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Aksamitiene E, Heffelfinger RN, Hoek JB, Pribitkin ED. Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing. Biol Proced Online 2024; 26:2. [PMID: 38229030 DOI: 10.1186/s12575-023-00227-w] [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: 06/13/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Some of the most complex surgical interventions to treat trauma and cancer include the use of locoregional pedicled and free autologous tissue transfer flaps. While the techniques used for these reconstructive surgery procedures have improved over time, flap complications and even failure remain a significant clinical challenge. Animal models are useful in studying the pathophysiology of ischemic flaps, but when repeatability is a primary focus of a study, conventional in-vivo designs, where one randomized subset of animals serves as a treatment group while a second subset serves as a control, are at a disadvantage instigated by greater subject-to-subject variability. Our goal was to provide a step-by-step methodological protocol for creating an alternative standardized, more economical, and transferable pre-clinical animal research model of excisional full-thickness wound healing following a simulated autologous tissue transfer which includes the primary ischemia, reperfusion, and secondary ischemia events with the latter mimicking flap salvage procedure. RESULTS Unlike in the most frequently used classical unilateral McFarlane's caudally based dorsal random pattern skin flap model, in the herein described bilateral epigastric fasciocutaneous advancement flap (BEFAF) model, one flap heals under normal and a contralateral flap-under perturbed conditions or both flaps heal under conditions that vary by one within-subjects factor. We discuss the advantages and limitations of the proposed experimental approach and, as a part of model validation, provide the examples of its use in laboratory rat (Rattus norvegicus) axial pattern flap healing studies. CONCLUSIONS This technically challenging but feasible reconstructive surgery model eliminates inter-subject variability, while concomitantly minimizing the number of animals needed to achieve adequate statistical power. BEFAFs may be used to investigate the spatiotemporal cellular and molecular responses to complex tissue injury, interventions simulating clinically relevant flap complications (e.g., vascular thrombosis) as well as prophylactic, therapeutic or surgical treatment (e.g., flap delay) strategies in the presence or absence of confounding risk factors (e.g., substance abuse, irradiation, diabetes) or favorable wound-healing promoting activities (e.g., exercise). Detailed visual instructions in BEFAF protocol may serve as an aid for teaching medical or academic researchers basic vascular microsurgery techniques that focus on precision, tremor management and magnification.
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Affiliation(s)
- Edita Aksamitiene
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA
- Present address: Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, 405 N. Mathews Ave | M/C 251, Room 4357, Urbana, IL, 61801, USA
| | - Ryan N Heffelfinger
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA
| | - Jan B Hoek
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, 1020 Locust St, Room 527, Philadelphia, PA, 19107, USA
| | - Edmund deAzevedo Pribitkin
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA.
- Sidney Kimmel Medical College, 31st Floor, 1101 Market Street, Philadelphia, PA, 19107, USA.
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Alterio D, Zaffaroni M, Bossi P, Dionisi F, Elicin O, Falzone A, Ferrari A, Jereczek-Fossa BA, Sanguineti G, Szturz P, Volpe S, Scricciolo M. Reirradiation of head and neck squamous cell carcinomas: a pragmatic approach-part I: prognostic factors and indications to treatment. LA RADIOLOGIA MEDICA 2024; 129:160-173. [PMID: 37731151 DOI: 10.1007/s11547-023-01713-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Reirradiation (reRT) of locally recurrent/second primary tumors of the head and neck region is a potentially curative treatment for patients not candidate to salvage surgery. Aim of the present study is to summarize available literature on both prognostic factors and indications to curative reRT in this clinical setting. MATERIALS AND METHODS A narrative review of the literature was performed on two topics: (1) patients' selection according to prognostic factors and (2) dosimetric feasibility of reRT. Postoperative reRT and palliative intent treatments were out of the scope of this work. RESULTS Patient-tumor and treatment-related prognostic factors were analyzed, together with dosimetric parameters concerning target volume and organs at risk. Based on available evidence, a stepwise approach has been proposed aiming to provide a useful tool to identify suitable candidates for curative reRT in clinical practice. This was then applied to two clinical cases, proposed at the end of this work. CONCLUSION A second course of RT in head and neck recurrence/second primary tumors is a personalized approach that can be offered to selected patients only in centers with expertise and dedicated equipment following a multidisciplinary team discussion.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Dionisi
