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Evin N, Selimoglu MN. Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap. Ann Plast Surg 2024; 92:540-548. [PMID: 38685495 DOI: 10.1097/sap.0000000000003815] [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: 05/02/2024]
Abstract
ABSTRACT Free flaps and their modifications are used to reconstruct multiple large defects in the lip and face. In this study, we present our results on the reconstruction of these defects using bipaddle and sensate free radial forearm-palmaris longus flaps and subsequent revision surgeries. Patient medical records of 11 patients with a mean age of 63.9 ± 12.8 years were retrospectively reviewed. Functional oral competence, lip cosmetics, lip sensation, and donor forearm scars were evaluated using the drooling rating scale, visual analog scale, Semmes Weinstein Monofilament test, and patient and observer scar assessment scale, respectively. The mean dimensions of distal and proximal skin paddles of bipaddle free radial forearm-palmaris longus flaps were 12.7 ± 9.9 and 20.5 ± 3.8 cm2. Mean lengths of the bridge and proximal pedicles were 4.7 ± 1.6 and 5.5 ± 0.7 cm. All the flaps survived. No drooling was observed in the 2 patients without lower lip defects. The mean drooling scores of the 9 patients with lower lip defects were statistically different (Analysis of Variance, pANOVA < 0.00001) at 3, 6, 9, and 12 months postoperatively. The differences between 3 and 12 months were the most significant (pANOVA < 0.00001, pTUKEY < 0.000001). The lip sensation and drooling scores showed a strong positive correlation (r = 0.8504). All patients were able to speak fluently, drink fluid without leakage, and blow a balloon easily. All patients and observers were satisfied with the lip cosmetics, with no significant difference between satisfaction scores (P = 0.087615).There was a statistically significant difference (P < 0.00001) between mean sensation scores of surrounding healthy lip (2.94 ± 0.27) and free flaps (4.15 ± 0.4). All the donor scars healed uneventfully.
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Affiliation(s)
- Nuh Evin
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul
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Chai K, Liu J, Xiao R, Zhang G, Zhan Y. A huge verrucous carcinoma of the lower lip reconstructed by double Abbe flap: A case report and literature review. Front Oncol 2023; 13:1086963. [PMID: 36816913 PMCID: PMC9931191 DOI: 10.3389/fonc.2023.1086963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Lip verrucous carcinoma is a rare low-grade neoplasm, with an unsightly appearance and locally aggressive nature. Treatment of verrucous carcinoma is as yet challenging, no well-defined guidelines for effective and safe management of this disease are available. A case of a patient with a huge verrucous carcinoma of the lower lip successfully treated by surgical excision and double Abbe flap reconstruction technique is presented, and striking features of lip locations of this tumor as well as their management are discussed.
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Affiliation(s)
- Ke Chai
- Department of Dermatology, Second Xiangya Hospital of Central South University, Changsha, China,Hunan Key Laboratory of Medical Epigenetics, Second Xiangya Hospital of Central South University, Changsha, China
| | - Jinbing Liu
- Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, China
| | - Rong Xiao
- Department of Dermatology, Second Xiangya Hospital of Central South University, Changsha, China,Hunan Key Laboratory of Medical Epigenetics, Second Xiangya Hospital of Central South University, Changsha, China
| | - Guiying Zhang
- Department of Dermatology, Second Xiangya Hospital of Central South University, Changsha, China,Hunan Key Laboratory of Medical Epigenetics, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yi Zhan
- Department of Dermatology, Second Xiangya Hospital of Central South University, Changsha, China,Hunan Key Laboratory of Medical Epigenetics, Second Xiangya Hospital of Central South University, Changsha, China,*Correspondence: Yi Zhan,
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Yasar E, Demir C, Kaya S, Alagoz M. Single flap use for synchronous reconstruction of full-thickness upper and lower lip defects due to high-voltage electrical burn. TURKISH JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.4103/tjps.tjps_98_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Evaluation of Primary and Secondary Free Flap Desyndactylization Techniques in Hand and Digit Reconstruction: A Systematic Review. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2020. [DOI: 10.1055/s-0040-1721705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractObjective Injuries of the hand often require free flap reconstruction. To minimize flap loss, evidence exists to surgically syndactylize digits when repairing multiple injuries, with delayed flap division, or desyndactylization. However, evidence suggests that division of the flap at the time of inset can be accomplished with minimal negative effect. The purpose of this study was to evaluate outcomes, following hand reconstruction with free flaps utilizing either acute or staged desyndactylization techniques.Methods A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Articles that described the use of a free flap for surgically syndactylized digits or multilobed flaps for coverage of multiple digits were included.Results One hundred sixty-one articles were reviewed with 34 fulfilling inclusion criteria. One hundred seventeen patients underwent 145 free flap reconstructions. Traumatic avulsions (49%) were the most common injuries, followed by burns (11%). Twenty-one (62%) papers described surgical syndactylization of digits, which were later desyndactylized and five (15%) papers included reconstruction of more than one digit with multilobed free flaps. Eight papers (24%) described both techniques. Overall, 100% of included flaps survived. Total complication rate was 6%, with six complications (67%) occurring in flaps with primary syndactylization.Conclusion Hand defects often require free flaps for reconstruction. Although free flaps for the reconstruction of digital defects is technically demanding, they result in better outcomes. With available evidence indicating complications rates less than those of staged desyndactylization, multidigit reconstruction with multilobed free flaps may be a more desirable technique.
