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Shetty D, Kumar N, Desai AK, Anehosur V. Single perforator-based anterolateral thigh flap, the workhorse flap, in oral cancer reconstruction: A tertiary care institution experience. J Cancer Res Ther 2023; 19:1255-1260. [PMID: 37787292 DOI: 10.4103/jcrt.jcrt_1761_21] [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] [Indexed: 10/04/2023]
Abstract
Background Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction. Materials and Methods All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study. Results Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration. Conclusion We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction.
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Affiliation(s)
- Deepthi Shetty
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Niranjan Kumar
- Department of Plastic and Reconstructive Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Anil Kumar Desai
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Venkatesh Anehosur
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
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Alhindi N, Mortada H, Alsubhi AH, Alhamed L, Aljahdali FH, Aljindan F. Quality of life in post-tongue reconstruction: a comprehensive systematic review and meta-analysis of radial free forearm flap versus anterolateral thigh flap. Eur J Plast Surg 2023. [DOI: 10.1007/s00238-023-02066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Watarai A, Yasunaga Y, Nakao J, Mori H, Araki J, Ishii Y, Yonezawa M, Kakinuma S, Mukaigawa T, Kadomatsu K. Groin and anterolateral thigh flaps for hemiglossectomy reconstruction: A comparison based on Japanese speech intelligibility. Auris Nasus Larynx 2023; 50:110-118. [PMID: 35597697 DOI: 10.1016/j.anl.2022.05.001] [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: 02/16/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The differences in speech function between groin flap reconstruction and anterolateral thigh (ALT) flap reconstruction after hemiglossectomy have not been clarified to date. This study aimed to compare Japanese speech intelligibility after hemiglossectomy reconstruction using groin and ALT flaps of similar thickness. METHODS Data of patients who underwent hemiglossectomy reconstruction with groin or ALT flaps between April 2010 and March 2020 were collected from the medical chart database. The ALT flap was the first choice for hemiglossectomy reconstruction, and a groin flap was used when the ALT flap was >10 mm. Cases in which speech intelligibility assessments based on Hirose's 10-point scoring system, the TKR speech test, and the Japanese speech intelligibility test for 100 monosyllables were performed after 6 months postoperatively were extracted. The per-patient scores for each assessment were initially compared between the two flap groups. Then, the results of the Japanese speech intelligibility test for 100 monosyllables were reanalyzed on a syllable-by-syllable basis. RESULTS Among the 44 hemiglossectomy patients who underwent free-flap reconstruction during the study period, 14 (seven each in the groin flap and ALT flap groups) underwent all three conventional speech intelligibility assessments after 6 months postoperatively. The two groups showed no significant difference in postoperative speech intelligibility in any of the three patient assessment methods. However, in intergroup comparisons based on per-syllable accuracy for each of the 100 monosyllables, the groin flap group showed 19 syllables with a significantly higher accuracy, whereas the ALT flap group showed one such syllable. In particular, five out of the six alveolar consonants (/t/ and /d/) were more accurately articulated in the groin flap group. Per-syllable accuracy was significantly higher in the groin flap group (74.6% vs. 66.7%; 95% confidence interval: 4.6-11.1, p < 0.001). CONCLUSION In patients undergoing hemiglossectomy reconstruction, our new analysis method, which compared intelligibility by syllables, showed that the groin flap yielded higher speech intelligibility than the ALT flap. This difference was evident at all four articulation points involving the tongue, whereas there was no significant difference at the two articulation points without tongue involvement.
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Affiliation(s)
- Aya Watarai
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan; Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yoshichika Yasunaga
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
| | - Junichi Nakao
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hiroaki Mori
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Jun Araki
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yoshitaka Ishii
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Minami Yonezawa
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shota Kakinuma
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Koichi Kadomatsu
- Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan
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Ranganath K, Jalisi SM, Naples JG, Gomez ED. Comparing outcomes of radial forearm free flaps and anterolateral thigh free flaps in oral cavity reconstruction: A systematic review and meta-analysis. Oral Oncol 2022; 135:106214. [DOI: 10.1016/j.oraloncology.2022.106214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
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Nokovitch L, Dupret-Bories A, Bach C, Barry B, Julieron M, Deneuve S. Observational study of the long-term impact of donor-site sequelae after head and neck reconstruction by free anterolateral thigh flap. Eur Ann Otorhinolaryngol Head Neck Dis 2021:S1879-7296(21)00054-5. [PMID: 33714685 DOI: 10.1016/j.anorl.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Free anterolateral thigh flap has many applications in head and neck reconstruction surgery. The aims of the present study were: (1) to assess functional and esthetic sequelae of harvesting for oncologic purposes; and (2) to assess long-term impact of harvesting on quality of life according to patient and to physician. MATERIALS AND METHODS Forty-one patients undergoing reconstruction by free anterolateral thigh flap following oncologic head and neck surgery were assessed by questionnaire at>6 months postoperatively. Donor site sequelae were assessed in consultation. Harvesting impact was assessed on 5-point Likert scales by patient and by surgeon. RESULTS Thirty nine percent of patients showed≥1 sequelae. Donor site sequela impact on sport, daily living and work was assessed by patients as none or mild in 94%, 98% and 100% of cases, respectively. Sixty-one percent of patients and 58.5% of surgeons considered scar esthetics to be discreet or very discreet. CONCLUSION Morbidity related to anterolateral thigh flap harvesting was low, and functional sequelae at the donor site were well tolerated. The scar was only moderately satisfactory, but could easily be hidden.
