The Microvascular Anastomotic System (3M coupler) uses a friction-fit union of implant rings composed of high-density polyethylene and stainless-steel pins. Several reports have described equal or greater patency rates, as well as more rapid performance, using the device, compared to conventional suturing techniques. Eighty-nine patients, who underwent head and neck surgery with free-tissue transfers, using the Microvascular Anastomotic System, were evaluated. A hundred and twenty-one venous anastomoses were done using the device. All but one was done in an end-to-end manner Arteries were anastomosed with a conventional suture technique. The flap survival rate was 100 percent. The authors conclude that the device is reliable and time-sparing for end-to-end venous anastomoses in head and neck reconstruction.
Restoration of oral and nasal function together with facial appearance is still challenging in maxillary reconstruction. Use of a composite flap transfer merely to fill the defect results in unsatisfactory functional and aesthetic outcomes. The authors present a reconstructive procedure for complex maxillary defects using the latissimus dorsi-scapular rib osteomusculocutaneous flap. Some modifications for the reconstruction of the nasal cavity and the hard palate contributed to excellent postoperative functions. Five cases of extended maxillary defect were reconstructed using a novel procedure between February of 1997 and October of 2000. The hard palate was reconstructed with a vascularized scapular angle. The infraorbital rim was reconstructed with a vascularized rib if it was required. A prop bone graft, replacing the zygomatic buttress, was added between the infraorbital rim and the hard palate. The latissimus dorsi muscle flap, which was supported by a skeletal framework and obliterated the remaining cavities around the bone grafts, was left exposed into the nasal cavity, and an 8-French (no. 10) nasal airway tube was placed as a stent in the nasal meatus for 3 weeks after surgery. A skin graft was applied on the scapular angle to reconstruct the oral side of the hard palate. If required, facial skin defect was repaired with a latissimus dorsi musculocutaneous flap or scapular flap. No major complications at the recipient or the donor sites occurred postoperatively in any of the five cases. In cases in which the eyeballs were preserved, almost normal facial appearance was obtained and an orbital extirpation case showed an acceptable postoperative appearance. All five patients returned to an unrestricted diet and their speech was assessed as normal by a speech test. Nasal breathing through the re-epithelialized meatus was possible in all cases. The reconstructed nasal cavity was maintained for more than 6 months in all cases and for more than 2 years in one early case. Rhinometry demonstrated normal function, and histologic findings of the re-epithelialized mucosa over the muscle flap in the nasal cavity revealed a nearly normal architecture. This technique simplifies the reconstructive procedure of massive maxillary defects, including those in the lateral wall of the nasal cavity. It also improves the postoperative oral and nasal functions of the patients.
We present a simple procedure for monitoring a free jejunal flap. Peristalsis is assessed by echography every 4 h during the first 3 postoperative days and once a day during the following 4 days. When peristalsis is not seen, it is stimulated by pushing on the skin and is again observed. This method has been used in five patients, and peristalsis was detected in all five. This method is simple, inexpensive, and noninvasive; thus it is a very effective technique for free jejunal flap monitoring
Surgery in the head and neck often results in large and complex tissue defects. The free rectus abdominis musculocutaneous flap has many advantages for reconstruction of these defects. A good volume of tissue can be harvested with a long and large-diameter vascular pedicle. A reliable blood supply enables thinning, shaping and molding of the flap, and it can be elevated with the patient in the supine position. The harvesting technique is easy with good visualization. The authors prefer this free flap for reconstructing relatively large defects in the head and neck, and have had experience with 55 cases, which were analyzed for results and complications.
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