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Cao LM, Kuo ZY, Yu YF, Jia J, Liu B, Bu LL. Postoperative volume maintenance rate of microvascular free flap in oral and maxillofacial region: Systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101728. [PMID: 38070674 DOI: 10.1016/j.jormas.2023.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/06/2023] [Indexed: 08/28/2024]
Abstract
BACKGROUND AND OBJECTIVES The resorption of flap's volume can be frequently observed in the transplantation of microvascular free flaps, which could significantly affect postoperative function. Therefore, it's essential to comprehend the postoperative flap volume and the mechanisms behind before making clinical decisions. METHODS Literature search was conducted from database on PubMed, EMBASE, Cochrane Library, Chinese database and Google Scholar. A random effects model meta-analyses and descriptive systematic review were performed. RESULTS The search identified 420 articles, of which 9 studies included in meta-analysis and 14 studies included in descriptive systematic review. Postoperative flap volume maintenance rate is used to represent the volume change. The pooled mean postoperative flap volume maintenance rate was 62.82 % for soft tissue flap (95 %CI: 58.83 to 66.82, p = 0.076, I2=56.3 %) and 85.96 % for bone flap (95 %CI: 84.19 to 87.73, p = 0.274, I2=20.4 %). Weight loss, muscle atrophy, and decreased serum albumin levels are risk factors for postoperative volume reduction of soft tissue flaps. The bone resorption rate of bone flaps in women is higher than that in men. CONCLUSION When designing microvascular free flaps for oral and maxillofacial surgery, soft tissue flaps should consider an anticipated postoperative shrinkage of 37 %, while bone flaps should consider an anticipated postoperative shrinkage of 14 %.
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Affiliation(s)
- Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Zheng-Ye Kuo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Yi-Fu Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Jun Jia
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China.
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Ismail T, Padilla P, Kurlander DE, Corkum JP, Hanasono MM, Garvey PB, Chang EI, Yu P, Largo RD. Profunda Artery Perforator Flap Tongue Reconstruction: An Effective and Safe Alternative to the Anterolateral Thigh Flap. Plast Reconstr Surg 2024; 153:1191e-1200e. [PMID: 37384852 DOI: 10.1097/prs.0000000000010890] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND The anterolateral thigh (ALT) perforator flap is a workhorse flap for tongue reconstruction. The authors present an alternative option using the profunda artery perforator (PAP) flap for glossectomy reconstruction compared with the ALT flap. METHODS A retrospective review was conducted of 65 patients who underwent subtotal or total glossectomy reconstruction between 2016 and 2020 (46 ALT versus 19 PAP flaps). Flap volume was assessed using computed tomography scans at two different time points. Quality of life and functional outcomes were measured using the MD Anderson Symptom Inventory for Head and Neck Cancer. RESULTS Patients receiving a PAP flap had significantly lower body mass index compared with those receiving an ALT flap (22.7 ± 5.0 versus 25.8 ± 5.1; P = 0.014). Donor-site and recipient-site complications were similar, as was the mean flap volume 7 months after surgery (30.9% for ALT versus 28.1% for PAP; P = 0.93). Radiation and chemotherapy did not appear to have a significant effect on flap volume change over time. The most frequently reported high-severity items in MD Anderson Symptom Inventory for Head and Neck Cancer were swallowing/chewing and voice/speech for both cohorts. Patients who had reconstruction with a PAP flap had significantly better swallowing function ( P = 0.034). CONCLUSIONS Both the PAP and ALT flaps appear to be safe and effective choices for subtotal and total tongue reconstruction. The PAP flap can serve as an alternative donor site, especially in patients with low body mass index and thin lateral-thigh thickness undergoing reconstruction of extensive glossectomy defects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Tarek Ismail
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Pablo Padilla
- Division of Plastic Surgery, University of Texas Medical Branch
| | - David E Kurlander
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Joseph P Corkum
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Matthew M Hanasono
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Patrick B Garvey
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Edward I Chang
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Peirong Yu
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
| | - Rene D Largo
- From the Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center
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3
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Thariat J, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, Merlotti A, Dejean C, Devauchelle B. Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy. Front Oncol 2024; 14:1379861. [PMID: 38665951 PMCID: PMC11043495 DOI: 10.3389/fonc.2024.1379861] [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: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Background Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy. Methods A systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT. Results Despite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap-tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications. Conclusion Flap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.