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Zhou B, Liao J, Zhu C, Yuan K, Liu Z, Lin Z, Huang Z, Chen W, Li J, Wang Y. Full cheek defect reconstruction using ALTF versus RFF: Comparison of quality of life, clinical results, and donor site morbidity. Oral Dis 2020; 26:1157-1164. [PMID: 32289869 DOI: 10.1111/odi.13354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to compare the quality of life (QOL) of patients, clinical results of the recipient site, and morbidities of the donor site between the use of free anterolateral thigh flaps (ALTFs) and radial forearm flaps (RFFs) for reconstruction of full cheek defects following tumor resection. MATERIALS AND METHODS We retrospectively reviewed 52 patients who underwent reconstruction of full cheek defects using free ALTFs and free RFFs following tumor ablation at our center. The range of mouth opening, speech, swallowing, facial appearance, donor site complications, and subjective symptoms based on the University of Washington Quality of Life (UW-QOL) questionnaire findings were assessed in the ALTF and RFF groups at 3, 12, and 36 months after surgery. RESULTS Quality of life, range of mouth opening, facial appearance, mood and anxiety, donor site appearance, subjective feeling, and functional impairment were better in the ALTF group than in the RFF group based on the physical examination findings and questionnaire scores. CONCLUSION This study found better QOL and better functional results at the recipient site and minor morbidities at the donor site with the use of free ALTFs in the reconstruction of full cheek defects.
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Affiliation(s)
- Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Juankun Liao
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Chuandong Zhu
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Kaifang Yuan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Zhixin Liu
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Zhaoyu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- Craniomaxillofacial Surgery Center, Sun Yat-sen University, Guangzhou City, China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- Craniomaxillofacial Surgery Center, Sun Yat-sen University, Guangzhou City, China
| | - Weiliang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- Craniomaxillofacial Surgery Center, Sun Yat-sen University, Guangzhou City, China
| | - Jinsong Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Oral and Maxillofacial-Head and Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Youyuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
- The Oral and Maxillofacial-Head and Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
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Klingelhöffer C, Obst A, Ettl T, Meier J, Müller S, Reichert T, Spanier G. Severe postoperative dysphagia as an early predictor for decreased overall survival in patients with oral cancer. J Craniomaxillofac Surg 2019; 47:1363-1369. [DOI: 10.1016/j.jcms.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/26/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
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Meng L, Shen J, Liu H, Zhang JC, Peng X, Mao C, Cai ZG, Zheng L, Shan XF, Yan YB. Comparison of the subjective satisfaction of the donor site morbidity: Free radial forearm flap versus anterolateral thigh flap for reconstruction in tongue cancer patients. Med Oral Patol Oral Cir Bucal 2019; 24:e236-e242. [PMID: 30818317 PMCID: PMC6441596 DOI: 10.4317/medoral.22679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/28/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of the study was to compare the differences of the subjective satisfaction of the donor site morbidity between the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) for tongue reconstruction. MATERIAL AND METHODS One hundred and nineteen patients underwent FRFF or ALTF reconstruction were retrospectively evaluated by a standardized self-established donor site morbidity questionnaire which included 5 domains, sensibility, movement disabilities, cosmetics, social activities and general impacts on the quality of life. RESULTS The Cronbach's coefficient alpha of the questionnaire was 0.707. The exploratory factor analysis revealed that the 5 items of the questionnaire might load onto two distinct subscales. Patients with ALTF had higher scores in the sensibility, cosmetics and the composite score (P < 0.05). No significant differences were found in the movement disabilities, social activities and general impacts on the quality of life between the two groups (P > 0.05). CONCLUSIONS ALTF has the advantage of better results of donor site morbidity, such as sensibility and cosmetics, over FRFF.
