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Al Omran Y, Evans E, Jordan C, Borg TM, AlOmran S, Sepehripour S, Akhavani MA. The Medial Sural Artery Perforator Flap versus Other Free Flaps in Head and Neck Reconstruction: A Systematic Review. Arch Plast Surg 2023; 50:264-273. [PMID: 37256040 PMCID: PMC10226800 DOI: 10.1055/a-2059-4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/07/2023] [Indexed: 06/01/2023] Open
Abstract
The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular reconstructions of the head and neck. The aim is to conduct a high-quality Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)- and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2)-compliant systematic review comparing the use of the MSAP flap to other microvascular free flaps in the head and neck. Medline, Embase, and Web of Science databases were searched to identify all original comparative studies comparing patients undergoing head and neck reconstruction with an MSAP flap to the radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap from inception to February 2021. Outcome studied were the recipient-site and donor-site morbidities as well as speech and swallow function. A total of 473 articles were identified from title and abstract review. Four studies met the inclusion criteria. Compared with the RFFF and the ALT flaps, the MSAP flap had more recipient-site complications (6.0 vs 10.4%) but less donor-site complications (20.2 vs 7.8%). The MSAP flap demonstrated better overall donor-site appearance and function than the RFFF and ALT flaps ( p = 0.0006) but no statistical difference in speech and swallowing function following reconstruction ( p = 0.28). Although higher quality studies reviewing the use of the MSAP flap to other free flaps are needed, the MSAP flap provides a viable and effective reconstructive option and should be strongly considered for reconstruction of head and neck defects.
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Affiliation(s)
- Yasser Al Omran
- Department of Plastic Surgery, Royal Free National Health Service Foundation Trust, London, United Kingdom
| | - Ellie Evans
- Department of Plastic Surgery, Royal Free National Health Service Foundation Trust, London, United Kingdom
| | - Chloe Jordan
- Department of Plastic Surgery, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Tiffanie-Marie Borg
- Academic Plastic Surgery Group, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Samar AlOmran
- Department of ENT, Salmaniya Medical Complex, Kingdom of Bahrain
| | - Sarvnaz Sepehripour
- Department of Plastic Surgery, Royal Free National Health Service Foundation Trust, London, United Kingdom
| | - Mohammed Ali Akhavani
- Department of Plastic Surgery, Royal Free National Health Service Foundation Trust, London, United Kingdom
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Alhindi N, Mortada H, Alsubhi AH, Alhamed L, Aljahdali FH, Aljindan F. Quality of life in post-tongue reconstruction: a comprehensive systematic review and meta-analysis of radial free forearm flap versus anterolateral thigh flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Deva FAL, Kalsotra G, Kalsotra P, Saraf A. Tissue Transfer After Tongue Resection: Micro-Vascular Reconstruction Using Radial Artery Free Flap versus Reconstruction by Split Thickness Skin Graft in T2 Lesions of Tongue Carcinoma. Indian J Otolaryngol Head Neck Surg 2022:1-11. [PMID: 36571096 PMCID: PMC9759059 DOI: 10.1007/s12070-022-03380-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
To compare postoperative complications, functional rehabilitation, surgical outcomes of the radial artery forearm free flap (RAFFF) and split thickness skin graft (STSG) reconstruction of postsurgical defect in T2 lesions of cancer oral cavity. Observational Prospective comparative study. Academic tertiary referral centre. In our study of forty four patients, after tumour resection, half underwent reconstruction using RAFFF (Group I) and another half by STSG (Group II). All of the patients were followed postoperatively to determine and compare their functional outcomes related to donor site and recipient site complications, speech, deglutition and mouth opening. The speech intelligibility and deglutition were each assessed using Articulation Handicap Index and Vedio-fluoroscopy using the Functional oral intake scale. Operative time for STSG reconstruction was shorter at 2.2 ± 0.97 SD hours compared to 5.9 ± 1.24 SD hours for RAFFF reconstruction. Hospital stay was 8.3 ± 1.19 SD days for STSG patients and 12.6 ± 1.7 SD days for RAFFF patients. The functional outcomes of speech quality and swallowing were near comparable in both groups but the donor site complications were significant in the RAFFF group. Operative time, hospital stay and donor site complications are both significantly reduced with the STSG as opposed to RAFF. Functional and oncologic results of both methods are near comparable. To conclude, STSG can be used for reconstruction of the post-surgical defects in T2 lesions of the tongue.