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He J, Qing L, Wu P, Zhou Z, Yu F, Cao Z, Tang J. Individualized design of double skin paddle anterolateral thigh perforator flaps to repair complex soft tissue defects of the extremities: An anatomical study and retrospective cohort study. J Plast Reconstr Aesthet Surg 2020; 74:530-539. [PMID: 33162385 DOI: 10.1016/j.bjps.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/11/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
This study describes our experience using individually designed double skin paddle anterolateral thigh perforator (ALTP) flaps to reconstruct complex soft tissue defects. An anatomical study of double skin paddle ALTP flaps was conducted in six fresh cadavers (12 thighs). We also performed a retrospective cohort study of 36 patients who underwent reconstruction using double skin paddle ALTP flaps from January 2009 to June 2019. The soft tissue defects were large or non-adjacent defects that could not be repaired by a single flap. Three types of double skin paddle ALTP flaps were designed. In type I, separate perforators supplied each flap: one perforator from the transverse branch of the lateral circumflex femoral artery (LCFA) and one from the descending branch of the LCFA (d-LCFA). In type II, both perforators were from the d-LCFA. In type III, a single perforator from the d-LCFA had two branches that each supplied one flap. In the cadaver study, type I was observed in 11 thighs, type II in 10, and type III in six. All patients were successfully treated using double skin paddle ALTP flaps. Four patients received type I flaps, 23 received type II, and nine received type III. Vascular compromise occurred in one patient, and the flap was saved by emergency revascularization. Most patients had satisfactory contours and functional recovery during follow-up. Individually designed double skin paddle ALTP flaps is a reliable option for reconstructing complex soft tissue defects. Moreover, we created an algorithm for microvascular reconstruction of complex soft tissue defects.
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Affiliation(s)
- Jiqiang He
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China
| | - Liming Qing
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China
| | - Zhengbing Zhou
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China
| | - Fang Yu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China
| | - Zheming Cao
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China
| | - Juyu Tang
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China.
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Chimeric Anterolateral Thigh Flap for Primary Functional Reconstruction of Complex, Composite Near Total Hemi Facial Post Excision Defects. J Craniofac Surg 2020; 31:e337-e343. [PMID: 32168125 DOI: 10.1097/scs.0000000000006276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Microvascular free tissue transfer has revolutionized the management of complex composite head and neck defects. AIM To evaluate the functional and aesthetic outcomes in the primary reconstruction of post-excisional near total hemifacial defects with the chimeric anterolateral thigh flaps (cALT). MATERIALS AND METHODS The author as a prelude to this clinical study has done a cadaveric study on the quadriceps artery angiosome. In this retrospective cohort study, data are collected from the records of 6 patients who had undergone primary cALT flap reconstruction for their post excisional near total hemifacial defects from January 2013 to December 2017. All 6 patients with various advanced malignancies involving the hemiface underwent wide local excision. Wide local excision resulted in the loss of skin and critical facial muscles that led to near total hemiface composite defects. Reconstructions were done with the cALT flaps that included segment of the vastus lateralis muscle harvested on its independent neurovascular perforator pedicle and the skin paddle on a separate perforator. In all cases, the facial nerve stumps were anastomosed to the nerve to vastus lateralis for reanimation of the face. In addition, 4 patients underwent primary radical neck dissection, but all had postoperative radiotherapy and chemotherapy. RESULTS All patients attained well-pronounced nasolabial fold, symmetrical smile, and good oral competence in an average period of 10.75 months post operatively. In an average of 22 months follow up, none of them had locoregional recurrences. None required any secondary procedures. CONCLUSION In the post excisional near total hemifacial composite defects, primary functional reconstruction with tailored cALT flaps can bring good aesthetic and functional results.