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Affiliation(s)
- L Meng
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China,
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Zhang PP, Meng L, Shen J, Liu H, Zhang J, Xiang X, Yan YB. Free radial forearm flap and anterolateral thigh flap for reconstruction of hemiglossectomy defects: A comparison of quality of life. J Craniomaxillofac Surg 2018; 46:2157-2163. [DOI: 10.1016/j.jcms.2018.10.006] [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] [Received: 06/20/2018] [Revised: 08/21/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
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Kao SST, Peters MDJ, Krishnan SG, Ooi EH. Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: A systematic review. Laryngoscope 2016; 126:1572-80. [DOI: 10.1002/lary.25894] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/16/2015] [Accepted: 01/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Stephen Shih-Teng Kao
- Department of ENT Head and Neck Surgery; Flinders Medical Centre; Bedford Park South Australia Australia
- Joanna Briggs Institute; Faculty of Health Sciences, The University of Adelaide; Adelaide South Australia Australia
| | - Micah D. J. Peters
- Joanna Briggs Institute; Faculty of Health Sciences, The University of Adelaide; Adelaide South Australia Australia
| | - Sabapathy Giri Krishnan
- Joanna Briggs Institute; Faculty of Health Sciences, The University of Adelaide; Adelaide South Australia Australia
- Department of ENT Head and Neck Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Eng Hooi Ooi
- Department of ENT Head and Neck Surgery; Flinders Medical Centre; Bedford Park South Australia Australia
- Department of ENT Head and Neck Surgery; Department of Surgery; Flinders University; Adelaide South Australia Australia
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Ozkan O, Ozkan O, Derin AT, Bektas G, Cinpolat A, Duymaz A, Mardini S, Cigna E, Chen HC. True functional reconstruction of total or subtotal glossectomy defects using a chimeric anterolateral thigh flap with both sensorial and motor innervation. Ann Plast Surg 2015; 74:557-64. [PMID: 25875723 DOI: 10.1097/SAP.0b013e3182a6add7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to report the motor functional outcomes and sensory recovery of patients who had undergone total or subtotal glossectomy for oral squamous cell carcinomas reconstructed with chimeric anterolateral thigh (ALT) flaps. METHODS Six patients, 4 men and 2 women, with a mean age of 49.5 years (range, 36-73 years) were included in the study. All patients were treated with chimeric ALT, including the vastus lateralis muscle with its motor nerve and skin paddle with its innervating nerve. All patients were administered functional tests involving sensory recovery, intelligibility, and swallowing. Flap sensibility was evaluated using light touch sensation with the Semmes-Weinstein monofilament test, 2-point discrimination according to the Weber sensitive test, warm and cold temperature sensations, and pain sensation. Intelligibility was scored by a speech therapist on a scale from 1 to 5. Swallowing was assessed by electromyography, deglutition scores (on a scale of 1 to 8), and modified barium swallow. Donor-site morbidities were recorded. RESULTS Mean follow-up was 26.6 months (6 months-5 years). The flaps were successful in all 6 patients. The donor site was closed primarily and no complications were seen in the follow-up period. Normal extension of the knee joint and no evidence of lateral patella instability occurred. Speech intelligibility was good (4) in 3 patients and acceptable (3) in 3. Deglutition scores were 6 in 2 patients, 5 in 2, and 4 in 2. Modified barium swallow revealed that 4 patients experienced bolus transit, but 2 required a liquid swallow to promote bolus transit. Electromyographic recordings showed innervations of the vastus lateralis muscle with active generation of motor unit potentials in 4 patients when trying to elevate the tongue. This was not performed in 1 patient, and 1 other had macroscopic muscle contractions. All sensory tests were satisfactory in all parameters. CONCLUSIONS The results of this reconstructive option were satisfactory in terms of motor function and sensitive assessment of the neotongue. This technique is strongly recommended for patients with total or subtotal glossectomy.
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Pascal S, Deveze A, Casanova D, Philandrianos C. Treatment of a mastoid defect by free anterolateral thigh flap. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:195-8. [PMID: 26363599 DOI: 10.1016/j.anorl.2015.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Free anterolateral thigh (ALT) flap constitutes an alternative to latissimus dorsi and radial forearm flaps for head and neck reconstruction. The authors report a case of mastoid reconstruction in a patient with multi-operated cholesteatoma associated with tubal dysfunction. CASE REPORT This patient presented a fistula of the lateral semicircular canal and invagination of retroauricular soft tissues responsible for non-compensated almost complete areflexia with anacusis. She did not present any signs of cholesteatoma recurrence, but chronic inflammation of the mastoidectomy cavity. The head and neck procedure consisted of translabyrinthine labyrinthectomy: resection of the atrophic retroauricular skin, resection of the vestibular neurosensory tissue and obliteration of the mastoidectomy cavity. An ALT flap measuring 5×5 cm, anastomosed to the superior thyroid artery and facial vein, was used to cover the defect. Careful defatting of the flap allowed filling of the defect, while providing a sufficient quantity of appropriate tissue. The postoperative course was uneventful and the patient was considerably improved. The only donor site sequelae consisted of a thin linear scar. CONCLUSION The free anterolateral thigh flap, a reliable, polyvalent flap that can be shaped as needed and which is associated with minimal donor site morbidity, constitutes a good alternative for head and neck reconstruction.