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Affiliation(s)
| | - Gopika Kalsotra
- grid.413224.20000 0004 1800 4333Department of ENT & HNS, GMC and SMGS Hospital, Jammu, J&K India
| | - Parmod Kalsotra
- grid.413224.20000 0004 1800 4333Department of ENT & HNS, GMC and SMGS Hospital, Jammu, J&K India
| | - Aditiya Saraf
- grid.413224.20000 0004 1800 4333Department of ENT & HNS, GMC and SMGS Hospital, Jammu, J&K India
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Helton M, Gardner JR, Dunlap Q, Pait TG, Sunde J, Vural E, Moreno MA. Free Tissue Transfer for Repair of Chronic Esophageal Perforations. OTO Open 2021; 5:2473974X211031472. [PMID: 34350371 PMCID: PMC8295968 DOI: 10.1177/2473974x211031472] [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: 05/04/2021] [Accepted: 06/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Anterior cervical discectomy and fusion have become a common intervention for cervical spine stabilization. However, complications can cause life-threatening morbidity. Among them, esophageal perforation is associated with severe morbidity, including dysphagia, malnutrition, and infection with the potential development of mediastinitis. Presentation is variable but often results in chronic morbidity. Herein we examine our experiences in the management of esophageal perforation with microvascular free tissue transfer. Study Design Retrospective review from January 2013 to September 2020. Setting Single academic tertiary care center. Methods This study comprised all patients (age, 41-73 years) undergoing free tissue transfer for the repair of chronic esophageal perforation secondary to anterior cervical discectomy and fusion at an academic tertiary care center. Four patients underwent repair via vastus lateralis myofascial onlay grafting for defects ≤2 cm in greatest dimension, while 1 patient underwent a fasciocutaneous radial forearm free flap repair of an 11 × 5-cm defect. Results Defect location ranged from hypopharynx to cervical esophagus. Mean operative time was 6.2 hours; the average length of stay for all patients was 6.6 days. Of 5 patients, 1 required additional hardware placement for spine stabilization. All patients underwent gastrostomy tube placement to bypass the surgical site during healing, and all eventually resumed an oral diet postoperatively. Recurrent fistula occurred in 1 of 5 patients. No flap failures were encountered in the study population. Conclusion Vastus lateralis myofascial onlay grafting and fasciocutaneous radial forearm free flap are robust, relatively low-morbidity interventions with a high success rate for definitive repair of chronic esophageal perforation. Repair should be undertaken in concert with a spine surgeon for management of the cervical spine.
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Affiliation(s)
- Matthew Helton
- Department of Neurosurgery, Jackson T. Stephens Spine and Neuroscience Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Quinn Dunlap
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - T Glenn Pait
- Department of Neurosurgery, Jackson T. Stephens Spine and Neuroscience Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jumin Sunde
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Emre Vural
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mauricio Alejandro Moreno
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Moreno MA, Small LT, Gardner JR, Kim AH, Vural E, Sunde J. Outcomes of Single Anastomoses for Superficial and Deep-System Venous Drainage of Radial Forearm Free Flaps. OTO Open 2021; 5:2473974X211006927. [PMID: 33997587 PMCID: PMC8108077 DOI: 10.1177/2473974x211006927] [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: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objective Venous insufficiency occurs in radial forearm free flaps (RFFFs) when either the deep venous system (DVS) or superficial venous system (SVS) is used as the venous outlet. We report our experience using the antecubital perforating vein (APV) in a single-vessel anastomosis to the median-cubital or cephalic vein to drain both systems. Study Design Retrospective review. Setting Single, academic, tertiary care center. Methods Data were collected from 72 patients who underwent RFFF from October 2009 to January 2017. In all cases, DVS and SVS were dissected, and an APV single-vessel anastomosis was attempted. Results Anatomical variations precluded single-vessel anastomosis in 11 (15.3%) cases. In 61 (84.7%) cases, single-vessel anastomosis produced unobstructed drainage for DVS and SVS without intrinsic venous insufficiency. Venous thrombosis and total loss occurred in 2 (3.3%) and 1 (1.6%) patients, respectively. Proximal dissection of the cephalic vein addressed a vessel-depleted neck in 3 cases. Conclusion The antecubital perforating vein is present and functional in most patients, allowing for single anastomosis techniques for RFFF. Antecubital perforators capture DVS and SVS outflow through a single, extended venous pedicle, eliminating the risk of venous insufficiency and need for vein grafts.
