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Knackstedt R, Grobmyer S, Djohan R. Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy. Breast J 2019; 25:1187-1191. [DOI: 10.1111/tbj.13420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Risal Djohan
- Department of Plastic Surgery Cleveland Clinic Cleveland Ohio
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Anatomic Targets for Breast Reconstruction Neurotization: Past Results and Future Possibilities. Ann Plast Surg 2019; 82:207-212. [PMID: 30628934 DOI: 10.1097/sap.0000000000001733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of providing neurotized autologous breast reconstruction is not novel, but the introduction of cadaveric nerve grafts has allowed for the development of new techniques and a resurgence in academic interest. There has been a surge in the number of publications regarding neurotized autologous breast reconstruction. However, recent articles and reviews have focused mainly on autologous, abdominal-based reconstruction. The sensory innervation of the most commonly used autologous tissues has been well described, allowing surgeons to perform accurate and reproducible dissections. However, there are numerous options for autologous breast reconstruction, and not all patients are candidates for abdominally based reconstruction. As more patients inquire to their possible reconstruction options, plastic surgeons will have to be well versed in the different neurotized options and appreciate the technical aspects associated with reconstructive success. In this review, we aim to discuss both established anatomic targets for autologous flap neurotization and future directions.
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Song D, Li Z, Zhou X, Zhang Y, Xie S, Peng X, Zhou B, Lü C, Yang L, Peng W. [Clinical application of free thoracoacromial artery perforator flap in reconstruction of tongue and mouth floor defects after resection of tongue carcinoma]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:222-226. [PMID: 29786257 DOI: 10.7507/1002-1892.201609090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the clinical outcome of free thoracoacromial artery perforator (TAAP) flap in the reconstruction of tongue and mouth floor defects after radical resection of tongue carcinoma. Methods Between May 2010 and February 2015, 11 cases of tongue carcinoma underwent radical resection and reconstruction of tongue and mouth floor defects with free TAAP flaps. The locations of tongue carcinoma were the lingual margin in 7 cases, the ventral tongue in 2 cases, and the mouth floor in 2 cases. According to Union for International Cancer Control (UICC) TNM stage, 3 cases were classified as T 4N 0M 0, 3 cases as T 4N lM 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, and 1 case as T 3N 0M 0. The disease duration ranged from 3 to 28 months, 10.6 months on average. The tumor size ranged from 6.0 cm×3 cm to 10 cm×5 cm. The TAAP flap ranged from 7.0 cm×4.0 cm to 11.0 cm×5.5 cm in size, and 0.6-1.2 cm (0.8 cm on average) in thickness, with a pedicle length of 6.8-9.9 cm (7.2 cm on average). Results All 11 flaps survived, the donor site was closed directly and healed primarily in all cases. The patients were followed up 12-24 months (17.2 months on average). The reconstructed tongue had satisfactory appearance and good functions of swallowing and language. No local recurrence was observed during follow-up. Only linear scar was left at the donor site, and the function of pectoralis major muscle was normal. Conclusion The TAAP flap is an ideal choice in the reconstruction of tongue defect after resection of tongue carcinoma, which has good texture, appearance, and function results.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008,
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, 200011, P.R.China
| | - Songlin Xie
- Department of Hand and Foot Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang Hunan, 421000, P.R.China
| | - Xiaowei Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Lichang Yang
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Wen Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
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Baas M, Duraku LS, Corten EML, Mureau MAM. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits? J Plast Reconstr Aesthet Surg 2015; 68:1025-35. [PMID: 26044088 DOI: 10.1016/j.bjps.2015.04.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tongue reconstruction after (hemi)glossectomy including sensory recovery is challenging. Although sensory recovery could improve functional outcome, no consensus on the need for reinnervation of the neo-tongue exists. Therefore, a systematic review was performed to determine if sensory reinnervation of free flaps in tongue reconstruction is better than no sensory reinnervation. The secondary study aim was to assess the effect of sensory reinnervation on overall functional outcome, such as speech and deglutition. METHODS Seven databases (Embase, Medline, Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar) were searched. Studies that reported the effect of sensory reinnervation on overall functional outcome were identified. RESULTS Fourteen articles were included in the systematic review, concerning a total of 271 tongue reconstructions. Free flaps that were used were the radial forearm (RF) flap (n = 137), the anterolateral thigh (ALT) flap (n = 65), the rectus abdominis (RA) flap (n = 20), and the tensor fascia latae (TFL) flap (n = 5). Seven out of seven articles directly comparing sensory reinnervation with no sensory reinnervation revealed superior sensibility in the reinnervated group. Moreover, the innervated RF and ALT flaps showed superior recovery of sensibility compared to other flaps used for the reconstruction of hemiglossectomy as well as total glossectomy defects. There are indications that sensory reinnervation may have a beneficial effect on overall tongue function. Age, smoking, and sex did not affect sensory recovery. Four out of five articles showed that postoperative radiotherapy does not have a long-term adverse effect on sensory recovery. CONCLUSIONS Sensory reinnervation of free flaps in the reconstruction of (hemi)glossectomy defects improves sensory recovery; however, evidence for beneficial effects on function is poor.