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Falzone
- Unità Operativa Multizonale di Radiologia Ospedale di Rovereto e Arco, Azienda Sanitaria per i Servizi Provinciali di Trento, Trento, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Major R, Surmiak M, Kasperkiewicz K, Kaindl R, Byrski A, Major Ł, Russmueller G, Moser D, Kopernik M, Lackner JM. Antimicrobial materials with improved efficacy dedicated to large craniofacial bone defects after tumor resection. Colloids Surf B Biointerfaces 2022; 220:112943. [DOI: 10.1016/j.colsurfb.2022.112943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
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Miller H, Bush K, Delancy M, Leo ND, Joshi H, Saracco B, Adams A, Gaughan J, Bonawitz S. Effect of preoperative radiation on free flap outcomes for head and neck reconstruction: An updated systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 75:743-752. [PMID: 34810143 DOI: 10.1016/j.bjps.2021.09.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is an ongoing debate about whether neoadjuvant radiation therapy is associated with higher rates of postoperative complications after head and neck reconstruction. Herle et al. conducted a systematic review in 2014 of 24 studies, finding higher complication rates in irradiated fields. We sought to perform an exhaustive updated systematic review and meta-analysis. METHODS We conducted an updated systematic review of the literature, as outlined in our protocol, which was registered on PROSPERO. Databases included Medline, Embase, Cochrane Central, and Web of Science. There were no limits placed on the date range, place of publication, or origin. Exclusion criteria included patients less than 18 years of age, studies with less than 20 participants (n < 20), case studies, skull base reconstructions, and local tissue rearrangements. The combined results of the studies and relative risks (RR) were calculated. RESULTS 53 studies were included for analysis, including 5,086 free flaps in an irradiated field, and 9,110 free flaps in a non-irradiated field. Of the 53 studies, 21 studies overlapped with those discussed in Herle et al.'s study, with a total of 32 additional studies. Neoadjuvant radiation was found to be a statistically significant risk factor for postoperative complications (RR 1.579, P < 0.001), total flap failure (RR, 1.565; P < 0.001), and fistula (RR, 1.810; P < 0.001). Our work reaffirmed the findings of the Herle et al. STUDY CONCLUSION Preoperative radiation was associated with a statistically significant increase in the risk of total flap failure, fistula, and total complications but not partial flap failure. These high-morbidity complications must be taken into consideration when determining which patients should receive neoadjuvant radiation therapy.
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Affiliation(s)
- Henry Miller
- Department of Surgery, Cooper University Hospital, Camden NJ, United States.
| | - Kathryn Bush
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Matthew Delancy
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Nicholas De Leo
- Department of Surgery, Cooper University Hospital, Camden NJ, United States
| | - Hansa Joshi
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Benjamin Saracco
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - Amanda Adams
- Cooper Medical School of Rowan University, Camden NJ, United States
| | - John Gaughan
- Cooper Research Institute, Cooper University Hospital, Camden NJ, United States
| | - Steven Bonawitz
- Department of Surgery, Cooper University Hospital, Camden NJ, United States
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Novel Technique with Double Free Flap Design for Advanced Mandibular Osteoradionecrosis: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3149. [PMID: 33133983 PMCID: PMC7544289 DOI: 10.1097/gox.0000000000003149] [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: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG). This technique also optimizes recipient site healing and functionality while minimizing donor site morbidity. Our initial experiences from a 4 patient case series are included. Mean operative time was 551 minutes (SD: 81 minutes). All donor sites were closed primarily. Mean time to discharge was 13 days (SD: 7 days), and mean time to full mobilization was 2 days (SD: 1 days). This double free flap technique completely envelops the FFG and plate with nonirradiated muscle. It allows for the transfer of an FFG without a skin island, thus avoiding the need for split skin graft closure. This results in faster healing and minimizes the risk of fibula donor site morbidity. The skin island of the vertical rectus abdominis musculocutaneous flap has the added benefit of providing intraoral lining, which minimizes contractures and trismus. Although prospective long-term studies comparing this approach to other double flap procedures are needed, we argue that this technique is an optimal approach to safeguard the mandibular FFG reconstruction against the inherent risks of renewed complications in irradiated unhealthy tissue.
