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Zhang M, Fu J, Liu X, Liu B, Mao X, Hu Z. Application of Free Flaps in Reconstruction of Head and Neck Soft Tissue Defects With Bone Exposure. Ann Plast Surg 2024; 93:S11-S14. [PMID: 38896852 DOI: 10.1097/sap.0000000000004000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Reconstruction of head and neck soft tissue defects with bone exposure is both challenging and technically demanding for plastic surgeon. Objectives in head and neck soft tissue defects with bone exposure reconstruction are consistent restoration of functionality while also improving appearance. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 4 years. METHODS A retrospective analysis was conducted from June 2019 to June 2023 on 12 patients treated at our hospital for head and neck soft tissue defects with bone exposure due to various causes. These included 4 cases of trauma from car accidents, 1 burn case, and 7 postoperative malignant tumor removals. The defect sizes ranged from 4 × 6 to 15 × 45 cm. Different free flaps were used for repair based on the defect, including 6 anterolateral thigh flaps, 3 forearm flaps, 2 latissimus dorsi flaps, and 1 dorsalis pedis flap. Flaps were designed and harvested to match the defect size and transplanted via anastomosed vessels. RESULTS All 12 flaps survived successfully. One patient required flap thinning surgery postoperatively. All patients were followed up for over 3 months, showing good color and texture of the transplanted flaps, satisfactory healing, and significant aesthetic improvement. Donor sites showed significant scarring without functional impairment. CONCLUSION Free flap repair for head and neck soft tissue defects with bone exposure is feasible and yields good results.
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Affiliation(s)
- Mingjun Zhang
- From the Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Wei D, Lyu J, Wang B, He Y, Bi L. Hirudin enhances perforator flap survival: Clinical application report and mechanistic exploration. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101868. [PMID: 38588856 DOI: 10.1016/j.jormas.2024.101868] [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: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE Hirudin, a potent anticoagulant, is used in traditional Chinese medicine (TCM) to treat thrombotic conditions and prevent postoperative thrombosis. Coagulation-related vascular complications are a common cause of perforator flaps failure. This study explores hirudin's potential to enhance flap growth by mitigating coagulation-related issues. MATERIALS AND METHODS Patients were divided into GroupⅠ(hirudin group) and GroupⅡ(control). Laboratory tests covered red blood cell count (RBC), hematocrit (HCT), platelet count (PLT), monocyte count (MONO), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-Dimer. Clinical parameters, including capillary refill time (CRT), flap swelling, and survival status, were evaluated. Animal experiments used Sprague-Dawley (SD) rats to establish random skin flaps. The experimental side received hirudin injection, while the control side received saline. Flaps were photographed to calculate survival rate, and CD31 immunohistochemical (IHC) analysis was performed to calculate microvessel density (MVD). RESULTS The study, with 29 patients, found significant CRT differences between groups on postoperative days 2 and 6 (p = 0.027; p = 0.019), favoring GroupⅠ. Swelling severity varied significantly over time; GroupⅡhad more pronounced swelling. GroupⅠshowed superior flap growth with fewer complications, statistically significant (p = 0.033). Specific lab indicators (MONO, PT, and FIB) were significant at certain times. In animal experiments, the experimental side consistently had higher flap survival and slightly increased CD31 expression at various times, with higher MVD on days 2 and 6. CONCLUSIONS Hirudin enhances flap survival through diverse mechanisms, supporting its role as a complementary approach in perforator flap surgeries.
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Affiliation(s)
- Dong Wei
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China
| | - Jiong Lyu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China
| | - Bo Wang
- Department of Pathology, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China
| | - Yong He
- Laboratory Animal Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China
| | - Ling Bi
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, PR China.
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Tapan M, İsler VC, Akman RF, Özkan Ö, Özkan Ö. An Oroauricular Fistula After Mandibular Osteosarcoma Resection. HANDCHIR MIKROCHIR P 2023; 55:462-465. [PMID: 37678410 DOI: 10.1055/a-2125-0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Bone tumors are rare malignancies and osteosarcoma is the most common malignant bone tumor. However, only 6% of all osteosarcomas occur in the mandible and maxilla 1. The location of these tumors also presents a unique set of challenges during resection and repair when compared to long bone tumors.
