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Suda S, Hayashida K. Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction. Life (Basel) 2024; 14:223. [PMID: 38398732 PMCID: PMC10890180 DOI: 10.3390/life14020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The unique anatomy of the scrotum, vital for thermoregulation and spermatogenic function, necessitates reconstruction with thin and pliable tissue. When the scrotal defect area is less than half the scrotal surface area, scrotal advancement flap can be performed. However, for larger defects, some type of transplantation surgery is required. Various options are explored, including testicular transposition, tissue expanders, split-thickness skin grafts, local flaps, and free flaps, each with merits and demerits based on factors like tissue availability, defect size, and patient specifics. Also, physicians should consider how testicular transposition, despite its simplicity, often yields unsatisfactory outcomes and impairs spermatogenesis. This review underscores the individuality of aesthetic standards for scrotal reconstruction, urging surgeons to tailor techniques to patient needs, health, and defect size. Detailed preoperative counseling is crucial to inform patients about outcomes and limitations. Ongoing research focuses on advancing techniques, not only anatomically but also in enhancing post-reconstruction quality of life, emphasizing the commitment to continuous improvement in scrotal reconstruction.
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Affiliation(s)
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan;
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Dave A, Priyadarshini P, Wadhwani K, Laxmidhar M, Vanjarapu RNVK. Use of super-thin anterolateral thigh flap in intra-oral reconstruction of soft tissue defects. Microsurgery 2023; 43:782-789. [PMID: 37724463 DOI: 10.1002/micr.31115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Traditional sub-fascial anterolateral thigh (ALT) flaps are bulky and often give unsatisfactory outcomes in several head and neck reconstructions where thin pliable flaps are required. As a result, despite high incidence of donor site complications, radial forearm flap is still commonly used for tongue, buccal mucosa and lip defects where a traditional ALT flap would be too bulky. The objective of this report was to evaluate the usefulness of super-thin ALT flap as an alternative to radial forearm flap for intra-oral reconstruction. PATIENTS AND METHODS Retrospective evaluation was done of all head and neck reconstructions performed by a single surgeon between December 2021 and May 2022. Twenty-two patients who had undergone super-thin ALT flaps for intra-oral reconstruction of soft tissue defects were included in the report. These included buccal mucosa (n = 11), tongue (n = 8), and buccal mucosa with neck skin defects (n = 3). All patients had undergone wide excision of oral squamous cell carcinoma, and had history of chewing tobacco. Average age of patients was 54 years, 16 were males and 6 were females. Mean BMI of the patients was 25.2 kg/m2 (Range: 20.5-31.0 kg/m2 ). Super-thin ALT flap was elevated in the plane of superficial fascia of the thigh, thus leaving behind the deeper fat. The flaps were shaped as per the measurements obtained from the specimen as well as the defect and intra-oral inset was done prior to vascular anastomosis. RESULTS Mean flap dimension was 8.3 × 6.7 cm (range: 6 × 5 to 20 × 7 cm). Mean flap thickness was 9 mm (range: 4-20 mm). Mean flap elevation time was 70.9 min (Range: 48-105 min). None of the flaps needed a re-exploration. All flaps survived completely. One patient had surgical site infection at the flap donor site which was managed conservatively. Mean follow up was 5 months (range: 3-10 months). All patients were able to take soft oral diet at the last follow up. CONCLUSIONS Super-thin ALT flaps raised in superficial fascia plane are reliable and provide thin, pliable tissue for head and neck reconstruction. Unlike other thin flaps, these are not limited by donor site morbidity and flap dimension.
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Affiliation(s)
- Aniket Dave
- Plastic and Reconstructive Surgery, Apollo CBCC Cancer care, Ahmedabad, India
| | | | - Kamlesh Wadhwani
- Plastic Surgery, Apollo Hospitals International Limited, Ahmedabad, India
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Tuluy Y, Bali ZU, Ünsal MÖ, Parspancı A, Yoleri L, Çiçek Ç, Filinte GT. Comparison of The Thickness of Free Anterolateral Thigh Flap in Different Fascial Planes: Clinical Results of Subfascial and Superficial Fat Flap. Arch Plast Surg 2023; 50:601-609. [PMID: 38143845 PMCID: PMC10736183 DOI: 10.1055/s-0043-1772586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/29/2023] [Indexed: 12/26/2023] Open
Abstract
Background The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses. Methods This study was conducted to investigate the correlation of the thickness of the traditional subfascial ALT flap and superficial fat flap with age, gender, and body mass index (BMI). A total of 42 patients (28 males and 14 females) were included in the study. Results Mean age was 50.2 (range, 16-75) years and mean BMI was 24.68 ± 4.02 (range, 16.5-34.7) kg/m 2 . The subfascial flap thickness was significantly thinner in male patients (16.07 ± 2.77 mm) than in female patients (24.07 ± 3.93 mm; p < 0.05), whereas no significant difference was found between male (4.28 ± 1.15 mm) and female patients (4.85 ± 1.09 mm) regarding superficial fat flap thickness ( p = 0.13). The thickness of both flaps had a positive correlation with BMI, and the strongest correlation was found for subfascial ALT thickness in female patients ( r = 0.81). Age had no effect on both flap thickness measurements. The anterior thigh is thicker in women than in men, although it varies according to BMI. This shows that flap elevation is important in the superthin plane, especially if a thin flap is desired in female patients in defect reconstruction with the ALT flap. Thus, a single-stage reconstruction is achieved without the need for a defatting procedure after subfascial dissection or a second defatting procedure 3 to 6 months later. Conclusion The appropriate ALT flap plane should be selected considering the gender and BMI of the patient.