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Affiliation(s)
- Mauricio Alejandro Moreno
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Alexandrea H Kim
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Emre Vural
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jumin Sunde
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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The impact of lip-split mandibulotomy on patients treated for pT2 oral tongue squamous cell carcinoma: a study of 224 patients. Oral Maxillofac Surg 2020; 25:313-318. [PMID: 33141300 DOI: 10.1007/s10006-020-00918-8] [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: 10/19/2018] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Head and neck surgeons often face a challenge in order to achieve adequate three-dimensional resection of tumours in the oral cavity, especially in the dentate patient. METHODS We compared the outcomes of lip-split mandibulotomy and trans-oral access, respectively, in patients treated for primary pT2 oral tongue SCC with regard to the status of the resection margins and the incidence of tumour recurrence. RESULTS Multivariate analysis showed a non-significant effect of the surgical technique used to the reported recurrence, F(1, 224) = 0.350, p = .555 and a significant effect on the margins achieved F(1, 224) = 11.381, p = .001. CONCLUSIONS Defects after excision of larger and more posterior tumours that are going to be reconstructed with free flaps represent a more probable indication for using an osteotomy access technique. Lip-split mandibulotomy is a low-morbidity technique which can deliver a sound oncological outcome and can be relatively easily taught to less experienced surgeons.
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Taufique ZM, Daar DA, Cohen LE, Thanik VD, Levine JP, Jacobson AS. The medial sural artery perforator flap: A better option in complex head and neck reconstruction? Laryngoscope 2018; 129:1330-1336. [DOI: 10.1002/lary.27652] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Zahrah M. Taufique
- Department of Otolaryngology–Head and Neck Surgery New York New York U.S.A
| | - David A. Daar
- Hansjorg Wyss Department of Plastic SurgeryNew York University Langone Health New York New York U.S.A
| | - Leslie E. Cohen
- Hansjorg Wyss Department of Plastic SurgeryNew York University Langone Health New York New York U.S.A
| | - Vishal D. Thanik
- Hansjorg Wyss Department of Plastic SurgeryNew York University Langone Health New York New York U.S.A
| | - Jamie P. Levine
- Hansjorg Wyss Department of Plastic SurgeryNew York University Langone Health New York New York U.S.A
| | - Adam S. Jacobson
- Department of Otolaryngology–Head and Neck Surgery New York New York U.S.A
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Wolff KD, Rau A, Kolk A. Perforator flaps from the lower leg for intraoral reconstruction: Experience of 131 flaps. J Craniomaxillofac Surg 2018; 46:338-345. [DOI: 10.1016/j.jcms.2017.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/11/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022] Open
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New aspects in free flap surgery: Mini-perforator flaps and extracorporeal flap perfusion. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017. [PMID: 28642191 DOI: 10.1016/j.jormas.2017.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The scope of microvascular tissue transfer in the Head and Neck reaches from coverage of simple soft tissue defects to complex 3-D reconstructions using multiple or chimeric flaps. This paper summarises the presentation given at the Congress of the French Society of Oral and Maxillofacial Surgery in Marseille 2017. It was the aim of our work to add further elements to this wide spectrum of reconstructive possibilities. METHODS For patients with small intraoral soft tissue defects in whom the use of a radial forearm flap would not be justified because of its donor site morbidity, but who nevertheless would take a benefit from a small free flap, we used mini-perforator flaps from the lower leg. These flaps were raised with negligible morbidity. Moreover, for patients necessarily needing a free flap, but having vessel depleted, irradiated necks, we have developed a first idea of extracorporeal flap perfusion to make microvascular anastomoses unnecessary. RESULTS Using donor sites from the lower leg, mini-soleus and medial sural perforator flaps were raised to cover defects of 2×3 to 2×4cm at the anterior floor of the mouth or lateral tongue. The success rate was 91%, and despite their small size, the flaps helped to maintain the mobility of the tongue. The donor site morbidity was minimal. After extensive experimental work on small animals and human tissue, four flaps could successfully be transferred so far by means of extracorporeal perfusion. In these patients, autonomisation took place between 5 and 12 days. CONCLUSIONS Although microvascular tissue transfer already allows for reconstruction in almost any possible defect constellation, mini-perforator flaps and machine-perfused transplants seem to represent new aspects of free flap surgery, being useful extensions of the reconstructive surgeon's armament.