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Sofiadellis F, Grinsell D. Refinements and restoring contour in head and neck reconstruction. ANZ J Surg 2015; 86:675-80. [PMID: 25904390 DOI: 10.1111/ans.13061] [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] [Accepted: 02/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date head and neck reconstructions of oncological defects have concentrated on primarily filling the defect to achieve primary wound healing, secondly restore function and lastly cosmesis. This paper describes a refinement of existing free tissue transfer techniques for improvement of contour, function and aesthetics. METHODS A retrospective review of 38 patients operated on by one surgeon at St Vincent's, Royal Melbourne and Western Hospitals over a 3-year period was conducted. Data were collected on patient demographics, tumour details, nature of the defect, type of reconstructive procedure, nature of additional tissue used, radiotherapy, complications and outcome. RESULTS We present refinements in using de-epithelialized skin paddles, flexor hallucis longus, and rectus and vastus lateralis muscle in order to achieve optimal reconstruction. Free tissue transfer refinements are discussed in anterolateral thigh, fibula, rectus and anteromedial thigh free flaps. The average defect size and volume of neck dissection prior to reconstruction is presented. A variation of radical, modified radical and selective neck dissections were required for oncological staging and clearance. Rare and minor associated complications are discussed. Post-operative radiotherapy treatment was used in the majority of patients with preoperative adjuvant therapy required in some salvage cases. All patients achieved primary wound healing post-operatively with no salivary leaks, flap failures or exposure of neck vessels. CONCLUSIONS Supplementary microsurgical tissue transfer of de-epithelialized skin, vastus lateralis, flexor hallucis longus and rectus muscles is a valuable option for restoring contour, aesthetics and vessel protection post-radiotherapy.
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Affiliation(s)
- Foti Sofiadellis
- Department of Plastics and Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Damien Grinsell
- Department of Plastics and Reconstructive Surgery, St Vincent's Hospital, The Western Hospital, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Choi JW, Kim KN, Park EJ, Eom JS, Hong JP, Park HN, Park CS, Kim SY, Nam SY, Choi SH, Roh J, Koh KS. Analysis of Morphological and Histologic Changes in Intraoral Fasciocutaneous Free Flaps Used for Oropharyngeal Reconstruction. Ann Plast Surg 2014; 72:674-9. [DOI: 10.1097/sap.0b013e31826aef6d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Lam L, Samman N. 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] [What about the content of this article? (0)] [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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Abstract
PURPOSE The anterolateral thigh (ALT) flap is widely used in reconstruction. Its advantage over other flaps is its purported minimal donor site morbidity. The present systematic review summarizes the types of complications and their incidence with this flap. A secondary objective is to delineate factors that influence these complications and make recommendations to avoid them. METHOD Two independent assessors undertook a systematic review of the literature using multiple databases. All patients with ALT flap reconstruction for any defect were included. Donor site complications including lateral thigh paresthesia, musculoskeletal dysfunction, hypertrophic scarring, wound breakdown, infection, donor site pain, seroma, hematoma, compartment syndrome and muscle necrosis were extracted from identified articles and tabulated. Based on the number of pooled events and the number of cases performed, an incidence rate was calculated. RESULTS Forty-two relevant articles were identified that included 2324 flaps. Of the 2324 flaps, the majority were fasciocutaneous (n=737), and 1303 of the flaps were used in head and neck reconstruction. The incidence of complications were: lateral thigh paresthesia (24.0%); musculoskeletal dysfunction (4.8%); hypertrophic scarring or wound dehiscence (4.8%); donor site pain (3.3%); seroma (2.4%); infection (2.2%); hematoma (0.7%); compartment syndrome (0.09%); and partial muscle necrosis (0.09%). CONCLUSION Lateral thigh paresthesia is the most common complication. Severe complications such as compartment syndrome and muscle necrosis can occur, but are rare. Preservation of the lateral cutaneous nerve of the thigh, femoral motor nerve branches and deep fascia decreases the risk of complications. The degree of vastus lateralis disruption did not show a significant impact on musculoskeletal dysfunction.