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Noothanapati NR, Akali NR, Buggaveeti R, Balasubramanian D, Mathew J, Iyer S, Thankappan K. Reconstruction in Salvage Surgery for Head and Neck Cancers. Craniomaxillofac Trauma Reconstr 2023; 16:211-221. [PMID: 37975025 PMCID: PMC10638975 DOI: 10.1177/19433875221109248] [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: 11/19/2023] Open
Abstract
Introduction Salvage surgery is the treatment option in recurrences and second primary tumors. This paper aimed to study the options and outcomes of reconstruction and the predictors of poor reconstructive outcomes in salvage surgery for head and neck cancers. Study Design This is a retrospective study of all patients who underwent reconstructive flap surgery as part of salvage surgery for head and neck cancers between the years 2004 and 2017. Methods The initial treatment may be single modality radiotherapy or surgery or multimodality with combinations of surgery, radiotherapy, and chemotherapy. Any pathology that required surgical salvage was included. Any procedures done purely as reconstructive surgery were excluded. Predictor variables included demographical, clinical, and treatment factors. The outcome parameter was the occurrence of any flap-related complication or not. The complications and morbidity related to the procedures are reported. Results Ninety-three patients underwent loco-regional flaps (LRF group), and 100 had free flaps (FF group). Pectoralis major flap was the commonest flap used in 68 patients (73.1%). Anterolateral thigh (ALT) flap was the commonest free flap and comprised 41% of the FF group. Any skin-related complication was seen in 35 patients (37.6%) and 41 (41%), respectively, in LRF and FF subsets. Any flap-related complication was seen in 16 patients (17.2%) and 29 patients (29%), respectively, in LRF and FF subsets. A summary measure "any one of the complications" was seen in 46 (49.5%) and 57 (57%), respectively, in LRF and FF subsets. Univariate and multivariate analysis for any flap-related complication identified no statistically significant predictor. Conclusions Soft tissue flaps were preferred in salvage reconstruction, though the defects had a bony component. In the microvascular free flap reconstruction era, pectoralis major flap has shifted its role from a "workhorse flap" to a "salvage flap." About half of the patients develop some complications. Flap-related complications are also common. In salvage surgery, it is important that an appropriate flap is selected, suitable for the setting, according to the indications, neck, and patient conditions.
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Affiliation(s)
- Nageswara R. Noothanapati
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Nisha R. Akali
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rahul Buggaveeti
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Jimmy Mathew
- Department of Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Choi Y, Sung KP, Lee SH. Simultaneous diagnosis and resection of orofacial rhabdomyosarcoma with frozen section biopsy: a case report. Arch Craniofac Surg 2023; 24:185-188. [PMID: 37654239 PMCID: PMC10475698 DOI: 10.7181/acfs.2023.00052] [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: 02/24/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 09/02/2023] Open
Abstract
Rhabdomyosarcoma is the most common soft tissue sarcoma in children, accounting for 4.5% of all cases of cancer in childhood. Although the head and neck are the most common sites of rhabdomyosarcoma, oral lesions are relatively rare and account for only 10% to 12% of head and neck rhabdomyosarcoma cases. This is a case report of a girl aged 2 years and 1 month who initially presented with an upper lip mass that invaded the oral mucosa, oral skin, and nostril skin, causing narrowing of the airway. Through our case, we show that rapidly growing small round cell malignancies, especially rhabdomyosarcoma, can be effectively diagnosed and treated at the same time using primary resection with intraoperative frozen section biopsy and that the time spent waiting for the results of preoperative biopsy can be saved in this way, particularly when the patient's symptoms are intensifying rapidly and require immediate operation.