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Major R, Kowalczyk P, Surmiak M, Łojszczyk I, Podgórski R, Trzaskowska P, Ciach T, Russmueller G, Kasperkiewicz K, Major Ł, Jabłoński R, Kropiwnicki J, Lackner JM. Patient specific implants for jawbone reconstruction after tumor resection. Colloids Surf B Biointerfaces 2020; 193:111056. [PMID: 32403035 DOI: 10.1016/j.colsurfb.2020.111056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/24/2020] [Accepted: 04/12/2020] [Indexed: 12/01/2022]
Abstract
In case of benign and malignant tumours affecting the maxillofacial region, the resection of jawbone reflects the standard therapy in more than 5.000 cases per year within the European Union. The resulting large bone defects lead to scarred, mangled facial appearance, loss of mastication and probably speech, requiring aesthetic and functional surgery as a basis for physical and physiological rehabilitation. Although autologous vascularized bone autografts reflect the current golden standard, the portion of bone available for the procedure is limited and subsequent high-dose anti-cancer chemo-/radiotherapy can lead to local tissue necrosis. Autologous vascularized bone from fibular or iliac-crest autografts is current golden standard in jawbone resection post-treatment, however, the portion of transplantable bone is limited and subsequent high-dose anti-cancer chemo-/radiotherapy often results in tissue necrosis Our research focuses on alternative treatment techniques: tissue reconstruction via novel patient-specifically manufactured maxillofacial implant that stimulates bone tissue growth. The planned neoformation of vascularized bone in such implants within the patient's own body as "bioreactor" is the safest approach in tissue engineering. The works described herein included the design of the metallic substrate of the implant with the use of computed tomography basing on real patients scans and then 3D-printing the substrates from the Ti6Al7Nb powder. The metal core was then evaluated in terms of structural characteristic, cytotoxicity and gene expression through the in vitro tests. Further experiments were focused on fabrication of the biocompatible coating for outer surface of the bone implant that would enhance the healing process and accelerate the tissue growth. Functional polymeric granulate dedicated for osteoconductive, osteoinductive and osteogenesis properties were elaborated. Another approach including the coating for the implant surface with two-phase biocompatible layer including polymeric microspheres and hydrogel carrier, which would provide long-time release of bone and cartilage growth factors around the implant were also done. The polymeric granulate containing βTCP improved bone cells growth, but it some modification has to be done in order to improve structural pores to ensure for better osteoconductivity. The biocompatible coating including PVP hydrogel and polymeric microspheres is still in the development process.
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Affiliation(s)
- Roman Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta St. 25, 30-059 Cracow, Poland.
| | - Piotr Kowalczyk
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland
| | - Marcin Surmiak
- Department of Medicine, Jagiellonian University Medical College, 8 Skawinska Street, 31-066 Cracow, Poland
| | - Ilona Łojszczyk
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland
| | - Rafał Podgórski
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland
| | - Paulina Trzaskowska
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland; Centre of Advanced Materials and Technologies CEZAMAT, Poleczki 19, 02-822 Warsaw, Poland
| | - Tomasz Ciach
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland; Centre of Advanced Materials and Technologies CEZAMAT, Poleczki 19, 02-822 Warsaw, Poland
| | - Guenter Russmueller
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20 1090 Wien, Austria
| | - Katarzyna Kasperkiewicz
- University of Silesia in Katowice, Faculty of Biology and Environmental Protection, Jagiellońska 28- 40-032 Katowice, Poland
| | - Łukasz Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta St. 25, 30-059 Cracow, Poland
| | | | | | - Juergen M Lackner
- Joanneum Research Forschungsges.m.b.H., Institute of Surface Technologies and Photonics, Functional Surfaces, Leobner Strasse 94, 8712 Niklasdorf, Austria
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Chiu WK, Chou CY, Chen SG, Chen C, Wang HJ, Yang TF. Is sequential free flap safe in oral cancer reconstruction in the same patient? An outcome and complication analysis. Jpn J Clin Oncol 2020; 50:152-158. [PMID: 31670807 DOI: 10.1093/jjco/hyz142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sequential free flap reconstruction in patient with head and neck cancer can provide reliable and effective wound coverage. Only a few studies have reported on the outcome and complications analysis but without consensus on the recipient vessels and flap chosen. Herein, we presented the outcome and analysed the risk factors for complications in sequential free flap reconstruction. PATIENTS AND METHODS Patients who had sequential free tissue transfers due to cancer recurrence, second primary cancer, or secondary correction of the soft tissue contractures and volume deficits were all included. Variables extracted included demographics, comorbidities, free flap characteristics, infection, dehiscence and flap necrosis rates. RESULTS In total, 40 patients with 92 free flaps were analyzed; 42 initial and 50 sequential free flaps. The most common recipient vessels for sequential flap were contralateral superficial thyroid vessels (68%). The most common flap for both initial and sequential free flap was anterolateral thigh flap (64.3 and 62%). The success rate of sequential free flap was 92.0 compared to 92.9% for initial free flap, which showed no significant difference. Female was independently associated with delayed wound healing with an odds ratio of 90.91 (95% confidence interval 0.001-0.17, P = 0.001), as well as diabetes with an odds ratio of 31.14 (95% confidence interval 2.60-373.19, P = 0.007). Sequential free flap was not a risk factor for any complication. CONCLUSIONS Sequential free flap is a reliable method for head and neck surgery without more complication rate comparing to initial free flap reconstruction. More attentions should be paid on patients with preferential risk for certain complications.