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Affiliation(s)
- Jessica Collins
- Department of Surgery, Division of Plastic and Reconstructive Surgery
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Cha W, Jeong WJ, Ahn SH. Latissimus dorsi muscle free flap revisited: a novel endoscope-assisted approach. Laryngoscope 2013; 123:613-7. [PMID: 23401065 DOI: 10.1002/lary.23757] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/31/2012] [Accepted: 09/05/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Achieving a functionally favorable and aesthetically acceptable outcome in oncologic and reconstructive surgery is important in the current era. Latissimus dorsi (LD) flap is traditionally performed with a large incision in lateral position. We report an endoscope-assisted harvest of LD muscle free flap in supine position to avoid a large scar and facilitate a two-team approach for oral cavity reconstruction. STUDY DESIGN Consecutive case series. METHODS Four consecutive patients underwent LD muscle free flap for various oral cavity reconstructions. LD muscle free flaps were harvested under endoscope assistance. RESULTS Endoscope-assisted LD free-flap harvest allowed a small incision in the axillary pit, which can be easily concealed without change of patient position, resulting in shortened operative time. Endoscopic harvest caused no acute complications, and donor site morbidity was minimal. Reconstructions with endoscope-assisted LD muscle free flap of the oral cavity defect site were successful in all cases. CONCLUSIONS Endoscope-assisted LD muscle free flap is a feasible and practical option for the reconstruction of selective oral cavity defects with aesthetically excellent donor site scar.
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Affiliation(s)
- Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital; and Seoul National University College of Medicine, Seongnam, Korea
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Abstract
Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), di Cagliari – Polo di Monserrato, Cagliari, Italy
| | - Matteo Atzeni
- Department of Surgery – Section of Plastic Surgery, Azienda Ospedaliero Universitaria (AOU), di Cagliari – Polo di Monserrato, Cagliari, Italy
| | - Warren Matthew Rozen
- Jack Brockhov Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alberto Alonso-Burgos
- Department of Radiology, Clinica Universitaria, Universidad de Navarra, Pamplona, Spain
| | - Raffaella Bura
- Department of Surgery – Section of Vascular Surgery, Azienda Ospedaliero Universitaria (AOU), di Cagliari – Polo di Monserrato, Cagliari, Italy
| | - Mario Piga
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), di Cagliari – Polo di Monserrato, Cagliari, Italy
| | - Diego Ribuffo
- Department of Surgery – Section of Plastic Surgery, Azienda Ospedaliero Universitaria (AOU), di Cagliari – Polo di Monserrato, Cagliari, Italy
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Maciejewski A, Krakowczyk Ł, Szymczyk C, Wierzgoń J, Grajek M, Dobrut M, Szumniak R, Jędrzejewski P, Ulczok R, Półtorak S. Salvage surgery of recurrence after laryngectomy--when should the alt free flap be modified? Med Sci Monit 2012; 18:CS31-6. [PMID: 22460099 PMCID: PMC3560816 DOI: 10.12659/msm.882606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Reconstruction of the pharynx and cervical esophagus has significantly progressed in the last 2 decades. A revolution in microvascular surgery has provided numerous choices for primary restoration, or in secondary reconstructions necessary for recurrences or complications of primary surgery. The goals of reconstruction after laryngopharyngoesophagectomy are to provide continuity of the alimentary tract, to protect major blood vessels, to heal the primary wound, and to restore the swallowing and breathing functions with minimal donor site and neck morbidity and deformation. CASE REPORT We present 3 cases with complex defects of the laryngopharynx, cervical esophagus and trachea and anterior neck skin following central neck exenteration safely reconstructed with a single anterolateral thigh flap. No postoperative complications occurred in any of the 3 cases of reconstructions, each using a single anterolateral thigh flap. CONCLUSIONS This approach significantly simplified the reconstruction, with quick recovery, short hospital stay and excellent functional and aesthetic results.
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Affiliation(s)
- Adam Maciejewski
- Department of Oncologic and Reconstructive Surgery, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Gliwice, Poland.