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Affiliation(s)
- Juliette Thariat
- Department of Radiotherapy, Centre François-Baclesse, Caen, France
- Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Caen, France
- Faculté de Médecine de Caen, Université de Normandie, Caen, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Orsay, France
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Deneuve
- Surgical Oncology Department, Centre Léon Bérard, UNICANCER, Lyon, France
- Inserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon Bérard, Lyon, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Ollioules, France
| | - Anna Merlotti
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, University Hospital of Amiens Picardy, Research Unit, UR7516 CHIMERE, University of Picardy Jules Verne, Institut Faire Faces, Amiens, France
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4
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Pfister P, Speck NE, Gahl B, Muller L, Fürst T, Kappos EA, Schaefer DJ, Largo RD, Ismail T. Impact of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 91:24-34. [PMID: 38401274 DOI: 10.1016/j.bjps.2024.02.026] [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: 09/13/2023] [Revised: 12/08/2023] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Limited data exist regarding the effect of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction. However, an adequate free flap volume is an important predictor of functional and patient-reported outcomes in head and neck reconstruction. METHODS A systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 6710 abstracts were screened, and 36 full-text papers were reviewed. Nineteen studies met the inclusion criteria and were used to extract data for this analysis. RESULTS A meta-analysis of 14 two-arm studies comparing the impact of adjuvant radiotherapy versus no adjuvant radiotherapy was performed. The main analysis revealed that 6 months postoperatively, irradiated flaps showed a significant reduction of volume (average, 9.4%) compared to nonirradiated flaps. The average interpolated pooled flap volumes 6 months postoperatively were 76.4% in irradiated flaps and 81.8% in nonirradiated flaps. After a median postoperative follow-up of 12 months, the total flap volume was 62.6% for irradiated flaps and 76% for nonirradiated flaps. Four studies reported that chemotherapy had no significant impact on free flap volume. CONCLUSIONS Compared to nonirradiated flaps, irradiated flaps were significantly reduced in volume (range, 5% to 15.5%). Clinicians should take this into account when planning the surgical reconstruction of head and neck defects. Conducting large-scale prospective studies with standardized protocols and well-defined follow-up measurements could contribute to defining the ideal, personalized free flap volume for optimal function and patient-reported outcomes.
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Affiliation(s)
- Pablo Pfister
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Nicole E Speck
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Surgical Outcome Research Center Basel, University Hospital Basel, Basel, Switzerland
| | - Laurent Muller
- Department of Ear, Nose and Throat Surgery, University Hospital Basel, Basel, Switzerland
| | - Thomas Fürst
- University Medical Library, University of Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
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5
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Utsunomiya H, Tanaka R, Akamine S, Kusano T, Kuroki T, Kadomatsu K. Longitudinal Volume Assessment of Reconstructed Breast Using Three-Dimensional Measurement: How Do DIEP and LD Flap Change Immediately after Surgery? Indian J Plast Surg 2024; 57:99-105. [PMID: 38774730 PMCID: PMC11105820 DOI: 10.1055/s-0044-1781447] [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] [Indexed: 05/24/2024] Open
Abstract
Background The deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps are two widely used autologous breast reconstructions. Despite studies on flap-volume changes, the time of the first measurement is not immediately after surgery. Therefore, this study aimed to investigate the change in volume over time from the immediate postoperative period using a three-dimensional (3D) scanner. Methods Patients who underwent breast reconstruction with a DIEP or LD flap between October 2019 and December 2020 at Showa University Koto Toyosu Hospital were included. The Kinect 3D scanner was used to measure the reconstructed and healthy breast volumes immediately after surgery and at 1, 3, 6, and 12 months. The control group was the healthy side, and the volumes obtained at each time point and ratios (to the immediate postoperative period) were calculated and analyzed using a linear mixed model. Results Of the 25 patients and 26 breasts examined, the postoperative increase in volume ratios was statistically significant in the DIEP flap group, except for the sixth month, but decreased significantly in the LD group. Compared with the control group, the volume ratio was significantly higher up to 3 months in the DIEP flap group and decreased significantly after 3 months in the LD flap group. Conclusions The volume of the LD flap continued to decrease immediately after surgery, whereas the volume of the DIEP flap increased by 10% up to 1M. Therefore, this increase in volume should be taken into consideration in studies where the initial measurements were not taken immediately after surgery.