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Affiliation(s)
- Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
| | - Chang-Yi Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taoyuan Armed Forces General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shyi-Gen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Cochrane, Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Hsian-Jenn Wang
- Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan.,Graduate Institute of Medical Informatics and Cardiology, Taipei Medical University and Hospital, Taipei, Taiwan
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Young AMH, Bache S, Segaren N, Murphy S, Maraka J, Durrani AJ. Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy. Front Surg 2019; 6:53. [PMID: 31921882 PMCID: PMC6932995 DOI: 10.3389/fsurg.2019.00053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Surgery to resect intra-oral malignancy is a well-established mode of primary treatment. The tissue requirement in this area is for a thin, pliable flap with minimal bulk and this has historically been provided by free tissue transfer with a radial forearm free flap (RFFF). More recently, a role for the anterolateral thigh free flap (ALTFF) has been described, although in populations with a westernized diet, body habitus may preclude use of an ALTFF due to flap thickness, relative to a radial forearm free flap. Methods: An analysis of data was performed retrospectively for 90 consecutive patients with intra-oral malignancy, requiring immediate soft tissue reconstruction by the senior author, at Addenbrooke's Hospital between July 2008 and April 2016. Cases requiring bony reconstruction were excluded. Data on patient age, sex, indication for surgery, tumor location and defect type, complications, success rates, and length of stay were recorded. Results: The majority of patients received an ALTFF (n = 56) with 38% receiving a RFFF (n = 34). Surgical resection took place in the floor of the mouth most frequently. These were closed with ALTFF and RFFF in 41 and 28 occasions, respectively. A success rate of 97% was observed in the RFFF group; 1 flap developed partial necrosis and required complete revision. In the ALTFF group, there was a 100% flap success rate. ALTFF usage resulted in a reduction in the number of intraoperative (p = 0.021) in addition a reduction in the number of days in ITU (p = 0.01) and post-operative clinic visits (p = 0.025). Conclusion: We present a series that used predominately the ALTFF to reconstruct intra-oral defects following resection of squamous cell carcinoma in a Western population. The results demonstrate that this treatment can produce at least as comparable results as to the use of a RFFF repair in this population, whilst avoiding the donor site morbidity and aesthetic compromise of a RFFF.
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Affiliation(s)
- Adam M H Young
- Department of Plastic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Bache
- Department of Plastic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Nicolas Segaren
- Department of Plastic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Suzane Murphy
- Department of Plastic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Jane Maraka
- Department of Plastic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amer J Durrani
- Department of Plastic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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Free Flap Outcomes of Microvascular Reconstruction after Repeated Segmental Mandibulectomy in Head and Neck Cancer Patients. Sci Rep 2019; 9:7951. [PMID: 31138880 PMCID: PMC6538601 DOI: 10.1038/s41598-019-44467-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 05/17/2019] [Indexed: 11/25/2022] Open
Abstract
This is the first study to investigate the impact of a second fibula flap or a soft tissue flap combined with bridging plate for a repeated segmental mandibulectomy reconstruction on flap outcomes in head and neck cancer patients. A retrospective comparative analysis (2007–2016) of 61 patients who underwent a second segmental mandibulectomy was performed. 20 patients underwent a fibula flap reconstruction whereas 41 had a soft tissue flap and plate reconstruction. No significant difference was seen in the operative time, total hospital stay, flap loss, re-exploration rates, plate exposure rate, or recipient site infection rate. On multivariate analysis, patients reconstructed with a soft tissue flap and bridging plate (odds ratio (OR) 3.997; 95% confidence interval (CI), 1.046–15.280, p = 0.043) and complications developed in previous surgery (OR 4.792; 95% CI, 1.120–20.493, p = 0.035) were shown to be independent predictors of a prolonged nasogastric tube dependence. The utilization of a soft tissue flap with plate is associated with comparative results of acute complication rate within 1 week, recipient site infection rate, and plate exposure rate to free fibula flaps alone. Free fibula flaps may result in a decreased risk for prolonged tube dependence compared to free soft tissue flap reconstructions.