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Bayol JC, Sury F, Petraud A, Laure B, Goga D. Le lambeau libre antérolatéral de cuisse en reconstruction faciale : particularités techniques du prélèvement et résultats à propos de six cas. ANN CHIR PLAST ESTH 2011; 56:504-11. [DOI: 10.1016/j.anplas.2009.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
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Seth R, Manz RM, Dahan IJ, Nuara MJ, Meltzer NE, McLennan G, Alam DS. Comprehensive Analysis of the Anterolateral Thigh Flap Vascular
Anatomy. ACTA ACUST UNITED AC 2011. [DOI: 10.1001/archfaci.2011.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rahul Seth
- Section of Facial Aesthetic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic (Drs Seth, Manz, Nuara, Meltzer, and Alam), Case Western Reserve University School of Medicine (Mr Dahan), and Imaging Institute, Cleveland Clinic (Dr McLennan), Cleveland, Ohio
| | - Ryan M. Manz
- Section of Facial Aesthetic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic (Drs Seth, Manz, Nuara, Meltzer, and Alam), Case Western Reserve University School of Medicine (Mr Dahan), and Imaging Institute, Cleveland Clinic (Dr McLennan), Cleveland, Ohio
| | - Isaac J. Dahan
- Section of Facial Aesthetic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic (Drs Seth, Manz, Nuara, Meltzer, and Alam), Case Western Reserve University School of Medicine (Mr Dahan), and Imaging Institute, Cleveland Clinic (Dr McLennan), Cleveland, Ohio
| | - Michael J. Nuara
- Section of Facial Aesthetic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic (Drs Seth, Manz, Nuara, Meltzer, and Alam), Case Western Reserve University School of Medicine (Mr Dahan), and Imaging Institute, Cleveland Clinic (Dr McLennan), Cleveland, Ohio
| | - Noah E. Meltzer
- Section of Facial Aesthetic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic (Drs Seth, Manz, Nuara, Meltzer, and Alam), Case Western Reserve University School of Medicine (Mr Dahan), and Imaging Institute, Cleveland Clinic (Dr McLennan), Cleveland, Ohio
| | - Gordon McLennan
- Section of Facial Aesthetic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic (Drs Seth, Manz, Nuara, Meltzer, and Alam), Case Western Reserve University School of Medicine (Mr Dahan), and Imaging Institute, Cleveland Clinic (Dr McLennan), Cleveland, Ohio
| | - Daniel S. Alam
- Section of Facial Aesthetic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic (Drs Seth, Manz, Nuara, Meltzer, and Alam), Case Western Reserve University School of Medicine (Mr Dahan), and Imaging Institute, Cleveland Clinic (Dr McLennan), Cleveland, Ohio
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Ensat F, Schubert H, Hladik M, Eder G, Oberascher G, Beck J, Kholosy HM, Wechselberger G. [The anterolateral thigh flap: its versatility in oncological soft tissue reconstruction of the head and neck region]. Chirurg 2011; 82:820, 822-7. [PMID: 21678104 DOI: 10.1007/s00104-011-2081-0] [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] [Indexed: 11/25/2022]
Abstract
The anterolateral thigh flap (ATL) has become a standard procedure in reconstructive microsurgery. In this study the results with the ALT for reconstruction in the head and neck area after tumor resection in 33 patients were retrospectively analyzed. Patients included 28 men and 5 women aged 47-70 years who suffered from intraoral and extraoral tumors. Satisfactory soft tissue coverage could be achieved in all patients and no flaps were lost. The ALT is a versatile free flap enabling reliable soft tissue reconstruction of complex defects in the head and neck region. Flap dissection and preparation of the recipient area can usually be performed simultaneously. Additional advantages include the long and strong caliber vascular pedicle, the low donor site morbidity and the different possibilities of tissue composition, making the ALT a workhorse flap in modern reconstructive microsurgery.
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Affiliation(s)
- F Ensat
- Abteilung für Plastische und Wiederherstellungschirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Lehrkrankenhaus der PMU Salzburg, Österreich.
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Sinna R, Qassemyar Q, Pérignon D, Benhaim T, Robbe M. À propos des lambeaux perforants…20 ans après. ANN CHIR PLAST ESTH 2011; 56:128-33. [DOI: 10.1016/j.anplas.2010.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
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Liu WW, Li H, Guo ZM, Zhang Q, Yang AK, Liu XK, Song M. Reconstruction of soft-tissue defects of the head and neck: radial forearm flap or anterolateral thigh flap? Eur Arch Otorhinolaryngol 2011; 268:1809-12. [PMID: 21387188 DOI: 10.1007/s00405-011-1548-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 02/14/2011] [Indexed: 11/29/2022]
Abstract
This study compared the reliability, practicability and impact to donor site functionality of radial forearm (RF) and anterolateral thigh (ALT) flaps used for the reconstruction of head and neck soft-tissue defects. The clinical data of patients who underwent reconstruction using RF flaps (n = 53) and ALT flaps (n = 21) after tumour ablation were reviewed. Pedicle length, skin area harvested and flap survival rate were compared between the two flap types. A questionnaire was used to compare the patients' perceptions of donor site functionality. Pedicle length did not significantly differ between RF and ALT flaps (7.5 vs. 9 cm, p = 0.733). A significantly larger mean area of skin was harvested in the ALT group than in the RF group (65 vs. 38 cm(2), p = 0.001). Flap survival rates did not differ between the two groups (p = 0.554). Patients in the ALT group were more satisfied with the appearance of the donor sites than were those in the RF group (p = 0.029). Significantly more patients in the RF group complained of donor site numbness than in the ALT group (p = 0.014). No ALT group patients complained of movement impairment or weakness at the donor sites, but 10% of RF group patients experienced impairment (p = 0.014) and 35% felt weakness (p = 0.001). The ALT and RF flaps showed similar practicability and reliability for the reconstruction of soft-tissue defects, but ALT flaps had fewer impacts to donor site functionality than RF flaps.