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Affiliation(s)
- Yavuz Tuluy
- Address for correspondence Yavuz Tuluy, MD Plastic, Reconstructive and Aesthetic Surgery, Manisa Turgutlu State HospitalTurgutlu, Manisa, 45000Turkey
| | | | - Merve Özkaya Ünsal
- Department of Plastic, Reconstructive and Aesthetic Surgery, İzmir, Turkey
| | - Aziz Parspancı
- Department of Plastic Reconstructive and Aesthetic Surgery, Bayburt State Hospital, Bayburt, Turkey
| | - Levent Yoleri
- Department of Plastic Reconstructive and Aesthetic Surgery, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Çağla Çiçek
- Department of Plastic Reconstructive and Aesthetic Surgery, İstanbul Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Gaye Taylan Filinte
- Department of Plastic Reconstructive and Aesthetic Surgery, İstanbul Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
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Yen CI, Lu YJ, Kao HK, Huang JJ, Wu CW, Chang CS, Chen HC, Hsiao YC. A 10-year experience in microsurgical reconstruction of the nose with a lower extremity flap. J Plast Reconstr Aesthet Surg 2023; 85:10-17. [PMID: 37453411 DOI: 10.1016/j.bjps.2023.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Traditionally, radial forearm free flaps are utilized for nasal lining reconstruction when local flaps cannot provide adequate coverage. However, according to our clinical observation, the skin of the forearm flap is relatively thin and prone to collapse. We present a series of nasal reconstructions using free flaps harvested from the lower extremities to determine if the thick flap could provide more support and decrease the tendency of airway collapse. METHODS From March 2011 to July 2021, we identified 15 patients who underwent total or subtotal nasal reconstruction with free flap from the lower extremities (10 anterolateral thigh flap, 4 medial sural artery perforator flap, and 1 profunda artery perforator flap). We included 15 patients who underwent free forearm flap reconstruction as controls. The Nasal Obstruction Symptoms Evaluation (NOSE) score was utilized to subjectively evaluate the degree of nasal obstruction symptoms. RESULTS The lower extremity group had a lower NOSE score than the forearm group (25.4 vs. 40). It took more time (6.5 vs. 4.2 months) and more surgeries (4.6 vs. 2.6) from the first free flap reconstruction till forehead flap reconstruction in the lower extremity group than in the forearm group, although the total number of surgeries was comparable between the 2 groups (7.2 vs. 8.1). CONCLUSIONS Utilizing free flaps from the lower extremities in total or subtotal reconstruction of the nasal lining may decrease the tendency of flap collapse and alleviate airway obstruction symptoms and may also allow reconstruction of surrounding defects simultaneously compared with using forearm flaps.