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Yang R, Wu X, Kumar PA, Xiong Y, Jiang C, Jian X, Guo F. Application of chimerical ALT perforator flap with vastus lateralis muscle mass for the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective cohort study. BMC Oral Health 2020; 20:94. [PMID: 32228569 PMCID: PMC7106716 DOI: 10.1186/s12903-020-01066-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with tongue carcinoma who undergo combined tongue and neck radical resection often have simultaneous oral and submandibular defects. Due to its high flexibility, the anterolateral thigh (ALT) perforator flap is gradually being adopted by surgeons for oral reconstruction. However, the tissue volume of perforator flaps is insufficient for the reconstruction of both the oral and submandibular regions. In this retrospective cohort study, we compared the postoperative outcomes and complications between patients reconstructed with using the classical ALT perforator flap and patients reconstructed using the chimeric ALT perforator flap with vastus lateralis muscle mass. METHODS From August 2017 to August 2019, 25 patients underwent reconstructive therapy using a classical ALT perforator flap (classical group), while 26 patients were reconstructed with the chimeric ALT perforator flap (chimeric group) after radical resection of tongue cancer in Xiangya Hospital, Central South University. The flap survival rate, incidence of submandibular infection, lateral appearance, lower extremity function, and quality of life were compared between the two groups. RESULTS There were no differences in flap survival rate and postoperative lower extremity function between the two groups. The incidence of submandibular infection was 15.4 and 40% in the chimeric and classical group, respectively. The duration of recovery was 12.20 ± 2.69 and 15.67 ± 4.09 days in the chimeric and classical group, respectively. The submandibular region fullness was satisfactory in the chimeric group. The postoperative quality of life in the chimeric group was better than that in the classical group (P < 0.05). CONCLUSIONS The chimerical ALT perforator flap with muscle mass reconstructs both the oral and submandibular defects accurately. It maintains the profile and fullness of the submandibular region and may reduce the incidence of submandibular infection.
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Affiliation(s)
- Rong Yang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China
| | | | - Pathak Ajit Kumar
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China
| | - Yafei Xiong
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China
| | - Canhua Jiang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China
| | - Xinchun Jian
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China
| | - Feng Guo
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China.
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Farber SJ, Latham KP, Kantar RS, Perkins JN, Rodriguez ED. Reconstructing the Face of War. Mil Med 2019; 184:e236-e246. [DOI: 10.1093/milmed/usz103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractIntroductionOngoing combat operations in Iraq, Afghanistan, and other theaters have led to an increase in high energy craniomaxillofacial (CMF) wounds. These challenging injuries are typically associated with complex tissue deficiencies, evolving areas of necrosis, and bony comminution with bone and ballistic fragment sequestrum. Restoring form and function in these combat-sustained CMF injuries is challenging, and frequently requires local and distant tissue transfers. War injuries are different than the isolated trauma seen in the civilian sector. Donor sites are limited on patients with blast injuries and they may have preferences or functional reasons for the decisions to choose flaps from the available donor sites.MethodsA case series of patients who sustained severe combat-related CMF injury and were treated at Walter Reed National Military Medical Center (WRNMMC) is presented. Our study was exempt from Institutional Review Board review, and appropriate written consent was obtained from all patients included in the study for the use of representative clinical images.ResultsFour patients treated by the CMF team at Walter Reed National Military Medical Center are presented. In this study, we highlight their surgical management by the CMF team at WRNMMC, detail their postoperative course, and illustrate the outcomes achieved using representative patient clinical images. We also supplement this case series demonstrating military approaches to complex CMF injuries with CMF reconstructive algorithms utilized by the senior author (EDR) in the management of civilian complex avulsive injuries of the upper, mid, and lower face are thoroughly reviewed.ConclusionWhile the epidemiology and characteristics of military CMF injuries have been well described, their management remains poorly defined and creates an opportunity for reconstructive principles proven in the civilian sector to be applied in the care of severely wounded service members. The War on Terror marks the first time that microsurgery has been used extensively to reconstruct combat sustained wounds of the CMF region. Our manuscript reviews various options to reconstruct these devastating CMF injuries and emphasizes the need for steady communication between the civilian and military surgical communities to establish the best care for these complex patients.
