patients underwent reconstruction. Median time from debridement to reconstruction was 67.5 days. Flap types included latissimus dorsi, scapula, anterolateral thigh, rectus, radial forearm, and fibula. Median follow-up was 7.7 months. No perioperative complications were encountered, and all subjects remained disease-free, able to speak and eat normally without prosthetic supplementation. Seven patients (87%) are currently alive. CONCLUSION Reconstruction of defects left by invasive fungal sinusitis using free-tissue transfer resulted in successful flap survival, with no disease recurrence for all defects and flap types reviewed. Survivors of AIFS are able to tolerate midface reconstruction, with favorable functional outcomes and survival rates. LEVEL OF EVIDENCE 4. Laryngoscope, 127:815-819, 2017.
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Affiliation(s)
- Jordan J Allensworth
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Scott H Troob
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Tyler S Weaver
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Javier D Gonzalez
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Daniel Petrisor
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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Kuuskeri M, O’Neill AC, Hofer SO. Unfavorable Results After Free Tissue Transfer to Head and Neck. Clin Plast Surg 2016; 43:639-51. [DOI: 10.1016/j.cps.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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