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Affiliation(s)
- Hiroki Utsunomiya
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ryutaro Tanaka
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Shuryo Akamine
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | - Tomoaki Kuroki
- Department of Plastic and Reconstructive Surgery, Showa University Hospital, Tokyo, Japan
| | - Koichi Kadomatsu
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Tokyo, Japan
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6
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Gewirtz JI, Zhao S, Brock G, Luttrull MD, Sethuraman S, Kang SY, VanKoevering KK, Seim NB. A Pilot Study: Free Flap Atrophy in Tongue Reconstruction Using 3D Volumetric Analysis. Ann Otol Rhinol Laryngol 2024; 133:253-260. [PMID: 37789590 DOI: 10.1177/00034894231204720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. METHODS Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. RESULTS Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P = .0417). Each successive postoperative month, the flap decreased by 1.54% (P < .0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P = .0093), obesity status (P = .0431), and base of tongue involvement (P = .0472). CONCLUSION Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction.
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Affiliation(s)
- Jordan I Gewirtz
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Michael D Luttrull
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - 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, Columbus, OH, USA
| | - 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, Columbus, OH, USA
| | - 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, Columbus, OH, USA
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7
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Thoenissen P, Najafi R, Sader R, Ghanaati S. Volume reduction of vascularized flaps in the field of cranio-maxillofacial surgery: A narrative-style review. J Craniomaxillofac Surg 2024; 52:203-211. [PMID: 38135647 DOI: 10.1016/j.jcms.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/15/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- Philipp Thoenissen
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany.
| | - Ramin Najafi
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Robert Sader
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Shahram Ghanaati
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
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8
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Wang L, Dong Q, Ye M, Du J, Zhou R, Cai X. Effect of Different Repair and Reconstruction Methods Combined with Psychological Intervention on Quality of Life and Negative Emotion in Patients with Oral Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7359584. [PMID: 35572838 PMCID: PMC9106514 DOI: 10.1155/2022/7359584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/02/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the effects of different repair and reconstruction methods combined with psychological intervention on the quality of life and negative emotion of patients with oral cancer. Methods 180 patients with oral cancer treated in our hospital from January 2018 to January 2020 were randomly divided into group A, group B, and group C, with 60 cases in each group. Group A and group B were repaired with submental island flap and free flap, respectively. Group C was divided into two groups, and group C was treated with routine nursing intervention. Group A and group B received psychological intervention. Clinical symptom scores, complication rate (CR), quality of life (according to the University of Washington quality of life questionnaire, UW-QOL), and negative emotion scores were compared. Results After intervention, the clinical symptom scores and negative emotion scores of groups A and B were lower than those of group C (P < 0.001), as well as the CR (P < 0.05), and the UW-QOL scores of groups A and B were higher than those of group C (P < 0.05), but no significant differences in these aspects were presented between group A and group B (P > 0.05). The main factors affecting quality of life were swallowing/chewing, language, and saliva in group A; swallowing/chewing, language, and taste in group B; and appearance, swallowing/chewing, emotion, and language in group C. Conclusion Psychological intervention can improve the mental state of patients with oral cancer after operation, optimize the effect of operation, and improve the quality of life. As the effect of psychological intervention on patients undergoing different repair and reconstruction methods is similar, it should be given according to patients' actual condition in the clinic.
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Affiliation(s)
- LinHu Wang
- Department of Stomatology, General Hospital of Central Theater Command of PLA, Wuhan 430070, China
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan 430070, China
| | - QingShan Dong
- Department of Stomatology, General Hospital of Central Theater Command of PLA, Wuhan 430070, China
| | - Mingfu Ye
- Department of Oral Implantology, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, 310068 Fujian, China
| | - Jiao Du
- Oral and Maxillofacial Surgery, Wuhan Savaid Stomatology Hospital, Wuhan 430021, China
| | - RongHua Zhou
- Oral and Maxillofacial Surgery, Wuhan Savaid Stomatology Hospital, Wuhan 430021, China
| | - XianHua Cai
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan 430070, China
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9
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Facial Nerve Revascularization Strategies in Facial Restoration. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4038. [PMID: 35047325 PMCID: PMC8758059 DOI: 10.1097/gox.0000000000004038] [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: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Facial transplants represent the current exemplar in the reconstruction of severely damaged faces, whereas conventional free flap reconstruction has its limitations in restoring both function and surface cover.