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Affiliation(s)
- Scott J Farber
- University of Texas Health Science Center San Antonio, Texas, Division of Plastic and Reconstructive Surgery, 7703 Floyd Curl Drive, MC 7844, San Antonio, TX
| | - Kerry P Latham
- Walter Reed National Military Medical Center Bethesda, MD, Division of Plastic Surgery, 4494 North Palmer Road, Bethesda, MD
| | - Rami S Kantar
- NYU Langone Health New York, NY, Hansjorg Wyss Department of Plastic Surgery, 307 E 33rd Street, New York, NY
| | - Jonathan N Perkins
- Walter Reed National Military Medical Center Bethesda, MD, Department of Otolaryngology-Head & Neck Surgery, 4494 North Palmer Road, Bethesda, MD
| | - Eduardo D Rodriguez
- NYU Langone Health New York, NY, Hansjorg Wyss Department of Plastic Surgery, 307 E 33rd Street, New York, NY
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Ettyreddy AR, Chen CL, Zenga J, Simon LE, Pipkorn P. Complications and Outcomes of Chimeric Free Flaps: A Systematic Review. Otolaryngol Head Neck Surg 2019; 161:568-575. [PMID: 31109239 DOI: 10.1177/0194599819844997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ablations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making. DATA SOURCES The librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997). REVIEW METHODS Candidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates. RESULTS A total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively. CONCLUSION Chimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.
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Affiliation(s)
- Abhinav R Ettyreddy
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Collin L Chen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Simon
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Wang S, Zhang Z, Xu Z, Duan W. Reconstruction of a subtotal upper lip defect with a facial artery musculomucosal flap, kite flap, and radial forearm free flap: a case report. World J Surg Oncol 2018; 16:194. [PMID: 30266089 PMCID: PMC6162940 DOI: 10.1186/s12957-018-1492-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For reconstructive surgeons, massive midface defects, including large, full-thickness wounds on the upper lip, can be very challenging. Although there are many methods for reconstruction of upper lip defects, it is difficult to obtain satisfactory restoration of oral functions and good cosmetic results. CASE PRESENTATION This case report presents a man with massive midface defects, including upper lip, left nose, and cheek defects. Over the previous 2 years, the patient had three reconstructions with sequential free flaps for the resection of recurrent tumors, the first of which was in March of 2016; this resulted in the patient having massive midface defects, including an upper lip defect, a defect on the left side of the nose, and one on the left cheek. The defects were reconstructed using a radial forearm free flap (RFFF), a facial artery musculomucosal (FAMM) flap, and a kite flap. In June 2016, he underwent a second reconstruction, this time of the left nose defect, using a left anterolateral thigh (ALT) flap. In March of 2017, the patient underwent a third reconstruction with the use of a free ALT on the left intraoral cheek and the defects on the neck. All flaps survived. No complications were encountered postoperatively. The patient regained good oral sphincter function with no reports of drooling. Although the patient underwent three surgeries, the reconstruction results were acceptable. CONCLUSIONS For massive midface defects, including large, full-thickness wounds on the upper lip, the combination of a FAMM flap, kite flap, and RFFF promotes the reconstruction of the complex midface structure and improves the resulting functionality.
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Affiliation(s)
- Shuai Wang
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China
| | - Zeliang Zhang
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China
| | - Zhongfei Xu
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China
| | - Weiyi Duan
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
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Reconstruction of Near-Total Loss of the Upper and Lower Lips due to Purpura Fulminans with Local Tissue and a Dual-Skin Paddled Anterolateral Thigh Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1505. [PMID: 29062669 PMCID: PMC5640375 DOI: 10.1097/gox.0000000000001505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022]
Abstract
It is difficult to totally reconstruct the lip, achieving good functional and aesthetic results. There have been few reports of reconstructing complete lip defects. Moreover, upper and lower lip necrosis by purpura fulminans has not been reported. We present a case of a 60-year-old male purpura fulminans patient with upper and lower lip necrosis. Fortunately, our patient had retained his oral commissure function. We reconstructed this defect with an orbicularis oris muscle-skin-mucosal pedicled flap derived from the region between the nasolabial folds for upper lip; a similar bipedicled flap for the lower lip and the donor site was closed with a dual-skin paddled anterolateral thigh flap. Postoperative results were satisfactory, that is, no lip tightness or aperture restriction was seen, and symmetry had been achieved. The new lips exhibited complete sensory recovery. Drooling was minimal during rest and feeding. We could select a method that combined the advantages of local and free flaps. We consider our method for this defect is superior to those described in previous studies, in that the restoration of lip sensation and oral sphincter function can be achieved to some extent in 1 stage while preserving the oral commissure function.
