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Escobar-Domingo MJ, Bustos VP, Akintayo R, Mahmoud AA, Fanning JE, Foppiani JA, Miller AS, Cauley RP, Lin SJ, Lee BT. The versatility of the scapular free flap: A workhorse flap? A systematic review and meta-analysis. Microsurgery 2024; 44:e31203. [PMID: 38887104 DOI: 10.1002/micr.31203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/03/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction. METHODS A comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection. RESULTS A total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%-4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2. CONCLUSION The SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions-both for vascularized bone and cutaneous skin-augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.
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Affiliation(s)
- Maria J Escobar-Domingo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Miami, Florida, United States
| | - Rachel Akintayo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir-Ala Mahmoud
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James E Fanning
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose A Foppiani
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amitai S Miller
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ferri A, Perlangeli G, Zito F, Ferrari S, Bianchi B, Arcuri F, Poli T. Technical refinements of the scapular tip-free flap for mandibular reconstruction. Microsurgery 2024; 44:e31176. [PMID: 38553855 DOI: 10.1002/micr.31176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The use of scapular tip chimeric free flaps (STFFs) for reconstructing mandibular defects has recently become popular, but its utility relative to other bone-containing free flaps remains debatable. The aim of the report is to describe how technical modification of STFF impacted in its use for mandibular reconstruction also commenting results obtained in a unicentric series of patients. PATIENTS AND METHODS Patients undergoing mandibular reconstruction using an STFF from January 1, 2014 to June 1, 2022 were retrospectively enrolled in this report. We collected data on chimeric flap type, bone management, vascular pedicles, and the final outcomes. In total, 31 patients (13 men and 18 women) with a mean age of 68 years were enrolled. According to the classification system of Urken, 15 patients had body defects, while 7 had ramus defects, another 7 had symphysis defects, and 2 had both ramus and bodily defects. STFF was always harvested working in two equips simultaneously, in supine position. Dissection included preparation of chimeric components of the flap as latissimus dorsi, serratus and scapular tip. After pedicle dissection scapular bone was cut basing on reconstructive needing with a rectangular (stick) shape including the border of the scapula. In cases of longer bone harvesting, circumflex pedicle was also included to perfuse the upper portion of the scapular border. In five cases, the STFF was harvested with only the scapular angle component, and was thus a composite osteomuscular flap; for the remaining 26 cases, a chimeric STFF was used. Circumflex pedicle was included for eight patients. Six of the seven patients with symphyseal defects underwent a single osteotomy. RESULTS The average length of the harvested was 69.92 mm (maximum length = 104 mm). The average height of transplanted bone was 26.78 mm (maximum height = 44.2 mm). Mouth-opening was normal in 25 patients, limited in 6 patients, and severely impaired in no patients. The cosmetic results were rated as excellent by 20 patients, good by 8 patients, and poor by 3 patients. CONCLUSION The STFF is an excellent option for mandibular reconstruction when other flaps are not available and for patients in poor general condition. Technical innovations here presented made possible to harvest long bone segments with accurate shape thanks to osteotomies if needed and with adequate soft tissues components of the chimeric flap, ensuring satisfactory functional and cosmetic results.
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Affiliation(s)
- Andrea Ferri
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Giuseppe Perlangeli
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Francesca Zito
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Silvano Ferrari
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Bernardo Bianchi
- Operative Unite of Maxillo-Facial Surgery, Hospital of Genova, Genoa, Italy
| | - Francesco Arcuri
- Operative Unite of Maxillo-Facial Surgery, Hospital of Genova, Genoa, Italy
| | - Tito Poli
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
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Mattavelli D, Verzeletti V, Deganello A, Fiorentino A, Gualtieri T, Ferrari M, Taboni S, Anfuso W, Ravanelli M, Rampinelli V, Grammatica A, Buffoli B, Maroldi R, Elisabetta C, Rezzani R, Nicolai P, Piazza C. Computer-aided designed 3D-printed polymeric scaffolds for personalized reconstruction of maxillary and mandibular defects: a proof-of-concept study. Eur Arch Otorhinolaryngol 2024; 281:1493-1503. [PMID: 38170208 PMCID: PMC10857968 DOI: 10.1007/s00405-023-08392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To investigate the potential reconstruction of complex maxillofacial defects using computer-aided design 3D-printed polymeric scaffolds by defining the production process, simulating the surgical procedure, and explore the feasibility and reproducibility of the whole algorithm. METHODS This a preclinical study to investigate feasibility, reproducibility and efficacy of the reconstruction algorithm proposed. It encompassed 3 phases: (1) scaffold production (CAD and 3D-printing in polylactic acid); (2) surgical simulation on cadaver heads (navigation-guided osteotomies and scaffold fixation); (3) assessment of reconstruction (bone and occlusal morphological conformance, symmetry, and mechanical stress tests). RESULTS Six cadaver heads were dissected. Six types of defects (3 mandibular and 3 maxillary) with different degree of complexity were tested. In all case the reconstruction algorithm could be successfully completed. Bone morphological conformance was optimal while the occlusal one was slightly higher. Mechanical stress tests were good (mean value, 318.6 and 286.4 N for maxillary and mandibular defects, respectively). CONCLUSIONS Our reconstructive algorithm was feasible and reproducible in a preclinical setting. Functional and aesthetic outcomes were satisfactory independently of the complexity of the defect.