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Affiliation(s)
- Cheng-I Yen
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Jui Lu
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Wei Wu
- Vendome Private Practice Aesthetic Medical Center, Taipei, Taiwan
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chang Chen
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Cha HG, Hur J, Ahn C, Hong JP, Suh HP. Ultrathin Anterolateral Thigh Free Flap: An Adipocutaneous Flap with the Most Superficial Elevation Plane. Plast Reconstr Surg 2023; 152:718e-723e. [PMID: 36780355 DOI: 10.1097/prs.0000000000010295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Although many efforts have been made to create thinner anterolateral thigh (ALT) flaps, their thickness varies among patients, and the flap may be still too thick to match shallow defects. The authors successfully harvested an ALT flap through the most superficial elevation plane, the superficial fat layer, which was useful to match the shallow defects. METHODS All patients who underwent ALT free flap reconstruction for upper and lower distal extremity defects were divided retrospectively into groups by ALT flap elevation plane: thin, above the deep fascia; superthin, at the superficial fascia; and ultrathin, through the superficial fat. Preoperative computed tomographic angiography and duplex ultrasonography planning were used for all patients. Anatomical characteristics of donor subcutaneous tissue and surgical details, including flap thickness, flap size, and incidence of flap necrosis were compared among the groups and between sexes. RESULTS The average deep and superficial fascial depths were 16.7 and 10.8 mm, 12.5 and 8.2 mm, and 9.1 and 5.6 mm ( P < 0.05), and the average flap thickness was 5.8 mm, 7.9 mm, and 7.8 mm ( P = 0.29) in the ultrathin, superthin, and thin ALT groups, respectively. No significant intergroup differences existed in flap size or complications. The deep and superficial fascia were located significantly deeper in female patients (9.4 and 6.0 mm in male patients and 14.9 and 9.6 mm in female patients, respectively). CONCLUSIONS With precise preoperative planning, the most superficially elevated, ultrathin ALT flap can achieve optimal reconstructions of thin body areas. Female patients with thicker thighs and patients with a high body mass index would benefit from this flap. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Han Gyu Cha
- From the Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine
| | - Joon Hur
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Chris Ahn
- Department of Plastic and Reconstructive Surgery, Sydney South West Cancer Therapy Service
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyunsuk Peter Suh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Danielian A, Cheng MY, Han PS, Blackwell KE, Kerr RPR. Medial Sural Artery Perforator Flap: A Middle Ground Between Anterolateral Thigh and Radial Forearm Flaps. Otolaryngol Head Neck Surg 2023; 169:852-857. [PMID: 37051889 DOI: 10.1002/ohn.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE The medial sural artery perforator (MSAP) flap has gained popularity in head and neck reconstruction primarily as a less morbid alternative to the radial forearm free flap (RFFF). However, no direct comparison of thickness exists among the MSAP, RFFF, and anterolateral thigh (ALT) flaps, which together represent the commonly utilized nonosseus-free flaps in head and neck reconstruction. Thus, this study aimed to compare these flap sites and identify predictors of thickness that will aid in reconstructive surgical planning. STUDY DESIGN Cross-sectional study. SETTING Tertiary referral hospital. METHODS The thickness of skin and subcutaneous tissue at the RFFF, MSAP, and ALT donor sites were measured in 54 adult patients using Doppler ultrasound. General linear models were generated to identify predictors of flap thickness. RESULTS The mean thickness of the RFFF, MSAP, and ALT flaps was 3.8 ± 2.2 mm, 7.4 ± 3.8 mm, and 9.6 ± 4.7 mm. Body mass index (BMI) was the only statistically significant contributing factor (p < .0001, coefficient: 0.15) for the RFFF. MSAP was affected by age (p = .006, coefficient = 0.06), female gender (p < .0001, coefficient = 3.2), and BMI (p < .001, coefficient = 0.25), while the ALT was affected by female gender (p = .0005, coefficient = 3.3) and BMI (p < .0001, coefficient = 0.35). Thus, the ratio of increase for flap thickness with respect to BMI is 3:5:7 for the RFFF, MSAP, and ALT flaps, respectively. CONCLUSION The MSAP is about twice the thickness of the RFFF and 2 mm thinner than the ALT; however, 22% of patients had thicker MSAP than ALT flaps. As the strongest predictors of flap thickness, female gender, and BMI may be taken into consideration during surgical planning for reconstruction.
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Affiliation(s)
- Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Peter S Han
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Keith E Blackwell
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rhorie P R Kerr
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Hsieh Y, Chen I, Lin C, Yang K, Liu W, Chiu C, Lee S, Chen L. Comparison of the outcomes of anterolateral thigh flap and peroneal flap in total laryngectomy reconstruction. Laryngoscope Investig Otolaryngol 2023; 8:645-650. [PMID: 37342117 PMCID: PMC10278101 DOI: 10.1002/lio2.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/09/2023] [Indexed: 06/22/2023] Open
Abstract
Background We usually use an ALT or peroneal flap in total laryngectomy reconstruction, depending on the surgeons' preference. No direct comparison of the outcomes of the ALT flap and peroneal flap exists. Methods From 2014 to 2022, we reviewed patients who had total laryngectomy and were reconstructed with an ALT flap and peroneal flap. Patient characteristics and surgical outcomes were collected and compared. Results The peroneal group had a significantly higher risk of neopharynx leakage (40% vs. 13.2%, p = .020) and late pharyngocutaneous fistula formation (30% vs. 5.3%, p = .009) than the ALT group. Peroneal flap was found to be the only independent risk factor for neopharynx leakage (p = .025, odds ratio [OR] = 5.5) and late pharyngocutaneous fistula formation (p = .02, OR = 7.7) in multivariate logistic regression. Conclusion In the reconstruction of total laryngectomy, the ALT flap is preferable over the peroneal flap.