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Affiliation(s)
- Wei-Wei Liu
- Department of Head and Neck Oncology, SUN Yat-sen University Cancer Centre, 651 East Dong Feng Road, Guangzhou, Guangdong, China.
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J Krochmal D, M Rebecca A, J Casey W, A Smith A. Anterolateral Thigh Flap Salvage Following Failed Deep Inferior Epigastric Artery Perforator Breast Reconstruction. Canadian Journal of Plastic Surgery 2011. [DOI: 10.1177/229255031101900102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The deep inferior epigastric artery perforator flap is an option for women desiring autologous tissue breast reconstruction. If this reconstruction fails, other autologous tissue flaps, including the gluteal artery perforator and latis-simus dorsi flaps, may be used for salvage. The anterolateral thigh (ALT) flap offers adequate tissue volume for breast reconstruction, acceptable fat quality and a long vascular pedicle. Other advantages include obviating the need for intraoperative position changes and harvesting tissue outside of the radiation field. Two cases involving ALT flaps used in the setting of deep inferior epigastric artery perforator failure are presented with favourable results. A review of the anatomy of the ALT flap is included.
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Affiliation(s)
| | - Alanna M Rebecca
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - William J Casey
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anthony A Smith
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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26
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Sagar B, Marres HA, Hartman EH. Hypopharyngeal reconstruction with an anterolateral thigh flap after laryngopharyngeal resection: Results of a retrospective study on 20 patients. J Plast Reconstr Aesthet Surg 2010; 63:970-5. [DOI: 10.1016/j.bjps.2009.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 02/16/2009] [Accepted: 04/16/2009] [Indexed: 11/21/2022]
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Hanasono MM, Skoracki RJ, Yu P. A Prospective Study of Donor-Site Morbidity after Anterolateral Thigh Fasciocutaneous and Myocutaneous Free Flap Harvest in 220 Patients: . Plast Reconstr Surg 2010; 125:209-14. [PMID: 19910852 DOI: 10.1097/prs.0b013e3181c495ed] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Avery CME. Review of the radial free flap: is it still evolving, or is it facing extinction? Part one: soft-tissue radial flap. Br J Oral Maxillofac Surg 2009; 48:245-52. [PMID: 19837491 DOI: 10.1016/j.bjoms.2009.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
The versatile fasciocutaneous radial flap is robust and reliable, straightforward to harvest, and often produces a satisfactory reconstruction with relatively little long-term morbidity at the donor site. Many surgeons prefer to use a limited number of trusted flaps, and these qualities will ensure that in the intermediate future most surgical trainees will continue to be shown the fasciocutaneous radial flap as both the basic training flap and the established option for reconstruction. Evidence from observational clinical studies and one randomised clinical trial indicates that there is increasing support for the use of the evolutionary technique of suprafascial dissection to minimise morbidity at the donor site. The suprafascial donor site may be repaired with either a meshed or unmeshed partial-thickness skin graft, or a fenestrated full-thickness skin graft, with good rates of successful healing. The application of a negative pressure dressing to the wound seems to facilitate the healing of all types of skin graft. The subfascial donor site, however, remains more prone to complications. It may be helpful to position the donor site of the flap more proximally, but this has not been proven. These refinements probably produce the best outcomes that can currently be achieved, given the inherent flaws of the radial donor site.
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Affiliation(s)
- C M E Avery
- University Hospitals of Leicester, Leicester LE1 5WW, UK.
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Ribuffo D, Atzeni M, Saba L, Milia A, Guerra M, Mallarini G. Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting. Ann Plast Surg 2009; 62:368-71. [PMID: 19325338 DOI: 10.1097/SAP.0b013e31817fe4c5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The vascular anatomy of the anterolateral thigh flap (ALTF) has many possible variations, and none of the currently used mapping techniques (eg, Echo Color Doppler) gives a thorough knowledge of all details. Among the last generation of angiographic diagnostic techniques, multi detector computed tomography, popularly known as Angio CT, has emerged as an outstanding noninvasive operator independent option, and has been described for deep inferior epigastric perforator and pedicled transverse rectus abdominis muscle planning. This study was conducted to evaluate its usefulness prior to ALTF harvesting.Nine consecutive patients were considered for oral or lower extremity reconstruction with the ALTF. After written informed consent was obtained from all patients, a preoperative Angio-CT study was performed for surgical planning. Accurate identification of septocutaneous or musculocutaneous perforator vessels was achieved and their location, course, and anatomic variations were reported and influenced surgery. Angio CT allows a complete vascular study of the donor area of the ALTF and evaluation of the best perforator vessels before surgery allows surgeons to get an ideal planning of the flap. This imaging method is currently proposed to every patient undergoing ALT flap reconstruction.