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10
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Yamazaki M, Suzuki T, Hiraga C, Yoshida Y, Baba A, Saitou H, Ogane S, Fujii T, Takano M, Katakura A, Tanaka I, Nomura T, Takano N. Effect of postoperative radiotherapy for free flap volume changing after tongue reconstruction. Oral Radiol 2021; 37:518-523. [PMID: 33184774 DOI: 10.1007/s11282-020-00489-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of postoperative radiotherapy (RT) on temporal volume changes with a cutaneous free flap (CF) and a myocutaneous free flap (MCF). METHODS The subjects were 24 men and 11 women (mean age, 50.5 ± 15.5 years) with tongue or floor of mouth cancer. Twenty-seven cases of CF and eight cases of MCF were selected. The flap volume change of the reconstructed tongue was calculated using computed tomography (CT) images taken immediately and at one year postoperatively using the DICOM image processing software OsiriX®. RESULTS The reduction rate in flap volume at one year postoperatively was 82.0 ± 15% in CF without RT, 70.3 ± 26.1% in CF with RT, 88.5 ± 14.7% in MCF without RT, and 99.5 ± 16% in MCF with RT. The MCF volume was significantly higher compared to the CF volume. Although postoperative RT reduced the CF volume by 30%, there was only a slight reduction in the MCF volume. CONCLUSIONS We evaluated the effect of postoperative RT on volume reduction in 35 cases of the reconstructed tongue with CF and MCF using a computer-assisted volume rendering technique. In this study, the effect of RT on volume reduction was different between the CF and MCF.
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Affiliation(s)
- Masae Yamazaki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Taiki Suzuki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
| | - Chiho Hiraga
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Yoshifumi Yoshida
- Department of Oral Medicine, Hospital Dentistry, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Akira Baba
- Department of Radiology, The Jikei University School of Medicine and University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 1058461, Japan
| | - Hirokazu Saitou
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Satoru Ogane
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Takako Fujii
- Department of Plastic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Masayuki Takano
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Akira Katakura
- Department of Oral Pathological Science and Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Ichiro Tanaka
- Department of Plastic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Nobuo Takano
- Oral Cancer Center, Tokyo Dental College, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
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11
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Kagaya Y, Arikawa M, Sekiyama T, Higashino T, Akazawa S. Chronological flap volume and distribution changes after reconstruction of total maxillectomy defect using a rectus abdominis myocutaneous flap. J Plast Reconstr Aesthet Surg 2021; 74:3341-3352. [PMID: 34215545 DOI: 10.1016/j.bjps.2021.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE After total or subtotal maxillectomy, reconstruction using a free rectus abdominis myocutaneous (RAMC) flap is a fundamental and useful option. The purpose of the present study was to clarify the degree of flap volume change and volume distribution change with time after total or subtotal maxillectomy and free RAMC flap reconstruction and to examine the factors affecting the results. METHODS A total of 20 patients who underwent total or subtotal maxillectomy with free RAMC flap reconstruction were examined, and the flap volume change rate (volume at final evaluation [POD 181-360] / volume at initial evaluation [POD 5-30]) was investigated using the results of imaging tests. Moreover, the flap was divided into four blocks (A-D) in the cranio-caudal direction, and the volume change of each block was individually analyzed. RESULTS The overall volume change rate of fat/muscle/total was 0.84 ± 0.21/0.36 ± 0.08/0.67 ± 0.15, at the mean follow-up period of 309±35 days after the operation. The multiple regression analysis revealed that weight loss (for fat), postoperative RT (for fat and muscle), and young age (for muscle) were independently associated with flap volume loss. The results also indicated that the fat volume was stable, whereas the muscle volume decreased to <40% over time, assuming there were no influencing factors. Regarding flap volume distribution change, the fat volume tended to gather toward the central-cranial direction, while the muscle volume gathered toward the cranial direction, and total flap volume gathered toward the central direction.
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Affiliation(s)
- Yu Kagaya
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Masaki Arikawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Sekiyama
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba 277-8577, Japan
| | - Satoshi Akazawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Zhang SL, Song J, Wang YR, Guo YJ, Zhao JZ, Sun L, Huang LT, Ma JT, Han CB. Short-term outcomes and safety of radiotherapy for immediate breast reconstruction with autologous flap transfer following breast-conserving surgery. BMC Cancer 2021; 21:214. [PMID: 33653297 PMCID: PMC7923603 DOI: 10.1186/s12885-021-07915-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer. METHOD A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. RESULTS In total, 84 breast cancer patients were enrolled, with 32 patients in the RT group and 52 in the non-RT group. At a median follow-up time of 33.3 months, no significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P = 1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P < 0.001). No significant difference in the reduction of flap size was observed at any timepoint between the two groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P > 0.05). Additionally, no grade 3 or greater RT-associated adverse events occurred during or after RT. CONCLUSION RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.