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Affiliation(s)
- Martijn Baas
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Liron S Duraku
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eveline M L Corten
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Speech and swallowing following tongue cancer surgery and free flap reconstruction – A systematic review. Oral Oncol 2013; 49:507-24. [DOI: 10.1016/j.oraloncology.2013.03.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 02/04/2013] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
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Woo SH, Jeong HS, Kim JP, Park JJ, Ryu J, Baek CH. Buccinator Myomucosal Flap for Reconstruction of Glossectomy Defects. Otolaryngol Head Neck Surg 2013; 149:226-31. [DOI: 10.1177/0194599813487492] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The use of the myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. We report the clinical advantages and pitfalls of using the buccinator myomucosal flap for tongue reconstruction after intraoral resection of tongue cancer. Study Design Prospective study. Setting University hospital. Subjects and Methods We used buccal artery–based buccinator myomucosal flaps for tongue reconstruction in 11 partial or total edentulous patients who underwent resection of tongue cancer. The size and site of the tongue defect ranged from one-third to one-half of the tongue in the lateral border. We analyzed the clinical features and oncologic and functional outcomes to define adequate indications. Results All flaps were successfully harvested and transposed, and the donor sites were primarily closed. The pedicles were safely divided 2 to 3 weeks postoperatively. In 8 of 11 patients, concurrent upper neck dissection was performed without compromising blood supply to the flap. The range of tongue motion and the volume of the reconstructed tongue were satisfactory, and the patients experienced no difficulties in swallowing or speech. Conclusion Particularly in edentulous patients, the buccal myomucosal flap can be a good option for reconstructing partial tongue defects after cancer surgery.
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Affiliation(s)
- Seung Hoon Woo
- Department of Otorhinolaryngology–Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Pyeong Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
| | - Jung Je Park
- Department of Otorhinolaryngology–Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
| | - Junsun Ryu
- Head and Neck Oncology Clinic, National Cancer Center, Ilsan, South Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Zetrenne E, Wirth GA, Evans GRD, Gelman J, Phipps GJ, Stamos MJ, Kobayashi MR. Reconstruction of traumatic transposition of the penis and scrotum and associated complex open abdominoperineal pelvic deformity with free innervated tensor fascia latae osteomyocutaneous flap. Ann Plast Surg 2005; 54:657-61. [PMID: 15900155 DOI: 10.1097/01.sap.0000162508.13430.97] [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: 11/26/2022]
Abstract
Guidelines for the repair of full-thickness defects of the lower abdominal wall have been established. However, lower abdominal defects associated with traumatic bladder herniation and pubic symphyseal diastasis or bony loss have not been addressed. Poor abdominal wall contour, protuberance, and recurrent hernias are likely when there is discontinuity of the midline pelvis in association with full-thickness lower abdominal defects and visceral herniation. We devised an operation that would not only restore bony continuity by providing a vascularized bone flap but also simultaneously maintain the integrity of the attachment of the tensor fascia latae muscle to the iliac crest and reestablish musculofascial continuity.