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Zeng L, Jiang C, Li N, Liu W, Wang F, Guo F. Vascularized Fascia Lata for Prevention of Postoperative Parotid Fistula Arising From Partial Parotidectomy During Neck Dissection. J Oral Maxillofac Surg 2017; 75:1071-1080. [DOI: 10.1016/j.joms.2016.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
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Salvage Free Anterolateral Thigh Composite Flap Transfer Based on the Musculocutaneous Perforator Retrograde Blood Flow Principle. J Craniofac Surg 2016; 27:e178-81. [DOI: 10.1097/scs.0000000000002427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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The innervated gracilis muscle for microsurgical functional lip reconstruction: review of the literature. Ann Plast Surg 2015; 74:204-9. [PMID: 23804028 DOI: 10.1097/sap.0b013e3182920c99] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reconstruction of the lower and upper lip should meet both aesthetic and functional requirements, whenever possible. Achievement of these goals presents a major challenge particularly in extensive lip defects requiring microsurgical reconstruction. Successful reconstructive outcomes have been reported using free fasciocutaneous flaps such as composite radial forearm flap or anterolateral thigh flap in conjunction with static tendon slings. In recent years, neurovascular gracilis muscle transfer has been introduced in hopes to overcome noncontractile properties of these flaps and to restore oral competence by muscle contractility. This article reviews the available data on the innervated gracilis muscle transfer for functional lip reconstruction. Tips and techniques gleaned from all of the current literature are discussed.
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The Combined Pedicled Anterolateral Thigh and Vastus Lateralis Flap as Filler for Complex Perineal Defects. Ann Plast Surg 2015; 75:66-73. [DOI: 10.1097/sap.0b013e3182a884c8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Multipaddled anterolateral thigh chimeric flap for reconstruction of complex defects in head and neck. PLoS One 2014; 9:e106326. [PMID: 25180680 PMCID: PMC4152256 DOI: 10.1371/journal.pone.0106326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022] Open
Abstract
The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck.
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Liu WC, Yang KC. One-stage through-and-through cheek, lips, and oral commissure reconstruction using a double-paddle peroneal chimeric flap: An innovative method. Head Neck 2014; 37:662-9. [DOI: 10.1002/hed.23658] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/25/2013] [Accepted: 03/01/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wen-Chung Liu
- Division of Plastic Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Kuo-Chung Yang
- Division of Plastic Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
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Peng F, Chen L, Han D, Xiao C, Bao Q, Wang T. Reconstruction of two separate defects in the upper extremity using anterolateral thigh chimeric flap. Microsurgery 2013; 33:631-7. [PMID: 24115307 DOI: 10.1002/micr.22170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 07/14/2013] [Accepted: 07/17/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Feng Peng
- Department of Hand Surgery, Huashan Hospital; Fudan University; Shanghai China
- Key Laboratory of Hand Reconstruction; Ministry of Health; Shanghai China
- Key Laboratory of Peripheral Nerve and Microsurgery; Shanghai China
| | - Lin Chen
- Department of Hand Surgery, Huashan Hospital; Fudan University; Shanghai China
- Key Laboratory of Hand Reconstruction; Ministry of Health; Shanghai China
- Key Laboratory of Peripheral Nerve and Microsurgery; Shanghai China
| | - Dong Han
- Department of Hand Surgery, Huashan Hospital; Fudan University; Shanghai China
- Key Laboratory of Hand Reconstruction; Ministry of Health; Shanghai China
- Key Laboratory of Peripheral Nerve and Microsurgery; Shanghai China
| | - Chenwei Xiao
- Department of Hand Surgery, Huashan Hospital; Fudan University; Shanghai China
- Key Laboratory of Hand Reconstruction; Ministry of Health; Shanghai China
- Key Laboratory of Peripheral Nerve and Microsurgery; Shanghai China
| | - Qiyuan Bao
- Department of Hand Surgery, Huashan Hospital; Fudan University; Shanghai China
- Key Laboratory of Hand Reconstruction; Ministry of Health; Shanghai China
- Key Laboratory of Peripheral Nerve and Microsurgery; Shanghai China