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Livaoğlu M, Karacal N, Bektaş D, Bahadir O. Reconstruction of full-thickness nasal defect by free anterolateral thigh flap. Acta Otolaryngol 2009; 129:541-4. [PMID: 18607893 DOI: 10.1080/00016480802258810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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
CONCLUSION Because of minimal donor region morbidity, pliability, the presence of long and large caliber vessels, and lack of visible scar, the free anterolateral thigh flap provides an ideal option for restoration of full-thickness nasal defects. OBJECTIVE Full-thickness nasal defect reconstruction requires internal nasal lining and external cover. In large defects, internal nasal lining replacement with traditional sources may not be expedient. We describe reconstruction of full-thickness nasal defects with free anterolateral thigh flap. PATIENTS AND METHODS From August 2005 to July 2007, six patients with full-thickness nasal defects underwent nasal reconstruction using free anterolateral thigh flap. All defects resulted from tumor resections. Four patients had a basal cell carcinoma, one an epidermoid carcinoma, and the other patient had recurrent malignant fibrous histiocytoma. RESULTS All flaps survived completely. The average hospitalization time was 3 days. No complication was observed.
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Tamimy MS, Rashid M, Islam MZ, Sarwar SUR, Aman S, Aslam A. A comparison of free transfer of radial forearm and anterolateral thigh flaps for head and neck reconstruction. Eur J Plast Surg 2009. [DOI: 10.1007/s00238-008-0317-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Suzuki H, Matsuura K, Hiraki N, Kadokawa Y, Hashida K, Udaka T, Nagatani G. Digastric muscle sew-up procedure for the repair of the floor of the mouth following pull-through operation for oral cancers. Ann Otol Rhinol Laryngol 2008; 117:745-8. [PMID: 18998502 DOI: 10.1177/000348940811701007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We report the digastric muscle sew-up procedure for the repair of the floor of the mouth following the pull-through operation for advanced oral cancers. METHODS Eleven patients with advanced oral cancers (of the tongue in 8 cases and of the floor of the mouth in 3 cases) were retrospectively analyzed. One-third glossectomy and hemiglossectomy were performed in 4 patients each; the other 3 patients underwent tumor resection on the floor of the mouth. After neck dissection and tumor resection via the pull-through approach, the floor of the mouth was repaired simply by sewing the digastric muscle to the mandibular base. The surfaces of the transected musculature of the tongue and the floor of the mouth were left uncovered and exposed to the oral cavity. RESULTS The postoperative wound healing was fairly good in all of the patients. Neck infection or the formation of a fistula on the floor of the mouth was not seen. The patients started transoral ingestion by the 10th postoperative day. Temporary difficulty in swallowing occurred in all patients, but was totally alleviated within 1 month. Their clarity of speech recovered to a tolerable level. CONCLUSIONS We believe that the digastric muscle sew-up procedure is a simple, safe, and timesaving method for the repair of small to medium-sized defects of the floor of the mouth created by ablative surgery in patients with advanced oral cancers.
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Affiliation(s)
- Hideaki Suzuki
- Dept of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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Fülöp M, Boér A, Remenár E, Lengyel C, Kásler M. [Applicable methods of reconstruction for the replacement of soft tissue after the radical resection of oral tumors]. Magy Onkol 2008; 52:261-7. [PMID: 18845496 DOI: 10.1556/monkol.52.2008.3.3] [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] [Indexed: 11/19/2022]
Abstract
In Hungary the number of oral and pharyngeal cancers is alarmingly high. While the mortality rate in 1955 was 282, by 2005 it rose to 1567. However, in the last 1-2 years stagnation can be observed. Nevertheless, even now significant proportions of men and women are involved. Alcohol consumption and smoking are invariably the leading causes, but one cannot disregard the shortcomings of oral cancer screenings, either. Unfortunately, drastic changes in this field are not likely to occur in the near future. Numerous solutions have been developed for the replacement of soft tissue. In our article, we describe and evaluate four of them. When using these techniques, we were often successful in replacing soft tissue deficiencies.
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Affiliation(s)
- Miklós Fülöp
- Országos Onkológiai Intézet Fej-nyak-, Allcsont- és Rekonstrukciós Sebészeti Osztály, Budapest.
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Valentini V, Cassoni A, Marianetti TM, Battisti A, Terenzi V, Iannetti G. Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects: Alternative or Replacement of the Radial Forearm Flap? J Craniofac Surg 2008; 19:1148-53. [DOI: 10.1097/scs.0b013e3181764ad6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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