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Kadam D. Salvage Secondary Reconstruction of the Mandible with Vascularized Fibula Flap. Craniomaxillofac Trauma Reconstr 2019; 12:274-283. [PMID: 31719952 DOI: 10.1055/s-0039-1685460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/07/2019] [Indexed: 10/27/2022] Open
Abstract
Primary restoration of the mandibular continuity remains the standard of care for defects, and yet several constraints preclude this objective. Interim reconstructions with plate and nonvascular bone grafts have high failure rates. The secondary reconstruction, when becomes inevitable, remains a formidable task. This retrospective study evaluates various issues to address secondary reconstruction. Twenty-one patients following mandibulectomy presented with various complications between 2012 and 2016 were included in the study. The profile of primary reconstruction includes reconstruction plate ( n = 9), reconstruction plate with rib graft ( n = 3), soft tissue only reconstruction ( n = 4), free fibula ( n = 2), inadequate growth of reconstructed free fibula during adolescence ( n = 1), nonvascular bone graft alone ( n = 1), and no reconstruction ( n = 1). All had problems or complications related to unsatisfactory primary reconstruction such as plate fracture, recurrent infection, plate exposure, deformity, malocclusion, and failed fibula reconstruction. All were reconstructed with osteocutaneous free fibula flap with repair of soft-tissue loss. All flaps survived and had satisfactory outcome functionally and aesthetically. Dental rehabilitation was done in four patients. One flap was reexplored for thrombosis and salvaged. The challenges in secondary reconstruction include difficulty in recreating true defects, extensive fibrosis and loss of planes, unanticipated soft-tissue and skeletal defects, reestablishing the contour and occlusion, insufficient bone strength, dearth of suitable recipient vessels, nonpliable skin, tissue contraction to accommodate new mandible, need of additional flap for defect closure, and postirradiation effects. Notwithstanding them, the reasonable successful outcome can be attainable.
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Affiliation(s)
- Dinesh Kadam
- Department of Plastic and Reconstructive Surgery, A. J. Institute of Medical Sciences, Mangalore, Karnataka, India
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11
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Ghazizadeh S, Kuan EC, Mallen-St Clair J, Abemayor E, Luu Q, Nabili V, St John MA. It Takes Two: One Resects, One Reconstructs. Otolaryngol Clin North Am 2018; 50:747-753. [PMID: 28755704 DOI: 10.1016/j.otc.2017.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Care of patients with advanced head and neck cancer is a multidisciplinary effort through all phases of care. Head and neck cancer surgery involves balancing oncologic control, functional preservation, and aesthetics. Given the advances in free tissue reconstruction, the majority of defects can be reconstructed using free tissue transfer flaps. A 2-team approach allows for early, continual communication and meticulous operative planning. Operations can be combined into a single effort. This approach maximizes efficiency and enables multidisciplinary collaboration for comprehensive surgical treatment. We present our experience and an outline of how responsibilities between the ablative and reconstructive teams are shared.
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Affiliation(s)
- Shabnam Ghazizadeh
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Edward C Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | | | - Elliot Abemayor
- UCLA Head and Neck Cancer Program, Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Quang Luu
- Division of Facial Plastic and Reconstructive Surgery, Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Vishad Nabili
- Division of Facial Plastic and Reconstructive Surgery, Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Maie A St John
- UCLA Head and Neck Cancer Program, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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12
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Hu S, Arnaoutakis D, Kadakia S, Vest A, Sawhney R, Ducic Y. Osseointegrated Implants and Prosthetic Reconstruction Following Skull Base Surgery. Semin Plast Surg 2017; 31:214-221. [PMID: 29075160 DOI: 10.1055/s-0037-1607201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Rehabilitation following ablative skull base surgery remains a challenging task, given the complexity of the anatomical region, despite the recent advances in reconstructive surgery. Remnant defects following resection of skull base tumors are often not amenable to primary closure. As such, numerous techniques have been described for reconstruction, including local rotational muscle flaps, pedicled flaps with skin paddle, or even free tissue transfer. However, not all patients are appropriate surgical candidates and therefore may instead benefit from nonsurgical options for functional and aesthetic restoration. Osseointegrated implants and biocompatible prostheses provide a viable alternative for such a patient population. The purpose of this review serves to highlight current options for prosthetic rehabilitation of skull base defects and describe their indications, advantages, and disadvantages.