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Affiliation(s)
- Youngwoong Choi
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ki Pyo Sung
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Soo Hyang Lee
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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Pak KY, Anderson SR, Langenfeld TL, Tan K, Slijepcevic A, Wimalawansa S, Ducic Y, Wax MK, Kadakia SP. Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients. Head Neck 2023; 45:1237-1243. [PMID: 36891641 DOI: 10.1002/hed.27337] [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: 11/02/2022] [Revised: 12/21/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The utilization of an arteriovenous loop is an underreported technique that affords the creation of reliable vascular options. Understanding the efficacy and impacting variables of microvascular reconstruction with an arteriovenous loop can be critical to its use. METHODS Multi-institutional study of 36 patients who underwent vein grafting or AV loop with free tissue transfer. RESULTS 58.3% of patients received prior radiation and 38.9% prior flap reconstruction. Flap success for vein grafting was 76% and AV loop was 100% (p = 0.16). Success for the radiated cohort was 90.5% and non-radiated 80% (p = 0.63). Flap success for the radiated, vein grafted patient was 83.3% and 100% flap success rate for radiated, AV loop patient (p = 0.49). Overall flap survival was 83.3% versus 97% overall success rate in the United States. CONCLUSION The AV loop is a viable modality for vessel-depleted free tissue reconstruction. Radiation and previous surgery do not significantly impact flap success rates.
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Affiliation(s)
- Kaitlynne Y Pak
- Division of Otolaryngology-Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Spencer R Anderson
- Division of Plastic & Reconstructive Surgery, Wright State University, Dayton, Ohio, USA
| | - Tyler L Langenfeld
- Boonshoft School of Medicine at Wright State University, Dayton, Ohio, USA
| | - Kenneth Tan
- Oregon Health Science University, Portland, Oregon, USA
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Science University, Portland, Oregon, USA
| | - Sunishka Wimalawansa
- Division of Plastic & Reconstructive Surgery, Wright State University, Dayton, Ohio, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Science University, Portland, Oregon, USA
| | - Sameep P Kadakia
- Division of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio, USA
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II-Y-Shaped Vascular Anastomosis for Free Flap Transfer in Head and Neck Reconstruction in Vessel-Depleted Neck. J Craniofac Surg 2023; 34:735-737. [PMID: 36100973 PMCID: PMC9944351 DOI: 10.1097/scs.0000000000009007] [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: 07/11/2022] [Accepted: 07/30/2022] [Indexed: 11/26/2022] Open
Abstract
In vessel-depleted neck, salvage free flap transfer for head and neck reconstruction is challenging because the difficulty of selecting the recipient vessel and the discrepancy of vessel diameters. Here, the authors describe a novel technique for vascular anastomosis, which allows 2 thin donor veins end-to-end anastomosed with the larger recipient vein. This II-Y-shaped vascular anastomosis for free flap reconstruction were performed at Department of Head and Neck Surgery, Oral and Maxillofacial Oncology, West China Stomatology Hospital, Sichuan University. The patient received anterolateral thigh flap transfer after tumor excision. The ligated stump of external jugular vein was anastomosed to the enlarged accompanying veins of the anterolateral thigh flap. The flap survived completely without complications. The II-Y-shaped vascular anastomosis procedures were easy to perform and no complications were observed. Result suggests this novel technique could be useful in free flap transfer in vessel-depleted neck as an efficient way of adjusting the limited diameters.
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Gschossmann JD, Balk M, Rupp R, Müller SK, Allner M, Sievert M, Mantsopoulos K, Koch M, Iro H, Gostian AO. Results of contralateral anastomosis of microvascular free flaps in head and neck reconstruction. EAR, NOSE & THROAT JOURNAL 2022:1455613221112338. [PMID: 35786046 DOI: 10.1177/01455613221112338] [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: 11/15/2022] Open
Abstract
OBJECTIVES Despite various solutions to the issue of ipsilateral vessel-depleted neck in microvascular head and neck reconstruction, concrete data on its safety and implementation are scarce. This paper focuses on the feasibility and success rates of contralateral anastomosis in free flap reconstruction in the head and neck region. METHODS This single-center retrospective study at a tertiary referral center includes all patients who underwent free flap reconstruction of the head and neck with contralateral anastomosis between January 1st, 2007 and February 28th, 2021. Primary objectives were frequency, success, and flap-associated complication rates. Secondary objectives were recipient vessels and flap type. RESULTS Of 318 patients who underwent microvascular reconstruction, anastomosis was performed on the contralateral side of the neck in 32 patients (10.0%). Recipient vessels involved mainly the superior thyroid artery (74.2%; n = 23) and the facial vein (51.1%; n = 23). Thirty patients (93.8%) received a radial forearm free flap. Flap-associated complications occurred in 12.5% of included cases (n = 4): one partial flap necrosis (3.1%), one anastomotic insufficiency (3.1%), one venous thrombosis of the microvascular pedicle (3.1%), and one wound dehiscence (3.1%). All of these complications were resolved without complete flap loss. CONCLUSION This study demonstrates that contralateral anastomosis is a successful and safe option in microvascular head and neck reconstruction, especially using a radial forearm free flap. Thus, anastomosing to the contralateral side of the neck can be advocated as a valuable option in the ipsilateral vessel-depleted neck.