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Affiliation(s)
- Yu‐Hsuan Hsieh
- Division of Plastic and Reconstructive Surgery, Department of SurgeryKaohsiung Veterans General HospitalKaohsiung CityTaiwan
- School of MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
- School of MedicineCollege of Medicine, National Sun Yat‐sen UniversityKaohsiung CityTaiwan
| | - I‐Wen Chen
- Department of PediatricsKaohsiung Veterans General HospitalKaohsiung CityTaiwan
| | - Cheng‐Ta Lin
- Division of Plastic SurgeryChi Mei Medical CenterLiouyingTaiwan
- School of Dentistry and Institute of Oral MedicineCollege of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Kuo‐Chung Yang
- Division of Plastic and Reconstructive Surgery, Department of SurgeryKaohsiung Veterans General HospitalKaohsiung CityTaiwan
- School of MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Wen‐Chung Liu
- Division of Plastic and Reconstructive Surgery, Department of SurgeryKaohsiung Veterans General HospitalKaohsiung CityTaiwan
- School of MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
- School of MedicineCollege of Medicine, National Sun Yat‐sen UniversityKaohsiung CityTaiwan
| | - Ching‐Ching Chiu
- Department of OtolaryngologyKaohsiung Veterans General HospitalKaohsiung CityTaiwan
| | - Shih‐Yu Lee
- Division of Plastic and Reconstructive Surgery, Department of SurgeryKaohsiung Veterans General HospitalKaohsiung CityTaiwan
| | - Lee‐Wei Chen
- Division of Plastic and Reconstructive Surgery, Department of SurgeryKaohsiung Veterans General HospitalKaohsiung CityTaiwan
- School of MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Hurrell MJL, Clark JR, Ch'ng S, Hubert Low TH, Nguyen KM, Elliott MS, Palme CE, Wykes J. Comparison between the radial forearm and superficial circumflex iliac artery perforator free flaps for oral soft tissue reconstruction. Int J Oral Maxillofac Surg 2023; 52:181-7. [PMID: 35786526 DOI: 10.1016/j.ijom.2022.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 01/11/2023]
Abstract
The radial forearm free flap (RFFF) is widely used for oral reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is an increasingly utilized alternative. The cases of 165 patients who received either an RFFF or SCIP flap for oral reconstruction at Chris O'Brien Lifehouse, Sydney were reviewed. The aim was to report on patient, pathology, treatment, and outcome variables and to compare these between the two flap groups. A RFFF was used in 126 patients and a SCIP flap in 39 patients. SCIP flap patients were younger (P < 0.001) and had shorter operative times (P < 0.001), shorter anaesthetic times (P < 0.001), and more frequent recipient site dehiscence (P = 0.005) when compared to RFFF patients. The SCIP flap was significantly less frequently used for composite resections including bone when compared to the RFFF (P < 0.001). The primary site distribution was more even for RFFF patients (P < 0.001). There were no SCIP flap failures; three RFFF failures occurred. SCIP flaps performed comparably in terms of operative and clinical outcomes. Most SCIP flaps were utilized in younger patients with partial glossectomy defects.
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Ring A, Beutel H, Kirchhoff P, Bushart SU, Dellmann NC, Farzaliyev F. [Reconstruction of posttraumatic soft tissue defects of the ankle using free fascial flaps from the anterolateral thigh]. Unfallchirurgie (Heidelb) 2023; 126:136-144. [PMID: 34686888 PMCID: PMC8533668 DOI: 10.1007/s00113-021-01100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Free fascial flaps from the anterolateral thigh (ALT) were used to reconstruct soft tissue defects after trauma to the ankle. This modification was compared to the conventional fasciocutaneous method. MATERIAL AND METHODS The defect size, the thickness of the subcutaneous fat layer on the thigh and the extent of the soft tissue covering the ankle were determined retrospectively. The evaluations were compared between fascial (Fo) and fasciocutaneous flaps (Fc). The foot and ankle outcome score (FAOS) was used. Esthetic outcome surveys were carried out. RESULTS A total of 18 isolated fractures of the ankle were evaluated. In 94% of the cases a closed soft tissue damage predominated. After fracture fixation using a plate, soft tissue defects with a mean area of 40.4 ± 13.1 cm2 (28-76 cm2) developed. The thickness of the soft tissue covering over the affected malleoli increased significantly in both groups as a result of the flap surgery (4.5 ± 0.7 vs. 21.1 ± 6.4 mm, p < 0.05). A significant difference was found when comparing the body mass index (BMI) between the groups (Fc 26.3 ± 3.4 kg/m2 vs. Fo 30.1 ± 4.2 kg/m2, p < 0.05). For both groups there was a positive correlation (r = 0.843) between the BMI and the thickness of the epifascial fat layer of the thigh. The FOAS survey revealed 75.9 ± 28.9 and 47.9 ± 32.4 points, respectively, for "function in daily life" and "foot and ankle-related quality of life". The esthetic reconstruction result was rated as "acceptable" by 55% and as "good" by 45%. DISCUSSION The modified method of a free fascial flap from the ALT can be useful in situations where a bulky flap makes it difficult to fit it into the defect.