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Affiliation(s)
- Shirley Hu
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York
| | - Demetri Arnaoutakis
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sameep Kadakia
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York
| | | | - Raja Sawhney
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Multiple Free Flap Reconstructions of Head and Neck Defects Due to Oral Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1337. [PMID: 28740764 PMCID: PMC5505825 DOI: 10.1097/gox.0000000000001337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
Objective: We studied complications following multiple free flap reconstructions in the head and neck. Methods: In this cohort, 26 patients (14 men and 12 women) who underwent multiple microvascular free flap reconstructions were included in the study. The reasons for secondary reconstruction were recurrence of tumor (12 cases), necrosis of transferred skin and/or bone (6 cases), reconstruction plate fracture or exposure (4 cases), and others (4 cases). A third reconstruction in 4 cases and a fourth reconstruction in 1 case were performed. Results: No flap necrosis occurred. Postsurgical infections occurred at only secondary reconstructions in 7 patients. Although 4 cases with a history of external radiation therapy were anastomosed at contralateral side, those 4 cases suffered from severe pre-and postsurgical infection of the ipsilateral side. Postsurgical infection occurred in 2 cases with anastomoses at the ipsilateral side of the neck and required drainage after secondary surgery. Conclusions: A history of external radiation therapy and the existence of severe preoperative infection affected complications after multiple reconstructions.
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14
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Shen Y, Li J, Ow A, Wang L, Lv MM, Sun J. Acceptable clinical outcomes and recommended reconstructive strategies for secondary maxillary reconstruction with vascularized fibula osteomyocutaneous flap: A retrospective analysis. J Plast Reconstr Aesthet Surg 2017; 70:341-351. [DOI: 10.1016/j.bjps.2016.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 10/13/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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15
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Ho AS, Zumsteg ZS, Meyer A, Riaz N, Rahmati R, Kraus DH, McCarthy C, Wong RJ, Shah JP, Lee NY. Impact of Flap Reconstruction on Radiotoxicity After Salvage Surgery and Reirradiation for Recurrent Head and Neck Cancer. Ann Surg Oncol 2016; 23:850-857. [PMID: 27506662 DOI: 10.1245/s10434-016-5492-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recurrent head and neck malignancies remain a therapeutic challenge. Tissue transfer, in addition to defect coverage and prevention of wound complications, may potentially decrease radiotoxicity. We evaluated radiation toxicity and survival outcomes of patients who underwent salvage surgery with reirradiation, comparing primary closure to flap reconstruction. METHODS Retrospective outcomes analysis of recurrent head and neck squamous cell carcinoma (HNSCC) patients treated with curative intent by salvage surgery (± flap reconstruction) and reirradiation from 1996 to 2011. Recurrent stage, reirradiation modality, chemotherapy use, and toxicities were evaluated. RESULTS Of 96 patients, 59 had primary closure, whereas 37 underwent flap reconstruction (26 free, 11 pedicled). Median radiation and reirradiation doses were 66 Gy and 60 Gy, respectively. Comparing nonflap and flap patients, there was no significant difference in acute mild toxicities (100 vs. 100 %, p = 1.0) or acute severe toxicities (33.9 vs. 37.8 %, p = 0.83). Nonflap patients experienced significantly greater incidence of both late mild toxicities (81.4 vs. 54.1 %, p = 0.006) and late severe toxicities (47.5 vs. 21.6 %, p = 0.02). Overall survival at 5 years was equivalent (33.1 vs. 34.7 %, p = 0.88). Free flap patients had greater delays to postoperative reirradiation and treatment package times compared with pedicled flap patients but no meaningful difference in survival outcomes. CONCLUSIONS Vascularized tissue potentially helps offset late toxicities associated with a second radiation course in recurrent head and neck cancer patients. In these selected patients, flap coverage may confer functional benefits and improve the long-term radiotoxicity profile.
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Affiliation(s)
- Allen S Ho
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Annika Meyer
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Rahmatullah Rahmati
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Dennis H Kraus
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Colleen McCarthy
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nancy Y Lee
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. .,Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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16
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Jeong WS, Oh TS. Oral and Oropharyngeal Reconstruction with a Free Flap. Arch Craniofac Surg 2016; 17:45-50. [PMID: 28913254 PMCID: PMC5556870 DOI: 10.7181/acfs.2016.17.2.45] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/04/2016] [Accepted: 02/11/2016] [Indexed: 01/28/2023] Open
Abstract
Extensive surgical resection of the aerodigestive track can result in a large and complex defect of the oropharynx, which represents a significant reconstructive challenge for the plastic surgery. Development of microsurgical techniques has allowed for free flap reconstruction of oropharyngeal defects, with superior outcomes as well as decreases in postoperative complications. The reconstructive goals for oral and oropharyngeal defects are to restore the anatomy, to maintain continuity of the intraoral surface and oropharynx, to protect vital structures such as carotid arteries, to cover exposed portions of internal organs in preparation for adjuvant radiation, and to preserve complex functions of the oral cavity and oropharynx. Oral and oropharyngeal cancers should be treated with consideration of functional recovery. Multidisciplinary treatment strategies are necessary for maximizing disease control and preserving the natural form and function of the oropharynx.