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Affiliation(s)
- Juliane D Gschossmann
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Balk
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarina K Müller
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Moritz Allner
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Antoniu O Gostian
- Department of Otorhinolaryngology, Head and Neck, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Shi YC, Li J, Li SJ, Li ZP, Zhang HJ, Wu ZY, Wu ZY. Flap failure prediction in microvascular tissue reconstruction using machine learning algorithms. World J Clin Cases 2022; 10:3729-3738. [PMID: 35647170 PMCID: PMC9100718 DOI: 10.12998/wjcc.v10.i12.3729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Microvascular tissue reconstruction is a well-established, commonly used technique for a wide variety of the tissue defects. However, flap failure is associated with an additional hospital stay, medical cost burden, and mental stress. Therefore, understanding of the risk factors associated with this event is of utmost importance.
AIM To develop machine learning-based predictive models for flap failure to identify the potential factors and screen out high-risk patients.
METHODS Using the data set of 946 consecutive patients, who underwent microvascular tissue reconstruction of free flap reconstruction for head and neck, breast, back, and extremity, we established three machine learning models including random forest classifier, support vector machine, and gradient boosting. Model performances were evaluated by the indicators such as area under the curve of receiver operating characteristic curve, accuracy, precision, recall, and F1 score. A multivariable regression analysis was performed for the most critical variables in the random forest model.
RESULTS Post-surgery, the flap failure event occurred in 34 patients (3.6%). The machine learning models based on various preoperative and intraoperative variables were successfully developed. Among them, the random forest classifier reached the best performance in receiver operating characteristic curve, with an area under the curve score of 0.770 in the test set. The top 10 variables in the random forest were age, body mass index, ischemia time, smoking, diabetes, experience, prior chemotherapy, hypertension, insulin, and obesity. Interestingly, only age, body mass index, and ischemic time were statistically associated with the outcomes.
CONCLUSION Machine learning-based algorithms, especially the random forest classifier, were very important in categorizing patients at high risk of flap failure. The occurrence of flap failure was a multifactor-driven event and was identified with numerous factors that warrant further investigation. Importantly, the successful application of machine learning models may help the clinician in decision-making, understanding the underlying pathologic mechanisms of the disease, and improving the long-term outcome of patients.