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Affiliation(s)
- Andrej Ring
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland.
- Ruhr-Universität Bochum, Bochum, Deutschland.
| | - Hendrik Beutel
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
- Ruhr-Universität Bochum, Bochum, Deutschland
| | - Pascal Kirchhoff
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Sebastian Ulrich Bushart
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Niklas-Chris Dellmann
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Farhad Farzaliyev
- Klinik für Allgemein‑, Viszeral und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
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Yin J, Wang L, Yang G, Qin X, Xiong P. Correlation Between Body Mass Index and Anterolateral Thigh Flap Thickness: A Retrospective Study From a Single Center in China. Front Surg 2021; 8:748799. [PMID: 34708071 PMCID: PMC8542684 DOI: 10.3389/fsurg.2021.748799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: During repair of oral and maxillofacial soft tissue defects, organ function is largely related to the amount of thickness of the flap. However, there are few studies on the influencing factors of the thickness of the flap. In this retrospective study, we aim to explore the correlation between body mass index (BMI) and anterolateral thigh (ALT) flap thickness by computed tomography (CT) and ultrasound and provide guidance for evaluating the ALT flap thickness before surgery. Methods: We selected three points A, B, and C on ALT flap and two skilled clinicians measured the thickness of these points. Age and gender as covariates and evaluated by the Chi-square analysis. Inter-group differences between the two BMI groups were examined by the student t test. Intra-group differences within each BMI group were tested by ANOVA. Linear regression analysis was performed to examine the relationship between BMI and ALT flap thickness. Results: One hundred sixty patients measured by CT were included in this study, and the ALT flap thickness measured by CT were 8.96 mm and 11.00 mm (P < 0.0001, t test) at point B in groups with BMI<24.0 and BMI≥24.0, respectively. The thicknesses at points A, B, and C were significantly correlated with the BMI (P < 0.001, correlation analysis, r = 0.462, 0.372, and 0.349 at the points A, B, and C, retrospectively, Pearson test). Conclusion: There was a significant correlation between the ALT flap thickness and BMI. A higher BMI was correlated with a thicker ALT flap.
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Affiliation(s)
- Jianxin Yin
- Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Wang
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gongxin Yang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xingjun Qin
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Yen YH, Lo SL, Liu SP, Pu CM. Eccentric free muscular perforator flaps in the proximal lateral leg for hand and foot reconstruction. Microsurgery 2021; 41:726-733. [PMID: 34617329 DOI: 10.1002/micr.30821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/25/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to introduce our modifications by using eccentrically located muscular perforators to shorten the distance between the recipient vessels and the flap pedicle for overcoming the "short pedicle" drawback of the proximal lateral leg perforator (PLLP) flap. PATIENTS AND METHODS A retrospective review of 12 cases undergoing free PLLP flap for hand and foot regions reconstruction during 2010 and 2019. The mean age was 43.3 years. Most defects resulted from burn and trauma injuries. The dimensions of defects ranged from 8 × 1.5 cm2 to 12 × 6.5 cm2 . Muscular perforators were designed eccentrically 1-3 cm away from the central point of the flap to shorten the distance between the recipient vessels and the pedicle. The flap was designed to be 0.5-1 cm larger than the defect. RESULTS The flap size ranged from 9 × 2 cm2 to 15 × 6 cm2 . All pedicles were long enough to ensure an appropriate anastomosis without tension. The post-operative course in all cases was uneventful. All flaps survived without complications. Primary repair of the donor sites was performed in all patients. Donor leg function was not hampered by flap harvesting. All patients were satisfied with the scar after at least 1 year of follow-up. CONCLUSION Based on our experience, selection of the eccentric locations of the musculo-cutaneous perforators were effective methods to overcome the short pedicle length of this flap type. Using our modifications, thin PLLP flaps can be used in foot and hand reconstruction with minimal donor site morbidity and a high success rate.