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Affiliation(s)
- Woo Shik Jeong
- Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lyons AJ, Nixon I, Papadopoulou D, Crichton S. Can we predict which patients are likely to develop severe complications following reconstruction for osteoradionecrosis? Br J Oral Maxillofac Surg 2013; 51:707-13. [PMID: 24176184 DOI: 10.1016/j.bjoms.2013.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/29/2013] [Indexed: 11/17/2022]
Abstract
High morbidity has been reported for free vascularised reconstruction for osteoradionecrosis (ORN) and there are no apparent risk factors. A single nucleotide polymorphism in the transforming growth factor beta 1 gene (TGF-β1) has been implicated in the cause of ORN and may also predict these complications. We studied a series of 30 consecutive patients who had had reconstruction for severe ORN with free tissue transfer in relation to their outcomes and complications for a number of risk factors including TFG-β1 genotype, age, sex, comorbidities, site and stage of tumour, type of initial operation, and dose of radiotherapy or chemoradiotherapy. Two patients died and 2 flaps failed. Using the Clavien-Dindo classification, 16 patients developed grade III complications and 6 grade II. Median (IQR) duration of inpatient stay was 19.5 (12-25) days and the median (IQR) duration of outpatient treatment was 6 (4-11) weeks. No specific risk factors for postoperative complications were identified. In view of the severity and unpredictability of the complications, careful preoperative counselling of patients is essential.
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Affiliation(s)
- Andrew J Lyons
- Head and Neck Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
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18
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The Application of Multilobed Flap Designs for Anatomic and Functional Oropharyngeal Reconstructions. J Craniofac Surg 2013; 24:2091-7. [DOI: 10.1097/scs.0b013e3182a2442c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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19
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Ciocca L, Mazzoni S, Fantini M, Persiani F, Marchetti C, Scotti R. CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery. J Craniomaxillofac Surg 2012; 40:e511-5. [DOI: 10.1016/j.jcms.2012.03.015] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/19/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
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20
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Tang CL, Wu YC, Lai CH, Lai CS, Lin CL, Lin SD, Chang KP. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap. J Plast Surg Hand Surg 2012; 46:335-8. [PMID: 22998147 DOI: 10.3109/2000656x.2012.718281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The pectoralis major myocutaneous pedicled flap (PMMPF) - the "workhorse" for head and neck reconstruction - is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.
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Affiliation(s)
- Chen-Ling Tang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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21
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Sidell DR, Aghaloo T, Tetradis S, Lee M, Bezouglaia O, DeConde A, St John MA. Composite mandibulectomy: a novel animal model. Otolaryngol Head Neck Surg 2012; 146:932-7. [PMID: 22282867 DOI: 10.1177/0194599811435633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Segmental mandibular defects can result after the treatment of various pathologic processes, including osteoradionecrosis, tumor resection, or fracture nonunion with sequestration. The variety of etiologies and the frequency of occurrence make the reconstruction of segmental mandibular defects a topic of significant interest. Despite these incentives, a well-established small-animal model of the segmental mandibulectomy, including composite resection, does not exist. The objective of this study is the creation of a reliable animal model that can be used to study the reconstruction of en bloc mandibular defects. Surgical techniques and an array of reconstructive options are described. STUDY DESIGN Description of an animal model. SETTING Animal laboratory at a quaternary care university medical center. METHODS We present an Animal Research Oversight Committee-approved prospective analysis of survival operations in the rat model. A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented. Postoperative management, early pitfalls, surgical complications, and future applications are discussed. RESULTS A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and 9 postoperative complications were recognized. There were 6 orocutaneous fistulas, 2 abscesses, and 1 seroma. There were 4 fatalities, which were attributed to anesthetic complications (2, intraoperative), hematoma formation (1, postoperative), and foreign-body aspiration (1, postoperative). CONCLUSION This novel animal model reliably replicates the en bloc segmental mandibular defects seen in our patient population and can be manipulated to achieve a wide variety of research objectives.
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Affiliation(s)
- Douglas R Sidell
- Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1624, USA.