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Affiliation(s)
- Yu-Cang Shi
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Jie Li
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Shao-Jie Li
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Zhan-Peng Li
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Hui-Jun Zhang
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Ze-Yong Wu
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Zhi-Yuan Wu
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
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Lee SS, Hong JW, Lee WJ, Yun IS. Perforating patterns of cutaneous perforator vessels in anterolateral thigh flaps for head and neck reconstruction and clinical outcomes. Arch Craniofac Surg 2022; 23:64-70. [PMID: 35526841 PMCID: PMC9081423 DOI: 10.7181/acfs.2022.00171] [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: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anterolateral thigh (ALT) flaps are versatile soft tissue flaps that have become the standard soft-tissue flaps used for head and neck reconstruction. They provide a long vascular pedicle, constant vessel diameter, abundant soft tissue coverage, and minimal donor site morbidity. The ALT flap was initially designed on the basis of a septocutaneous (SC) perforator. However, more recent research has shown that a substantial number of ALT flaps are now based on musculocutaneous (MC) perforators, and the ratio between MC and SC perforators varies among studies. In this study, we analyzed the perforating pattern of ALT flaps along with their clinical outcomes during head and neck reconstruction in the Korean population. Methods From October 2016 to July 2020, 68 patients who had undergone an ALT flap procedure for head and neck reconstruction were enrolled retrospectively. The perforating pattern of the cutaneous perforator vessel (MC perforator/SC perforator/oblique branch), pedicle length, and flap size were analyzed intraoperatively. Patient demographics and flap necrosis rates were also calculated. Results The highest number of cutaneous perforator vessels supplying the ALT flap were the MC perforators (87%). The proportion of MC perforators was significantly higher than that of the SC perforators and oblique branches. Flap necrosis occurred in seven cases (11.86%); sex, hypertension, diabetes mellitus, coronary artery disease, perforator course, and history of radiotherapy did not significantly affect flap necrosis. Conclusion The ALT free flap procedure remains popular for reconstruction of the head and neck. In this study, we observed that the majority of cutaneous vessels supplying the flaps were MC perforators (87%). When using the MC perforator during flap elevation, careful dissection of the perforator is required to achieve successful ALT flaps because intramuscular dissection is difficult. Perforator pattern and history of radiotherapy did not affect flap necrosis.
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Affiliation(s)
- Sang Soo Lee
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Hong
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jae Lee
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - In-Sik Yun
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
- Correspondence: In-Sik Yun Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea E-mail:
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11
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Face Autotransplantation After an Accident. J Craniofac Surg 2022; 33:e346-e347. [PMID: 35240668 DOI: 10.1097/scs.0000000000008506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Microsurgical replantation is considered the best method to treat avulsion or amputation injuries of unique head parts, including the scalp, eyelid, nose, ear, lip, and tongue. However, there is currently no report on microsurgical replantation of substitutable facial tissues in the literature. This report presents a patient with avulsed facial composite tissue composed of the skin and subcutaneous layers treated by microsurgical replantation. The present case shows that microsurgical replantation of small facial composite tissues is feasible. The authors suggest that the indication spectrum for microsurgical replantation should be expanded beyond current clinical practice.
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Choi JY, Seo JH, Cha WJ, Seo BF, Jung SN. A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report. Arch Craniofac Surg 2022; 22:341-344. [PMID: 34974692 PMCID: PMC8721430 DOI: 10.7181/acfs.2021.00563] [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: 11/11/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022] Open
Abstract
Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.
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Affiliation(s)
- Jong Yun Choi
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hwa Seo
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Jin Cha
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bommie Florence Seo
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-No Jung
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Abdel Razek AAK, Saleh GA, Denever AT, Mukherji SK. Preimaging and Postimaging of Graft and Flap in Head and Neck Reconstruction. Magn Reson Imaging Clin N Am 2021; 30:121-133. [PMID: 34802575 DOI: 10.1016/j.mric.2021.07.004] [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: 11/19/2022]
Abstract
Head and neck reconstructive surgical techniques are complex; now the microvascular free tissue transfer is the most frequently used. The postreconstruction imaging interpretation is challenging due to the altered anatomy and flap variability. We aim to improve radiologists' knowledge with diverse methods of flap reconstruction for an accurate appreciation of their expected cross-sectional imaging appearance and early detection of tumor recurrence and other complication.