| | - Tao Wang
- Department of Hand Surgery, Huashan Hospital; Fudan University; Shanghai China
- Key Laboratory of Hand Reconstruction; Ministry of Health; Shanghai China
- Key Laboratory of Peripheral Nerve and Microsurgery; Shanghai China
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Jiang C, Guo F, Li N, Huang P, Jian X, Munnee K. Tripaddled anterolateral thigh flap for simultaneous reconstruction of bilateral buccal defects after buccal cancer ablation and severe oral submucous fibrosis release: A case report. Microsurgery 2013; 33:667-71. [PMID: 23922263 DOI: 10.1002/micr.22140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 03/26/2013] [Accepted: 05/07/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Canhua Jiang
- Department of Oral and Maxillofacial Surgery; Xiangya Hospital, Central South University; Changsha China
| | - Feng Guo
- Department of Oral and Maxillofacial Surgery; Xiangya Hospital, Central South University; Changsha China
| | - Ning Li
- Department of Oral and Maxillofacial Surgery; Xiangya Hospital, Central South University; Changsha China
| | - Pengxin Huang
- Department of Oral and Maxillofacial Surgery; Xiangya Hospital, Central South University; Changsha China
| | - Xinchun Jian
- Department of Oral and Maxillofacial Surgery; Xiangya Hospital, Central South University; Changsha China
| | - Krishna Munnee
- Department of Plastic Surgery; Victoria Hospital; Candos Mauritius
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20
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Moreno MA. Video-assisted harvesting of anterolateral thigh free flap: technique validation and initial results. Otolaryngol Head Neck Surg 2013; 149:219-25. [PMID: 23629969 DOI: 10.1177/0194599813487490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide a description of a minimally invasive, video-assisted technique (VAT) to identify the cutaneous perforators of the anterolateral thigh (ALT). The objective of the study was to compare this technique with standard open exploration of the thigh and to describe the learning curve for the procedure. STUDY DESIGN Case series with chart review. SETTING Academic tertiary institution. SUBJECTS AND METHODS Twenty-six cases operated between December 2009 and June 2012. In all of these cases, an open thigh exploration, considered the gold standard, was performed immediately after the VAT. Data retrieved included surgical findings, demographics, and outcomes. RESULTS There were 17 men and 9 women with a mean age of 60 years. The average flap size was 91 cm(2) (range, 39-264 cm(2)), and a chimeric double skin paddle flap was harvested in 6 cases. Forty-nine of 53 total perforators were successfully identified endoscopically. Findings on endoscopic and open exploration were highly correlated (r = 0.92, P = .000). The overall sensitivity for the technique was 92.4% (confidence interval, 80.9-97.5) but reached 100% for perforators located at the midpoint of the anterior-superior iliac spine-patella line. All flaps survived, and there were no technique-related complications. The learning curve plateaued after 15 cases, with a mean endoscopic operative time of 18.2 minutes for the last 10 procedures. CONCLUSION This VAT is a safe and reliable method to identify cutaneous perforators of the lateral thigh. The procedure is straightforward and has a moderate learning curve. This approach has a role in minimizing donor site morbidity and assisting in flap design.
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Affiliation(s)
- Mauricio Alejandro Moreno
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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21
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Xie G, Hu Z, Miao C, Chen W, Mei L. The free triple chimeric dorsalis pedis flaps for repair of multifinger soft tissue defects: A report of two cases. Microsurgery 2013; 33:660-6. [PMID: 23568574 DOI: 10.1002/micr.22088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Guangzhong Xie
- Division of Hand and Microsurgery; Houjie Hospital; Dongguang Guangdong Province China
| | - Zhengbo Hu
- Division of Hand and Microsurgery; Houjie Hospital; Dongguang Guangdong Province China
| | - Cunliang Miao
- Division of Hand and Microsurgery; Houjie Hospital; Dongguang Guangdong Province China
| | - Wenxiong Chen
- Division of Hand and Microsurgery; Houjie Hospital; Dongguang Guangdong Province China
| | - Linjun Mei
- Division of Hand and Microsurgery; Houjie Hospital; Dongguang Guangdong Province China
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