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10
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Free tissue flaps in head and neck reconstruction: clinical application and analysis of 93 patients of a single institution. Braz J Otorhinolaryngol 2017; 84:416-425. [PMID: 28571928 PMCID: PMC9449187 DOI: 10.1016/j.bjorl.2017.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/25/2017] [Accepted: 04/15/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates. Objective To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions. Methods This was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients’ demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed. Results The patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up. Conclusion Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.
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Pang P, Li RW, Shi JP, Xu ZF, Duan WY, Liu FY, Huang SH, Tan XX, Sun CF. A comparison of mandible preservation method and mandibulotomy approach in oral and oropharyngeal cancer: A meta-analysis. Oral Oncol 2016; 63:52-60. [DOI: 10.1016/j.oraloncology.2016.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/15/2016] [Accepted: 11/08/2016] [Indexed: 01/11/2023]
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Li H, Li J, Yang B, Su M, Xing R, Han Z. Mandibular lingual release versus mandibular lip-split approach for expanded resection of middle–late tongue cancer: A case-control study. J Craniomaxillofac Surg 2015; 43:1054-8. [DOI: 10.1016/j.jcms.2015.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/07/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022] Open
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Abstract
Our purpose was to evaluate the feasibility of radial forearm free (RFF) flap, platysma myocutaneous (PM) flap, and anterolateral thigh (ALT) flap in buccal reconstruction. This study consisted of 56 patients who were categorized into 3 groups. The Student t test was used to analyze the variables. Patients in group platysma flap were significantly older, the dissection of platysma flap was easier, and the defect was significantly smaller than those in group radial forearm flap and group ALT flap. The reduction in the widths of mouth opening between group PM, group RFF, and group ALT were compared. However, the reduction of mouth-opening widths in group RFF and group ALT was significantly less than that in group PM. Platysma myocutaneous flap may be more suitable in patients with small to middle-size defect and poor status, although the flap cannot achieve a reliable result; anterolateral thigh flap and radial forearm flap can preserve the interincisal distance well even for large buccal defect, but it takes more time and skills in the operation.
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Tornero J, Cruz-Toro P, Farré A, Vega-Celiz J, Skufca J, Nogués J, Maños-Pujol M. Free Radial Forearm Flap in Head and Neck: Our Experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tornero J, Cruz-Toro P, Farré A, Vega-Celiz J, Skufca J, Nogués J, Maños-Pujol M. [Free radial forearm flap in head and neck: our experience]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 65:27-32. [PMID: 24342698 DOI: 10.1016/j.otorri.2013.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/28/2013] [Accepted: 09/10/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Oncologic surgery leads to important defects and sequelae, as well as notable cosmetic and functional alterations. In this aspect reconstructive surgery has an essential role, allowing more radical excision and lower associated functional and cosmetic morbidities. The aim of this study was to present and evaluate the experience and results of the reconstructive microsurgery unit in our centre's ENT department. METHODS Retrospective study of procedures performed between 2006 and 2012. RESULTS A total of 36 cases were reviewed. The primary tumour was found in the oropharynx (58%) in the majority of cases. In 5 cases the procedure was performed for reconstruction and fistula closure (4 pharyngostoma and 1 tracheoesophageal fistula). Failure from total necrosis was 16% (6/36). No associated mortality has been reported. The most common postoperative complications were wound dehiscence in 5 patients and pharyngostoma (fistula) in 5 cases. Prior radiotherapy significantly influenced the increase in the overall incidence of complications (P<05). CONCLUSIONS Reconstructive surgery currently plays an important role in surgery for head and neck cancer. The radial forearm flap is a safe, reliable method for reconstruction of most defects in the ENT field. This type of intervention provides greater autonomy and safety in surgical oncology.