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Affiliation(s)
- Yu-Hsiu Yen
- Division of Plastic Surgery, Department of Surgery, Sijhih Cathay General Hospital, New Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shih-Lun Lo
- Division of Plastic Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Pi Liu
- Division of Plastic Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Chi-Ming Pu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Division of Plastic Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
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Kelahmetoglu O, Mehdizade T, Unal M, Keles MK, Guneren E. Free ALT Perforator Flap in Nonobese Patients: The Recontouring of Soft Tissue Defects Around Foot. Indian J Orthop 2021; 56:445-451. [PMID: 35251508 PMCID: PMC8854467 DOI: 10.1007/s43465-021-00518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The anterolateral thigh (ALT) perforator flap is well-described and versatile option for reconstruction of soft tissue defects around foot and ankle. This retrospective review was performed for reconstruction of soft tissue defects around foot with ALT perforator flaps in patients with normal and overweight body mass index (BMI). METHODS Between January 2016 and November 2020, ALT flaps were used in 30 patients for foot defects. RESULTS Etiologic factors were trauma (18 patients), diabetic foot ulcer (6 patients), tumor (3 patients), infection (2 patients) and burn contracture (1 patient). Mean body mass index (BMI) value was 24.9 ± 4.1 (17-30). Mean flap dimension was 145 ± 86 (40-420) cm2. Recipient vessels were anterior tibial artery in 17 patients (56%), posterior tibial artery in 12 patients (40%), reversed flow dorsalis pedis artery in 1 patient (3.3%). In 24 patients (80%), 2 vein anastomoses were done. Debulking were applied in two patients (6.6%). Donor area was grafted in four patients (13.3%). Mean flap score was 1.25 ± 0.5. Mean flap thickness was 10 ± 2 (7-14) mm. Visual Analogue Scale (VAS) score was 7.75 ± 1.04 (6-10). The patients were followed up for a mean of 14 ± 11 (1-30) months. CONCLUSION We think that ALT flap is still reliable and precious option because it provides ideal soft tissue reconstruction by means of recontouring of foot in nonobese patients.
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Affiliation(s)
- Osman Kelahmetoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Turan Mehdizade
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa Unal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Ethem Guneren
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Steiner SA, Schweizer R, Klein H, Waldner M, Giovanoli P, Plock JA. Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps. Eur J Plast Surg 2021; 44:669-77. [DOI: 10.1007/s00238-021-01830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background
Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction.
Methods
We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications.
Results
Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months).
Conclusions
Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites.
Level of evidence: Level IV, therapeutic study.
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Hanson-Viana E, Rojas-Ortiz J, Rendón-Medina MA, Pacheco-López RC, Ríos-Lara López LR, Palacios-Juárez J. Influence of BMI, Age, and Gender on the Thickness of Most Common Thinned Flaps. Plast Reconstr Surg Glob Open 2021; 9:e3409. [PMID: 33968546 DOI: 10.1097/GOX.0000000000003409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
Background: Since the description of superficial fascia flap harvesting, a new window of opportunity has been open in obese patients, where a higher subcutaneous thickness of tissue is present. To our knowledge, the impact of body mass index on superficial fascial flaps has not been reported. Methods: We recruited 122 patients from April 2019 to January 2020. From these patients, the 3 most common thinned flaps were selected: the superficial circumflex iliac perforator flap; the anterolateral thigh flap at the perforator A, B, and C; and the thoracodorsal flap. Two vertical measures were registered: the distance from the skin to the superficial fascia, and from this point to the deep fascia. Results: The average flap measurement presented here was within the range, as previous clinical studies. The superficial fatty layer thickness in the superficial circumflex iliac perforator and anterolateral thigh flap was somewhat similar in thickness between overweight and obese patients, showing a minimal increase with higher body mass index. The anterolateral thigh flap was found thicker among women, and no statistical difference was shown between age groups in any of the flaps. Conclusions: A better understanding of the fat layers’ thickness will result in better planning, minimizing secondary debulking procedures, decreasing operative time, and reducing general complications among obese patients. Thus, a better understanding of flap structure and physiology in obese patients will lower complications and give more predictable results.
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Pugliese P, De Francesco F, Campodonico A, Pangrazi PP, Antonini A, Riccio M. Medial Sural Perforator “Nerve through Flap”: Anatomical Study and Clinical Application. Trauma Care 2021; 1:15-22. [DOI: 10.3390/traumacare1010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Nerve recovery after a complex trauma is affected by many factors and a poorly vascularized bed is often the cause of failure and perineural scar. Many techniques have been devised to avoid this problem and the possibility to transfer a nerve with a surrounding viable sliding tissue could help in this purpose; Methods: We performed an anatomic study on 8 injected specimens to investigate the possibility to raise a medial sural artery perforator (MSAP) flap including the sural nerve within its vascularized sheath; Results: In anatomic specimens, a visible direct nerve vascularization was present in 57% of legs (8 out of 14). In 43% a vascular network was visible in the fascia layer. There were no vascular anomalies. In one patient the MSAP flap was raised including the sural nerve with its proximal tibial and peroneal components within the deep sheath. The tibial and peroneal component of the sural nerve were anastomized independently with the common digital nerve of 4th and 5th fingers and with the collateral nerve for the ulnar aspect of the 5th. After 9 months, the patient showed an improving nerve function both clinically and electromyographically without any problem due to nerve adherence; Conclusions: Given the still debated advantage of a vascularized nerve graft versus a non-vascularized one, this flap could be useful in those cases of composite wounds with nerve lesions acting as a “nerve through flap”, in order to reduce nerve adherence with a viable surrounding gliding tissue.