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Affiliation(s)
- Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
| | - Vincenzo Verzeletti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
| | - Alberto Deganello
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), Milan, Italy
| | - Antonio Fiorentino
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Department of Otorhinolaryngology, Head and Neck Surgery, "Nuovo Santo Stefano" Civil Hospital, Prato, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada
| | - Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
- Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - William Anfuso
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), Milan, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, School of Medicine, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Ceretti Elisabetta
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, School of Medicine, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Giannini L, Alliata A, Cristofaro V, Incandela F, Pompilio M, Ottini A, Cavalieri S, Nuzzolese I, Iacovelli NA, Franceschini M, Deganello A. Radiation-Induced Oropharyngeal Squamous Cell Carcinoma: Case Report and Review of the Literature. Curr Oncol 2023; 30:6708-6719. [PMID: 37504352 PMCID: PMC10378216 DOI: 10.3390/curroncol30070492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Radiation therapy (RT) is a mainstay for the treatment of head and neck (HN) cancers, with 80% of patients receiving such treatment. Radiation-induced malignancies represent a life-threatening long-term effect of RT, with an incidence of 0.5% to 15%. CASE DESCRIPTION After 13 years, a 33-year-old woman treated with chemo-radiotherapy for nasopharyngeal carcinoma developed a locally advanced, radiation-induced, p16-negative oropharyngeal squamous cell carcinoma (SCC) at the base of the tongue. Chemo/immunotherapy was administered as a first-line treatment. Given the optimal response and the feasibility of surgery, after three cycles, the patient underwent a total glossectomy, bilateral neck dissection, and reconstruction with a thoraco-dorsal free flap. A histological examination found SCC with a residual cancer burden of 70% and free margins. DISCUSSION The mechanisms responsible for carcinogenesis after RT are still not completely clear. Diagnosis may be challenging due to the previous treatment; growth patterns are unusual, and lymphotropism is lower. Prognosis is usually poor since surgical resectability is often not achievable. CONCLUSIONS Radiation-induced malignancies are difficult to treat. Patient management should always be discussed at a multidisciplinary level. Future research is needed to assess whether the promising results of clinical studies with pre-operative immunotherapy in locally advanced HN SCC patients may be translated into radiation-induced cancers.
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Affiliation(s)
- Lorenzo Giannini
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Andrea Alliata
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Valentina Cristofaro
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Madia Pompilio
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Arianna Ottini
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Imperia Nuzzolese
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | | | - Marzia Franceschini
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Alberto Deganello
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Deganello A, Bosio P, Giannini L, Parolini F, Berretti G, Sordi A, Rampinelli V, Gualtieri T. Matrix for Mucosal Regeneration in Transoral Glossectomy for Squamous Cell Carcinoma: Objective and Subjective Functional Evaluation. Curr Oncol 2023; 30:1354-1362. [PMID: 36826065 PMCID: PMC9954828 DOI: 10.3390/curroncol30020104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Numerous options to manage local reconstruction following transoral partial glossectomy are possible. In this work, we present our experience using a matrix for mucosal regeneration, Integra®, after transoral resections of squamous cell carcinoma of the oral tongue. METHODS A retrospective analysis of patients treated for tongue carcinoma and reconstruction with Integra®, from September 2017 to September 2022. Functional outcomes were evaluated by measuring swallowing and speech abilities, tongue motility, and subjective quality of life. RESULTS The series accounts for 13 consecutive patients, staged from Tis to T3, no positive resection margins were found, average defect size was 17.8 cm2. The average histologically measured depth of invasion was 4.1 mm (range 2-12 mm), and no recurrences were observed during follow-up. All patients maintained excellent swallowing function, the average number of recognized words by an external listener during a phone call was 70.5 out of 75, the lingual motility test was good (a mean score of 4.5 out of 6 movements correctly executed) and subjective questionnaires results were optimal. Less satisfying functional results were recorded in elderly patients receiving a wider surgical resection. CONCLUSIONS This reconstructive technique for allows obtaining optimal healing and functional outcomes in patients with tumors suitable for transoral glossectomy.
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Affiliation(s)
- Alberto Deganello
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), 20133 Milan, Italy
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
- Correspondence: ; Tel.: +39-0223902793
| | - Paolo Bosio
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Lorenzo Giannini
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), 20133 Milan, Italy
| | - Federico Parolini
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giulia Berretti
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandra Sordi
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Vittorio Rampinelli
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Tommaso Gualtieri
- Otolaryngology Head and Neck Surgery Department, Spedali Civili di Brescia, 25123 Brescia, Italy
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