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Affiliation(s)
- Jordi Tornero
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España
| | - Paula Cruz-Toro
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España.
| | - Anna Farré
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España
| | - Jorge Vega-Celiz
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Skufca
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España
| | - Julio Nogués
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Manel Maños-Pujol
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Li ZN, Li RW, Liu FY, Fang QG, Zhang X, Sun CF. Vertical platysma myocutaneous flap that sacrifices the facial artery and vein. World J Surg Oncol 2013; 11:165. [PMID: 23883279 PMCID: PMC3735476 DOI: 10.1186/1477-7819-11-165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 07/07/2013] [Indexed: 11/29/2022] Open
Abstract
Background Platysma myocutaneous flap (PMF) is a generally used technique for defect reconstruction after an oral cancer resection. The aim of the study is to present our experience using vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction. Methods A retrospective review of the medical records of 54 patients who underwent vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction was performed. A comparison between PMF that sacrificed and that preserved the facial vessels was made, and we also compared PMF that sacrificed the facial vessels with radial forearm free flap (RFFF). Statistics concerning the patients’ clinical factors were gathered. Results The mean age of the 54 patients who underwent PMF that sacrificed the facial artery and vein was 62.0 ± 10.98 years. The co-morbid disease rate of PMF was 53.7%. The flap size ranged from 12 × 5.5 cm to 7 × 5 cm. Survival of the flap was found in all of the cases, with partial necrosis in four cases (7.4%) and total loss in none of the cases. The operation time was 5.7 ± 1.17 h. The complication and success rates were 27.8% and 92.6%, respectively. The 3-year and 5-year survival rates were 77.8% (21/27) and 69.23% (9/13), respectively. The majority of the patients (87.0%) in our series were satisfied with the results of the surgery. There was no significant difference between PMF that sacrificed or that preserved the facial vessels, both in success rate (P = 1) or complication rate (P = 0.72). The patients in the PMF group were older than the patients in the RFFF group (P = 0.011), the operation time was shorter (P < 0.001), and the co-morbid disease rate was higher (P = 0.002). Although the complication rate of PMF (15/54, 27.8%) was higher than that of RFFF (2/34, 5.9%) (P = 0.011), their success rates were similar (92.6%, 94.1%) (P = 1.00). Conclusions Vertical PMF that sacrifices the facial artery and vein has specific advantages including in ease preparation and limitations. This technique may provide an effective method for intraoral reconstruction. Our experience in handling the flap may contribute to the success rate.
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Gerressen M, Pastaschek CI, Riediger D, Hilgers RD, Hölzle F, Noroozi N, Ghassemi A. Microsurgical Free Flap Reconstructions of Head and Neck Region in 406 Cases: A 13-Year Experience. J Oral Maxillofac Surg 2013; 71:628-35. [DOI: 10.1016/j.joms.2012.07.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Saloura V, Langerman A, Rudra S, Chin R, Cohen EEW. Multidisciplinary care of the patient with head and neck cancer. Surg Oncol Clin N Am 2013; 22:179-215. [PMID: 23453331 DOI: 10.1016/j.soc.2012.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Head and neck cancer is a heterogeneous group of cancers, which require a multidisciplinary approach to achieve excellent treatment results. This article focuses on current treatment guidelines and controversies in the management of head and neck cancer. It also provides insight into future directions and newest advances in the treatment of head and neck cancer.
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Affiliation(s)
- Vassiliki Saloura
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL 60637-1470, USA.