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Affiliation(s)
- Eleonore Zetrenne
- Aesthetic and Plastic Surgery, Institute, University of California, Irvine, Orange 92868, USA
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Zhao Z, Zhang Z, Li Y, Li S, Xiao S, Fan X, Li Y, Liu P, He M, Deng C. The buccinator musculomucosal island flap for partial tongue reconstruction. J Am Coll Surg 2003; 196:753-60. [PMID: 12742209 DOI: 10.1016/s1072-7515(03)00100-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ideal tongue reconstruction after partial or total glossectomy should be accomplished with like tissue. The buccinator musculomucosal island flap is similar to lingual tissue, consisting of thin, pliable mucosa of mucus production, with high cell renewal rate and minimal scar formation, excellent color, contour, texture match, and buccinator muscle fibers over the flap's entire length, providing tongual muscle reconstruction without a conspicuous donor site. STUDY DESIGN The buccinator musculomucosal island flap, based on the facial artery and vein, is designed in a shuttle or in a fish-mouth fashion, encompassing the oral commissure anteriorly. If the flap design is made in a three-leaf shape, a larger flap will be obtained without an oral corner deformity or mouth opening difficulty. The flap is safe and simple to raise. The pedicle of the flap is longer and quite reliable and has a wide range of applicability. The flap may be used for reconstruction of the partial glossectomy defect (tongual defect was not more than half a tongue). The surgeon must know about possible anatomic variations, especially in the venous system, and plan to raise a contralateral buccinator musculomucosal island flap if homolateral facial vascular variation jeopardizes the flap's survival. RESULTS The flap was successfully used for partial tongue reconstruction in 16 patients, and all flaps have survived without complications. Satisfactory results (including configuration and function of the neotongue) were achieved. Electromyographic studies performed on one patient with half glossectomy revealed reinnervation of the muscle in the flap with active motion of the reconstructed tongue. CONCLUSION The buccal musculomucosal island flap based on the facial artery and vein is a better reconstruction option with the same or similar kind of tissue as the tongue and, with the addition of the reinnervated flap, offers the potential for improved physiologic motion.
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Affiliation(s)
- Zhenmin Zhao
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Chinese Peking Union Medical College, Beijing, China
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Abstract
Carcinoma of the tongue is a common condition treated by oral and maxillofacial surgeons. The tongue is a complex anatomical site at the entrance of the oropharynx, bounded by the floor of mouth and lingual mandibular cortex; its form and mobility are crucial for efficient swallowing; speech, and the appreciation of taste. Single and multiple treatments have been used, but the tongue remains a difficult area to assess and treat. In this paper, we have attempted to review some of the papers published over the last 20 years with particular reference to prognosis and functional outcome. We have dealt exclusively with squamous cell carcinoma of the tongue and its management by surgery, radiotherapy, brachytherapy, photodynamic therapy, and chemotherapy.
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Affiliation(s)
- S Prince
- Department of Oral and Maxillofacial Surgery, Queen Mary's University Hospital, Roehampton, London, UK
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Ikeda K, Yokoyama M, Okada K, Tomita K, Nagayama I. Oral reconstruction using the peroneal flap. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:595-9. [PMID: 9613401 DOI: 10.1016/s0007-1226(97)90504-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eight cases of oral reconstruction using the peroneal flap are reported. Six are for tongue and two are for oral wall. All flaps survived completely. The peroneal flap has many merits: the flap is thin and wide, the peroneal vessels have a large diameter lumen and long pedicle, the donor site has few sequela, and simultaneous surgery is possible. In addition, the characteristics of the flap skin change gradually to that of mucous membrane, and hairs disappear in a year or two. We believe that for reconstruction of the oral cavity the peroneal flap is a better source than any other flap.
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Affiliation(s)
- K Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Japan
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Katou F, Shirai N, Kamakura S, Ohki H, Motegi K, Andoh N, Date F, Nagura H. Intraoral reconstruction with innervated forearm flap: a comparison of sensibility and reinnervation in innervated versus noninnervated forearm flap. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 80:638-44. [PMID: 8680967 DOI: 10.1016/s1079-2104(05)80243-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the cutaneous sensibility and sensory reinnervation in patients who underwent intraoral reconstruction with an innervated or noninnervated forearm flap. STUDY DESIGN Results of the use of innervated forearm flaps in oral reconstruction was compared with the use of noninnervated flaps. The evaluation of sensibility and reinnervation comprised clinical sensibility tests and immunohistochemical investigation of postoperative biopsy specimens against S-100 and neurofilament. RESULTS The innervated flaps (4 patients) provided earlier and qualitatively better recovery of sensation than the noninnervated flaps (9 patients). Immunohistochemical investigation revealed the existence of a larger number of regularly arranged sensory nerve fibers in the cutaneous tissue of the innervated flaps than in the noninnervated flaps. Examination with an electron microscope found the structure of these nerve fibers to be well preserved in the innervated flaps, whereas nerve fibers in the noninnervated flaps were degenerative. CONCLUSION These findings suggest (1) that the innervated flaps are superior to the noninnervated flaps not only for the repair of defects but also for the restoration of function and (2) that the innervated flaps contribute to the improvement of the quality of life for patients.
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Affiliation(s)
- F Katou
- Department of Oral and Maxillofacial Surgery 1, School of Dentistry, Tohoku University, Sendai, Japan
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