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Lin YS, Liu WC, Yang KC. Peroneal flap: How to harvest and clinical appraisal for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2021; 74:1515-23. [PMID: 33358676 DOI: 10.1016/j.bjps.2020.11.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 08/26/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A peroneal flap, the boneless version of fibula flap, is considered as the equivalent of radial forearm flap of the lower leg. Because it is thinner than an anterolateral thigh (ALT) flap, the use of a peroneal flap is a viable option for the repair of soft tissue defects when a thin flap could bring about better functional and cosmetic outcomes. In this article, we describe the details of peroneal flap harvest and present our experience with the use of peroneal flaps for head and neck reconstruction. MATERIALS AND METHODS Between 1996 and 2017, a total of 265 peroneal flaps were used to reconstruct a variety of head and neck defects. With the same vascular anatomy and slight modifications to the harvesting technique of a fibula flap, a peroneal flap can be harvested within 1-2 h. All medical records were retrospectively reviewed. RESULTS A peroneal flap can be harvested as different types of chimeric flaps to fit a variety of head and neck defects. The peroneal flap failure rate was 3.4% and the postoperative complication rate was 12.8%. CONCLUSION A peroneal flap might be an alternative option for the reconstruction of head and neck defects.
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Park EP, Le JM, Gigliotti J, Feinstein J, Ying YP, Morlandt AB. Does Supplemental Regional Anesthesia Decrease Length of Stay and Opioid Use for Patients Undergoing Head and Neck Microvascular Reconstruction? J Oral Maxillofac Surg 2020; 79:712-721. [PMID: 32976833 DOI: 10.1016/j.joms.2020.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to compare length of hospital stay and opioid usage among head and neck surgery (HNS) patients treated with and without regional anesthesia for microvascular free-flap donor sites. METHODS The authors performed a retrospective cohort study for HNS patients undergoing microvascular free-flap reconstruction. The control group received no regional anesthesia. The experimental group had a regional anesthesia nerve block performed immediately before surgery. The primary outcome variable was length of stay, and the secondary outcome variable was total morphine milliequivalents. The data were analyzed using Student t tests, analysis of variance, Mann-Whitney U test, Kruskal-Wallis test, χ2 test, and multiple linear regression. RESULTS The study sample was composed of 148 patients with a mean age of 58.1 years. The mean length of stay for the control group was 6.74 ± 1.57 days, compared with the experimental group at 5.84 ± 1.01 days (P < .0001). The mean morphine milliequivalent was 256.5 ± 164.6 mg for the control group and 208.9 ± 164.8 mg for the experimental group (P = .56). Importantly, the demographics, pathology spectrum, flap selection, duration of procedure, and complication rate were similar in both groups. CONCLUSIONS This study demonstrates that for HNS patients undergoing microvascular reconstruction, regional nerve block at the donor site is associated with significantly shorter hospital stays. Although there was a trend toward decreased opioid usage in the regional anesthesia group, these results did not reach statistical significance. Consideration should be given to incorporate regional anesthesia techniques into early recovery after surgery protocols for centers performing high-volume head and neck microvascular reconstruction.
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Affiliation(s)
- Earl Peter Park
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Science Center, New Orleans, LA.
| | - John Minh Le
- Surgical Resident, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jordan Gigliotti
- Assistant Professor, Department of Oral & Maxillofacial Surgery, McGill University, Montreal, Canada
| | - Joel Feinstein
- Associate Professor and Director of Regional Anesthesia for University Hospitals, Department of Anesthesia and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Yedeh P Ying
- Assistant Professor, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Anthony B Morlandt
- Associate Professor and Section Chief of Oral Oncology and Microvascular Surgery, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
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Daar DA, Taufique ZM, Cohen LE, Thanik VD, Levine JP, Jacobson AS. In Response to "Regarding the MSAP Flap: A Better Option in Complex Head and Neck Reconstruction?". Laryngoscope 2020; 130:E457. [PMID: 32343418 DOI: 10.1002/lary.28702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/06/2022]
Affiliation(s)
- David A Daar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Zahrah M Taufique
- Department of Otolaryngology, New York University Langone Health, New York, New York, U.S.A
| | - Leslie E Cohen
- Division of Plastic Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
| | - Vishal D Thanik
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Jamie P Levine
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Adam S Jacobson
- Department of Otolaryngology, New York University Langone Health, New York, New York, U.S.A
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Li J, Song P, Yang D, Liu L, Wang J. Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report. Br J Oral Maxillofac Surg 2019; 58:355-357. [PMID: 31862118 DOI: 10.1016/j.bjoms.2019.10.318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/29/2019] [Indexed: 11/17/2022]
Abstract
A 34-year-old woman presented with a progressive oral ulcer, and redness and swelling of the skin over the mandible. Radiological and histological examination showed adenoid cystic carcinoma of the mandible and floor of the mouth with extensive invasion. We radically resected the tumour with sufficient margins, and cut off segments of fibula, reshaped them and fixed them into the mandibular angles bilaterally. We used three perforator flaps, (the soleus muscle, the third, and fourth perforator flaps) to reconstruct the defects of the tongue, mentum, and oral floor, respectively. Recovery was good postoperatively, and there was no infection or any other complications.
