Orofacial Soft Tissue Reconstruction with Locoregional Flaps in a Health Resource-Depleted Environment: Experiences from Nigeria

Retrospective cross-sectional study to evaluate outcome of loco-regional flaps in head and neck reconstruction in Sudanese patients

Introduction

The soft tissue of the head and neck region poses both esthetic and functional aspects and must be retorted simultaneously, as any defect will be easy recognizable and will affect the quality of patient's life. Reconstruction by local- regional flap still the most popular approach used and outcome also better than other options.

Objectives

To assess the outcome of loco-regional flaps in head and neck reconstruction in Sudanese patients.

Patients and methods

Retrospective cross-sectional, multicenteric study (Soba University Hospital, Khartoum North Teaching Hospital and an associated specialized hospital) - Khartoum, Sudan, 84 patients underwent head/neck reconstruction during the period from 2017 up to 2021 were included.

Results

Out of 84 patients, 47.6% were female and 52.4% were male. The etiology of head and neck defects in the majority (69%) was neoplastic, and in 11.9% it was trauma. According to site of defect, in 23.8% of patients was Cheek unit, 21.4% was nasal site, and 16.7% was neck site. Surgery in 85.7% of patients were primary, while in 14.3 was delayed. Fasciocutaneous flaps were used in 64.3%, followed by myocutaneous flap in 28.6%; functional outcome was excellent in 61.9%, adequate in 35.7%, and was inadequate in only 2.4%. The majority of patients 66.2% did not develop any complications.

Conclusion

Loco-regional flaps are ideally useful in covering head and neck defects. It has an acceptable esthetic and functional outcome in the majority of cases. It can be considered as a reliable option for reconstruction especially in resource constrained centers.

Temporoparietal Flap for Facial Reconstruction: Donor Site Morbidity

Background

Temporoparietal flap (TPF) is recommended when thin delicate tissue for medium sized defect is needed. The most used form of this flap is for auricle reconstruction. In this article usage of this flap for facial reconstruction other than auricle is discussed, emphasing on donor site morbidity.

Method

In this retrospective study, archived files of the Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Mashhad, Iran were evaluated from 2016-2020. Patients whom TPF was used for facial reconstruction were included. Flap survival was checked and donor site morbidity was evaluated in the form of skin scar and frontal nerve branch injury.

Results

This flap was used in 8 patients for facial reconstruction. All the cases had experienced Alopecia and this was the greatest when the skin of scalp was also included. All of the patients could elevate the eyebrow that means intact frontal branch of facial nerve.

Conclusion

TPF is a versatile flap for facial reconstruction. However, alopecia is high in composite fasciocutaneous form of this flap.

Pertes de substances maxillo-faciales d’origine traumatique au centre hospitalier universitaire Yalgado Ouedraogo

OBJECTIVE

This work aims to report the modalities of management of maxillofacial substance loss following trauma in our context.

METHODS

This was a descriptive cross-sectional study with retrospective data collection of 55 cases of maxillofacial substance loss of traumatic origin over a period of 7 years from 2014 to 2020 in the department of stomatology and maxillofacial surgery of Yalgado Ouedraogo University Hospital.

RESULTS

The annual prevalence was 7.86 cases. The etiology was dominated by road traffic accidents (80% of cases). Loss of labial substance was the most frequent (58.18%). The lesions were severe, Lakmann type IV in 76.36% of cases. Bone loss occurred in 9.10% of the cases and was mainly located in the mandible. The repair of substance losses by locoregional flaps was the main technique for soft tissue reconstruction. Bone defects were repaired with non-vascularized bone grafts. The evolution was satisfactory in the majority of cases (80.3%). Infections were the main complications (5 cases) and the sequelae were dominated by unaesthetic scars (45.45%).

CONCLUSION

The management of maxillofacial substance loss of traumatic origin must be early and adequate for a better aesthetic and functional result.

Head and Neck Wound Reconstruction Using Biodegradable Temporizing Matrix Versus Collagen-Chondroitin Silicone Bilayer

BACKGROUND

Head and neck reconstruction is challenging because of the functional requirements of movement, sensation, and cosmesis of this highly visible region. This study is the first to compare Novosorb biodegradable temporizing matrix (BTM) and Integra collagen-chondroitin silicone (CCS) skin substitutes for reconstruction of soft tissue head and neck wounds.

METHODS

This retrospective review included adults who underwent wound reconstruction of the head/neck with either BTM or CCS between 2015 and 2020. Patient-level data, complications, and closure rates were compared.

RESULTS

The review identified 15 patients: 5 who received BTM and 10 who received CCS. Mean age at dermal template placement was 55 (range, 28-79) years. Race, sex, smoking status, medical comorbidities, defect size, radiation history, prior surgeries, and follow-up time were not significantly different between groups. Wound etiologies for BTM and CCS included burn (40% vs 60%), trauma (20% vs 20%), surgical wounds (20% vs 20%), and skin cancer (20% vs 0%), respectively (P = .026). Skin grafts were placed in 8 (80%) wounds after CCS placement, compared with 3 (60%) after BTM (P = .670). Template reapplication was required in 2 (40%) BTM wounds and 3 (30%) CCS wounds (P = 1.0). Infection, hematoma, and seroma were comparable between groups, although skin graft failure was higher in the CCS group at 3 (37.5%) compared with 0 for BTM (P = .506). More secondary procedures were required after CCS placement (CCS, 1.9 ± 2.2; BTM, 0.9 ± 0.8; P = .090). Definitive closure in patients not lost to follow-up occurred in 4 (100%) BTM and 6 (75%) CCS cases (P = 1.0).

CONCLUSIONS

Head and neck wounds treated with BTM had comparable closure and complication rates as CCS bilayer and required fewer secondary procedures and skin grafts. These findings suggest that BTM is safe and efficacious for application in head and neck wounds and may be considered as an economical alternative.