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Affiliation(s)
| | - Gehad A Saleh
- Faculty of Medicine, Department of Diagnostic Radiology, Mansoura University, Elgomhoria Street, Mansoura 35512, Egypt
| | - Adel T Denever
- Faculty of Medicine, Department of Surgery, Mansoura University, Elgomhoria Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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Choi BH, Park SO, Ahn HC. Reconstructive methods to resolve intractable fistulas that develop after radiation therapy in patients with head and neck cancer. Arch Craniofac Surg 2021; 22:247-253. [PMID: 34732036 PMCID: PMC8568500 DOI: 10.7181/acfs.2021.00353] [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: 08/09/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Radiation therapy (RT) is frequently used for supportive treatment and management of advanced head and neck cancers. This study performed a retrospective review of the treatment methods that were used for intractable draining fistulas in seven patients who had received RT for head and neck cancers. Treatment methods used for two of the seven patients are presented in detail. Methods From 2009 to 2020, seven patients underwent reconstructive surgery for intractable fistulas which occurred after RT for head and neck cancers. Patient characteristics, medical history, treatment method, and treatment outcome were reviewed for each case. The type of surgery performed, failure rate, and treatment period were also analyzed. Results In this study, a total of seven patients received additional management for radiation-induced fistulas. Patients underwent a mean of 3.3± 1.4 surgeries (maximum: six surgeries) to resolve their fistulas. The mean time interval from the first surgery to the last surgery for the patients to achieve resolution of the fistula was 8.7 months. Loco-regional flaps have performed an average of 1.9± 1.5 times. However, all loco-regional flaps failed. Instead, the patients’ intractable fistulas were resolved with the use of distant flaps or free tissue transfers. Conclusion Fistulas that develop after head and neck cancer treatment following RT are difficult to treat with simple loco-regional flap procedures. Therefore, more aggressive treatment techniques, such as distant flap or free tissue transfer, may be needed to shorten patients’ treatment periods and avoid unnecessary surgeries.
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Affiliation(s)
- Bu Hyeon Choi
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hee Chang Ahn
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
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15
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Kudpaje A, Thankappan K, Rajan RP, Vidhyadharan S, Balasubramanian D, Wakure A, Mathew J, Sharma M, Iyer S. Outcomes of Re-exploration Procedures After Head and Neck Free Flap Reconstruction. Indian J Surg Oncol 2021; 12:530-537. [PMID: 34658581 DOI: 10.1007/s13193-021-01368-8] [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: 10/15/2020] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
This study was conducted to evaluate the outcomes of re-exploration procedures done after head and neck microvascular flap reconstructions. This is a retrospective review of 109 flaps in 106 patients (three patients had two flaps each) that underwent re-exploration procedures in 1001 consecutive free flap surgeries. The outcome was analysed in terms of the type of the flaps, re-exploration rate, flap salvage rate and overall flap success rate. Free radial forearm (RFF) was the commonest flap done (354, 35.3%). One hundred nine flaps underwent re-exploration procedures in 106 patients. Out of this, 79 flaps could be salvaged, and 30 flaps failed. There were also another ten flaps, which failed without any re-exploration. The overall re-exploration rate was 10.8%. The flap salvage rate was 72.4%. The overall flap success rate was 96.1%. Nearly three-fourths of the flaps with vascular compromise can be successfully salvaged with appropriate and timely intervention.
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Affiliation(s)
- Akshay Kudpaje
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India.,Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, AIMS Ponekkara PO, Kochi, Kerala India
| | - Rajisha Paruthappara Rajan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Sivakumar Vidhyadharan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Abhijeet Wakure
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Jimmy Mathew
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Mohit Sharma
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
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16
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Shin JY, Lee SY, Roh SG, Lee NH. Effects of perioperative radiation treatment on stricture and fistula formation in hypopharyngeal reconstruction: a meta-analysis. Arch Craniofac Surg 2021; 22:71-77. [PMID: 33957731 PMCID: PMC8107459 DOI: 10.7181/acfs.2021.00080] [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: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022] Open
Abstract
Hypopharyngeal reconstruction is a surgically challenging procedure, and postoperative management is important due to a high rate of complications following surgery. In particular, stricture and fistula formation is the most common long-term postoperative complication. Through systematic review and meta-analysis of 21 studies, a significant radiation effect of stricture and fistula formation was found in patients who underwent hypopharyngeal reconstruction. The perioperative radiation must be seen as a critical factor for stricture and fistula formation in hypopharyngeal reconstruction.