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Affiliation(s)
- Shu-Ling Zhang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jun Song
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yan-Ru Wang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yi-Jia Guo
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jian-Zhu Zhao
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Li Sun
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Le-Tian Huang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jie-Tao Ma
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Cheng-Bo Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Factors Affecting Volume Change of Anterolateral Thigh Flap in Head and Neck Defect Reconstruction. J Oral Maxillofac Surg 2020; 78:2090-2098. [DOI: 10.1016/j.joms.2020.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/22/2022]
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Razavi CR, Hostetter J, Shukla A, Cheng Z, Aygun N, Boahene K, Byrne PJ, Richmon J, Quon H, Desai SC. Predictors of Free Flap Volume Loss in Nonosseous Reconstruction of Head and Neck Oncologic Defects. EAR, NOSE & THROAT JOURNAL 2020; 101:48-53. [PMID: 32633655 DOI: 10.1177/0145561320938903] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Free tissue reconstruction of the head and neck must be initially overcorrected due to expected postoperative free flap volume loss, which can be accelerated by adjuvant radiation therapy. In this study, we aim to identify patient and treatment-specific factors that may significantly contribute to this phenomenon and translate these characteristics into a predictive model for expected percent free flap volume loss in a given patient. METHODS Patients with a history of oral cavity and/or oropharyngeal cancer who underwent nonosseous free flap reconstruction were reviewed between January 2009 and November 2018 at a tertiary care center. Demographics/characteristics, total radiation dose, radiation fractionation (RF), and pre/postradiation free flap volume as evaluated by computed tomography imaging were collected. Free flap volume was measured by a fellowship-trained neuroradiologist in all cases. Only patients receiving adjuvant radiotherapy with available pre/postradiation imaging were included. Multivariable linear regression modeling for prediction of free flap volume loss was performed with optimization via stepwise elimination. RESULTS Thirty patients were included for analysis. Mean flap volume loss was 42.7% ± 17.4%. The model predicted flap volume loss in a significant fashion (P = .004, R2 = 0.49) with a mean magnitude of error of 9.8% ± 7.5%. Age (β = 0.01, P = .003) and RF (β = -0.01, P = .009) were individual predictors of flap volume loss. CONCLUSIONS Our model predicts percent free flap volume loss in a significant fashion. Age and RF are individual predictors of free flap volume loss, the latter being a novel finding that is also modifiable through hyperfractionation radiotherapy schedules.
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Affiliation(s)
- Christopher R Razavi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jason Hostetter
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aishwarya Shukla
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nafi Aygun
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kofi Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shaun C Desai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Wilting FNH, Hameeteman M, Tielemans HJP, Ulrich DJO, Hummelink S. "Three-dimensional evaluation of breast volume changes following autologous free flap breast reconstruction over six months". Breast 2020; 50:85-94. [PMID: 32113147 PMCID: PMC7380344 DOI: 10.1016/j.breast.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/07/2020] [Indexed: 01/11/2023] Open
Abstract
Objectives To date, little is known about postoperative changes in breast volume after autologous breast reconstruction. The purpose of this retrospective study was to investigate breast volume changes following autologous free flap reconstruction and the factors affecting flap volume. Materials and methods Patients who underwent deep inferior epigastric perforator, superficial inferior epigastric artery and profunda artery perforator flaps between December 2016 and January 2019 were included. Exclusion criteria were breast complications requiring surgical debridement, and the absence of at least two suitable three-dimensional images postoperatively. Three-dimensional stereophotogrammetry volume measurements were performed at the time of standard surgical check-ups. Changes in breast volume were modeled using a quartic polynomial curve function in a nested mixed effects model. Results 136 breasts in 101 patients were included. An average decrease of predicted breast volume was found from 637.8 cc (95%-CI [624.4, 651.1]) at two weeks to 566.6 cc (95%-CI [535.1, 598.0]) after three and 567.6 cc (95%-CI [515.9, 617.6]) after six months postoperatively. Reconstruction timing and first postoperatively measured breast volume showed a statistically significant difference in initial reconstructed breast volume and in the shape of the relationship between time and breast volume, whereas autologous technique and BMI only showed a statistically significant difference in initial reconstructed volume and mastectomy indication in the shape of the relationship. Conclusion The final overall flap volume decreased to 88.9% of its original volume after six months. Gaining more insight into the factors influencing flap volume is of crucial importance to facilitate predictable surgical outcomes.
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Affiliation(s)
- Floor N H Wilting
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Marijn Hameeteman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanneke J P Tielemans
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Long-Term Serial Measurement of Muscle Volume in TRAM Flaps Using the Eclipse Treatment Planning System. Plast Reconstr Surg 2019; 143:1137e-1141e. [DOI: 10.1097/prs.0000000000005609] [Citation(s) in RCA: 2] [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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