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Affiliation(s)
- J Li
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233000, China
| | - P Song
- Department of Plastic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233000, China.
| | - D Yang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233000, China
| | - L Liu
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233000, China
| | - J Wang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233000, China
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Oh J, Lee TH, Lee JH, Tae K, Park SO, Ahn HC. Exclusive tongue tip reconstruction of hemiglossectomy defects using the underrated lateral arm free flap with bilobed design. Arch Craniofac Surg 2019; 20:37-43. [PMID: 30840817 PMCID: PMC6411518 DOI: 10.7181/acfs.2018.02005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/02/2018] [Indexed: 11/12/2022] Open
Abstract
Background Tongue reconstruction is challenging with the unique function and anatomy. Goals for reconstruction differ depending on the extent of reconstruction. Thin and pliable flaps are useful for tongue tip reconstruction, for appearance and mobility. This study reports lateral arm free flap (LAFF) as a safe and optimal option for hemi-tongue reconstruction, especially for tongue tip after hemiglossectomy. Methods Thirteen LAFFs were performed for hemi-tongue reconstruction after hemiglossectomy from 1995 to 2018. Of the 13 patients, seven were male and six were female, age varying from 24 to 64 years. Results All flaps healed uneventfully without complications. Donor sites were closed primarily. The recipient vessels for microvascular anastomosis were mainly superior thyroidal artery, external jugular vein. All patients returned to normal diet, with no complaints regarding reconstructed tongue and donor site. Conclusion The LAFF is hairless, thin (especially with lateral epicondyle approach), and potentially sensate. They are advantageous features for tongue tip and hemi-tongue reconstruction. Donor site sacrifices the inessential posterior radial collateral artery, and the scar is hidden under short sleeve shirts. We believe that LAFF can be considered as the first choice flap for hemitongue reconstruction, over radial forearm free flaps.
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Affiliation(s)
- Jeongseok Oh
- Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Hyeon Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Hee Chang Ahn
- Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
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Akdeniz Doğan ZD, Çavuş Özkan M, Tuncer FB, Saçak B, Çelebiler Ö. A Comparative Clinical Study of Flap Thickness: Medial Sural Artery Perforator Flap Versus Anterolateral Thigh Flap. Ann Plast Surg 2018; 81:472-4. [DOI: 10.1097/sap.0000000000001488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lin YS, Liu WC, Wang KY, Lin YS, Yang KC. Obliquely-arranged double skin paddles: A novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap. Microsurgery 2018; 39:108-114. [DOI: 10.1002/micr.30322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Ying-Sheng Lin
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Division of Plastic and Reconstructive Surgery; National Taiwan University Hospital Yulin Branch; Yulin County Taiwan
| | - Wen-Chung Liu
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
- National Defense Medical Center; Taipei Taiwan
| | - Kuan-Ying Wang
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Yaoh-Shiang Lin
- National Defense Medical Center; Taipei Taiwan
- Department of Otolaryngology Head and Neck; Kaohsiung Veterans General Hospital; Taiwan
| | - Kuo-Chung Yang
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- College of Medicine; National Yang-Ming University; Taipei Taiwan
- National Defense Medical Center; Taipei Taiwan
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Wolff KD, Rau A, Kolk A. Perforator flaps from the lower leg for intraoral reconstruction: Experience of 131 flaps. J Craniomaxillofac Surg 2018; 46:338-345. [DOI: 10.1016/j.jcms.2017.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/11/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022] Open
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Abstract
Our goal was to describe our experience of the folded radial forearm flap (RFF) flap in through-and-through buccal defect reconstructions.Patients who had received a folded RFF flap for full-thickness cheek defect reconstruction were included. The flap success rate and functional results were evaluated.Six patients were enrolled. All flaps survived totally without any complication; the mean flap size was 75.5 (range 32-135) cm. The mean mouth-open width was 4.2 (range 3.5-4.7) cm at 6 months after operation. All patients were satisfied with the appearance and were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling.Radial forearm flap was a reliable method for through-and-through buccal reconstruction with high success rate and good functional result.
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Affiliation(s)
- Fei Liu
- Department of Stomatology, the First Affiliated Hospital of zhengzhou University, Zhengzhou
| | - Lei Wang
- Department of Stomatology, School of Stomatology, Xinxiang Medical Collage, Xinxiang
| | - Shuang Pang
- Department of Stomatology, Nanyang Stomatology Hospital, Nanyang
| | - Quancheng Kan
- Department of Gastroenterology, the First Affiliated Hospital of zhengzhou University, Zhengzhou, PR China
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