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Kesting MR, Hölzle F, Wales C, Steinstraesser L, Wagenpfeil S, Mücke T, Rohleder NH, Wolff KD, Hasler RJ. Microsurgical reconstruction of the oral cavity with free flaps from the anterolateral thigh and the radial forearm: a comparison of perioperative data from 161 cases. Ann Surg Oncol 2011; 18:1988-94. [PMID: 21311983 DOI: 10.1245/s10434-011-1584-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Free flaps are commonly used for reconstruction of extensive tumor resection defects in the oral cavity. The radial forearm free flap (RFFF) is the most frequent choice. However, a major problem of RFFF is a limitation in its size. The anterolateral thigh free flap (ALTFF) has become popular as an alternative donor site in maxillofacial surgery. We have compared patient data after reconstructions of the oral cavity using the RFFF or ALTFF. MATERIALS AND METHODS Perioperative data of 161 oral cancer patients with ALTFF (45) or RFFF (116) reconstructions were reviewed and statistically analyzed for the following characteristics: sex, histology, primary tumor localization, defect type, American Society of Anesthesiology score, success rates, revisions, wound healing disorders, fistula rates, type of reconstruction, prolonged stay in an intensive care unit (ICU) and in hospital, donor site, flap size, length of operation, and number of follow-up visits. RESULTS Flap success was 97.8% (44 of 45) in the ALTFF group and 97.4% (113 of 116) for RFFF. The mean size was higher in ALTFF than in RFFF (110 vs. 29 cm(2); P < 0.001). ALTFF needed less postoperative care and developed fewer wound healing disorders (P = 0.005 and P = 0.035). Operative time was significantly shorter in RFFF reconstructions (P = 0.020). Intraoperative arterial spasm was the most significant complication in ALTF and postoperative venous thrombosis in RFFF. CONCLUSIONS ALTFF has distinct advantages over RFFF with respect to intraoral reconstruction. However, the RFFF remains as a very reliable flap because of the minimal variability in its anatomy.
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Affiliation(s)
- Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany.
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23
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Rohleder NH, Wolff KD, Hölzle F, Wagenpfeil S, Wales CJ, Hasler RJ, Kesting MR. Secondary Maxillofacial Reconstruction with the Radial Forearm Free Flap: A Standard Operating Procedure for the Venous Microanastomoses. Ann Surg Oncol 2011; 18:1980-7. [DOI: 10.1245/s10434-011-1555-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Indexed: 11/18/2022]
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Abstract
Reoperative reconstruction of the midface is a challenging issue because of the complexity of this region and the severity of the aesthetic and functional sequela related to the absence or failure of a primary reconstruction. The different situations that can lead to the indication of a reoperative reconstructive procedure after previous oncologic ablative procedures in the midface are reviewed. Surgical techniques, anatomic problems, and limitations affecting the reoperative reconstruction in this region of the head and neck are discussed.
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Affiliation(s)
- Julio Acero
- Department of Oral and Maxillofacial Surgery, Gregorio Marañon Hospital, Complutense University, Madrid, Spain.
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Udoff RA, Elam JC, Gourin CG. Primary surgery for oropharyngeal cancer. Otolaryngol Head Neck Surg 2010; 143:644-9. [DOI: 10.1016/j.otohns.2010.06.922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/05/2010] [Accepted: 06/30/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The development of new techniques for transoral resection has led to a renewed interest in primary surgical treatment of oropharyngeal squamous cell cancer (SCCA). We reviewed our experience with primary surgery for oropharyngeal SCCA to identify factors associated with survival. STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Patients who underwent primary surgical treatment of oropharyngeal SCCA from 1985 to 2002 were analyzed. Patients who failed nonoperative treatment or had distant metastases at presentation were excluded. RESULTS A total of 105 patients met study criteria. The majority of patients (91%) had advanced stage disease (III/IV). All patients received postoperative radiation; chemotherapy was used in eight patients. Five-year disease-free survival was 83 percent for stage I, 67 percent for stage II, 56 percent for stage III, and 43 percent for stage IV disease. Crude local control rates were 94 percent for T1 disease, 90 percent for T2 disease, 81 percent for T3 disease, and 80 percent for T4 disease; crude regional control rates were 100 percent for N0 disease, 90 percent for N1 disease, 84 percent for N2 disease, and 82 percent for N3 disease. Cox proportional hazards models revealed that nodal stage (hazard ratio [HR] 2.3, P = 0.02) and black race (HR 2.6, P = 0.004) were the only significant predictors of disease-free survival. CONCLUSION: Primary surgical treatment of oropharyngeal SCCA is effective in achieving excellent locoregional control and permits deintensification of adjuvant therapy, even in patients with advanced stage disease. Nodal status and race are the primary determinants of disease-free survival. These data provide useful information for counseling and treatment planning.
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Affiliation(s)
- Ross A. Udoff
- From the Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta, GA
| | - Jackson C. Elam
- From the Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta, GA
| | - Christine G. Gourin
- and the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
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