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Fang QG, Li ZN, Zhang X, Liu FY, Xu ZF, Sun CF. Clinical reliability of radial forearm free flap in repair of buccal defects. World J Surg Oncol 2013; 11:26. [PMID: 23363472 PMCID: PMC3598887 DOI: 10.1186/1477-7819-11-26] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/13/2013] [Indexed: 11/11/2022] Open
Abstract
Background The ideal method for buccal defects should provide good outcome of both function and appearance; our goal is to highlight the reliability of radial forearm flap in buccal reconstruction. Methods A retrospective study was conducted. From 2005 to 2012, 20 radial forearm flaps were used to repair the defects. We analyzed the superiority and reliability of the flap; in addition, we reviewed some related literature and made a comparison between radial forearm flap and platysma flap. Results All radial forearm flaps totally survived, but two flaps suffered venous obstruction, hematoma, respectively. Radial forearm flap preserved the original interincisal distance well. In our follow-up, all patients had sufficient mouth-opening width (mean: 4.3 cm). Conclusion Radial forearm flap is a reliable method for buccal defect reconstruction.
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Affiliation(s)
- Qi-Gen Fang
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No, 117, Nanjing North Street, Heping District, 110002, Shenyang, Liaoning, People's Republic of China
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Abstract
BACKGROUND The goal of this article is to review the current literature on the use of acellular dermal matrix in forearm, wrist, and hand reconstruction. METHODS A comprehensive literature search was performed using the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, and Web of Knowledge. Articles were categorized as acellular dermal matrix used in soft-tissue repair and in ligament reconstruction. Search terms included "acellular dermal matrix," "biologic dressing," "skin replacement," "dermal allograft," "AlloDerm," "FlexHD," "Permacol," and "Strattice." These were all cross-referenced with "forearm," "wrist," and "hand." Data extraction focused on indications, surgical techniques, clinical outcomes, and complications. Exclusion criteria included regeneration templates, neonatal foreskin, and review articles. RESULTS More than 100 articles published between 1994 and 2011 were identified. Upon final review, five prospective case-control studies, three retrospective case-control studies, four case reports, one cross-sectional cohort, one prospective consecutive series, and one study type unknown were evaluated. Matrix was most commonly used in burn reconstruction. It has also been used in ligament and joint reconstruction for first carpometacarpal arthritis. One article illustrated the use of porcine matrix in basal joint arthritis, a practice that was abruptly terminated because of a concern over increased infections. CONCLUSIONS The clinical indications for acellular dermal matrix have increased throughout the last 15 years. Hand surgeons have been cautious but diligent in developing alternative treatment options in hand reconstruction, with a focused effort to reduce donor-site morbidity. Although acellular dermal matrices continue to find innovative uses to solve upper extremity surgical problems, more comparative prospective trials are needed.
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Handschel J, Burghardt S, Naujoks C, Kübler NR, Giers G. Parameters predicting complications in flap surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:589-94. [PMID: 23246227 DOI: 10.1016/j.oooo.2012.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 08/21/2012] [Accepted: 09/09/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this prospective study was to determine laboratory parameters predicting complications and/or failure in flap surgery. STUDY DESIGN Fifty-seven patients undergoing reconstructive surgery with cutaneous free and pedicled flaps were included. Blood samples were taken 2 days before surgery and 1, 3, 5, 7, and 14 days after. Parameters associated with thrombophilia, bleeding disorders, and wound healing were determined. RESULTS In 45 (77%) of 57 patients no complications occurred. Bleeding (9%) and venous thrombosis of the flaps (9%) led in 18% of the cases to surgical revisions. Activated protein C resistance showed a significant (P < .05) cluster in cases with venous thrombosis, whereas it was absent in all other cases. Fibrinogen, factor VIII:C, von Willebrand factor (vWF) activity, and VWF antigen were significantly (P < .05) higher in patients with venous thrombosis compared with all other patients. CONCLUSIONS Laboratory parameters of thrombosis and bleeding appear to be associated with complications in flap surgery.
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Affiliation(s)
- Jörg Handschel
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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Parker RJ, Eley KA, Von Kier S, Pearson O, Watt-Smith SR. Functional fibrinogen to platelet ratio using thromboelastography as a predictive parameter for thrombotic complications following free tissue transfer surgery: A preliminary study. Microsurgery 2012; 32:512-9. [DOI: 10.1002/micr.21978] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/10/2022]
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