Infrahyoid myocutaneous flap in head and neck reconstruction: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to analyse the literature on the infrahyoid myocutaneous flap (IHMCF) and evaluate its clinical outcomes. The MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus databases were searched (inception to December 31, 2021). Meta-analyses were then conducted to estimate the overall rates of partial flap loss, total flap loss, salivary fistula, and surgical revision. The 21 studies that met the inclusion criteria included 768 patients undergoing head and neck reconstruction with 773 IHMCF. The oral cavity (77.7%) and oropharynx (13.0%) were the most reconstructed sites. The meta-analyses estimated a pooled partial flap loss rate of 10.4% (99% confidence interval (CI) 5.4-16.7%), total loss rate of 1.8% (99% CI 0.8-3.2%), salivary fistula rate of 3.0% (99% CI 1.3-5.3%), and surgical revision rate of 1.9% (99% CI 0.7-3.7%). Fast flap harvesting and low donor site morbidity were other flap features. Previous thyroid surgery or neck dissection and advanced lymph nodal stage were considered contraindications to IHMCF reconstruction by most authors, while prior neck radiotherapy was reported as a relative contraindication. This pedicled cervical flap is a versatile and reliable reconstructive option for medium-sized head and neck defects. Careful preoperative assessment of the neck condition allows for its safe use.

[Historical development of reconstructive surgery in head and neck oncology]

Die rekonstruktive Chirurgie ist ein wichtiger Bestandteil der Tumorchirurgie des Kopf-Hals-Bereichs. Große ablative Tumorresektionen wurden bereits Anfang des 20. Jahrhunderts durchgeführt, nachdem es möglich wurde, durch verbesserte Operationstechnik den intraoperativen Blutverlust zu reduzieren bzw. durch Transfusionen auszugleichen. Ein weiterer Meilenstein war die postoperative Infektprophylaxe durch die Einführung der Antibiotika. John Conley erkannte als einer der Pioniere der radikalen Tumorchirurgie die dringende Notwendigkeit rekonstruktiver Maßnahmen. Die Anfänge waren jedoch begleitet von funktionellen postoperativen Einschränkungen, die schließlich erst durch die Einführung des Deltopektoral- und des Pektoralis-major-Lappens verbessert werden konnten. Ein weiterer Schritt war die Einführung der mikrovaskulären Transplantate, die eine bessere, der Situation angepasste Rekonstruktion erlaubte. Anfangs waren jedoch die Komplikationsraten aufgrund mangelnder Technik der Anastomosierung kleiner Gefäße und unzureichender Instrumente sehr hoch. Daher konnte sich diese Methode nur schleppend durchsetzen. Die Techniken der Lappenentnahme und der Mikrogefäßanastomose entwickelten sich jedoch weiter, sodass die mikrovaskuläre Gewebetransplantation zu einer zuverlässigen Methode wurde, die heute zum Standardrepertoire der rekonstruktiven Chirurgie gehört.

Soft tissue coverage of the upper limb: A flap reconstruction overview

Different opinions about the reconstructive choice for upper limb are described in literature: advancement or rotation flaps, regional flaps and free flaps are the most common reconstructive options. Local and regional flaps can be used to cover small defects while large wounds require the use of free flaps or distant pedicled flaps. The coverage of large wounds opens a discussion about when to use free flaps and when distant pedicled flaps. This review will describe the different methods used for the coverage of soft tissues injuries affecting hand and/or forearm (excluding fingers). The aim is to show all flap reconstructive options in order to support the inexperienced surgeon during the management of traumatic injuries of the upper limb.

Contemporary role of pectoralis major regional flaps in head and neck surgery

Countless disadvantages of the "old" pectoralis major have been listed while the amazing versatility of the free flap armamentarium gives the opportunity to suit the defect deriving from virtually every ablative head and neck surgery with a tailored reconstruction. Nevertheless, pectoralis major is still the "workhorse" for head and neck reconstruction in developing countries thanks to its ease of harvest, and minimal requirements in term of instrumentation. Furthermore, even in facilities with a high volume of reconstructions by free flaps, a certain number of pectoralis major flaps is still raised every year. The history, present role and current indications of the most widely head and neck reconstructive procedure ever has been reviewed.