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Affiliation(s)
- Jin Yong Shin
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sun-Young Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.,Department of Radiation Oncology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Si-Gyun Roh
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Nae-Ho Lee
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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17
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Bouland C, Albert N, Boutremans E, Rodriguez A, Loeb I, Dequanter D, Javadian R. Risk factors assessment in fibular free flap mandibular reconstruction. ANN CHIR PLAST ESTH 2021; 66:351-356. [PMID: 33810915 DOI: 10.1016/j.anplas.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The fibular free flap (FFF) is the best choice method for mandibular reconstruction. However, the failure and the complications risk factors (RF) are not yet fully identified. This study aims to analyze these RF in order to improve the success rate. MATERIAL This retrospective study includes all patients who benefited from a FFF mandibular reconstruction between the first of January, 2014 and the thirty-first of December, 2018 in the Department of Stomatology and Maxillofacial Surgery department of the CHU Saint-Pierre Hospital, Brussels, Belgium. RESULTS Thirty patients benefited from this intervention. The overall success rate was 90%. Majority of the patients were men (67%) (mean age: 52 years). The main associated co-morbidities were: alcohol (50%), tobacco consumption (67%) and previous radiotherapy (20%). The mean operative time was 9,5hours. The morbidities rates at the receiving site (RS) and the donor site (DS) were respectively 43% and 30%. Infection and dehiscence of the RS were the main complications. Statistical analysis identified RF for RS infections: atherosclerosis and operative time; RS dehiscence (previous cervical dissection and secondary reconstruction); flap necrosis (ischemia time, rate of infection at the recipient site, history of radiation therapy, alcohol consumption, National Nosocomial Infection Surveillance score (NNISS), and history of cervical dissection); and DS morbidities (NNISS and dehiscence rate at the DS in the early period). CONCLUSION The FFF mandibular reconstruction offers a significant success rate. Nevertheless, this study highlighted several failure and complications RF of the procedure. Previous neck dissection and radiotherapy, operative and the ischemia time, were RF associated with complication at the RS. Furthermore, the NNIS score and the dehiscence rate were also reported as RF for FFF necrosis.
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Affiliation(s)
- C Bouland
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - N Albert
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - E Boutremans
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A Rodriguez
- Department of Otolaryngology-Head & Neck surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - I Loeb
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - D Dequanter
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - R Javadian
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Suh JM, Chung CH, Chang YJ. Head and neck reconstruction using free flaps: a 30-year medical record review. Arch Craniofac Surg 2021; 22:38-44. [PMID: 33714251 PMCID: PMC7968978 DOI: 10.7181/acfs.2020.00745] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background The free flap surgical method is useful for the reconstruction of head and neck defects. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 30 years. Methods Between 1989 and 2018, a total of 866 free flap procedures were performed on 859 patients with head and neck defects, including 7 double free flaps. The causes of vascular crisis and salvage rate were analyzed, and the total flap survival rate calculated among these patients. Additionally, the survival and complication rates for each flap type were compared. Results The 866 cases included 557 radial forearm flaps, 200 anterolateral thigh flaps, 39 fibular osteocutaneous flaps, and 70 of various other flaps. The incidence of the vascular crisis was 5.1%; its most common cause was venous thrombosis (52.3%). Salvage surgery was successful in 52.3% of patients, and the total flap survival rate was 97.6%. The success rate of the radial forearm flap was higher than of the anterolateral flap (p<0.01), and the primary sites of malignancy were the tongue, tonsils, and hypopharynx, respectively. Conclusion The free flap technique is the most reliable method for head and neck reconstruction; however, the radial forearm free flap showed the highest success rate (98.9%). In patients with malignancy, flap failure was more common in the anterolateral thigh (5.5%) and fibular (5.1%) flaps.
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Affiliation(s)
- Joong Min Suh
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chul Hoon Chung
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yong Joon Chang
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
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Chung JH, Kim KJ, Jung KY, Baek SK, Park SH, Yoon ES. Recipient vessel selection for head and neck reconstruction: A 30-year experience in a single institution. Arch Craniofac Surg 2020; 21:269-275. [PMID: 33143393 PMCID: PMC7644354 DOI: 10.7181/acfs.2020.00339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects. Methods In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient’s demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed. Results Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n= 107), followed by the anterolateral thigh flap (n= 18) and fibula flap (n= 10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis. Conclusion Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.
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Affiliation(s)
- Jae-Ho Chung
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Ki-Jae Kim
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Kwang-Yoon Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Eul-Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea
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