Free flaps have become the main alternative for intraoral reconstruction in current practice. However, controversy exists on pros and cons of different free flap options for this challenging area. Although there are various studies focusing on different free flap options, comparative studies are very few and there is not a single study comparing all 4 thin free flap options for intraoral reconstruction. Between 2018 and 2021, 30 patients underwent intraoral reconstruction. Four pliable and thin flaps, medial sural artery perforator flap, superficial circumflex iliac artery perforator flap, radial forearm free flap, and superthin anterolateral thigh flap were used for reconstructions and compared per functionality and patients’ quality of life. One medial sural artery perforator flap and 1 superficial circumflex iliac artery perforator flap failed because of perfusion problems, and the remaining flaps survived. Harvest time and donor site closure were with significant difference (P<0.05) between groups. Quality of life results were similar except one of the disease-specific questions. In authors’ opinion, anterolateral thigh flap is the best option in normal-weight individuals because of its reliability, pliability, and constant reliable vascular structure. Although other options may be considered in overweighted patients, thinly elevated anterolateral thigh flap still seems to be the most reliable option.
Background/Aim: The power of free flaps for lower extremity injury reconstruction is no longer a matter of debate; however, contrasting views remain regarding the timing of reconstruction. The mainstay article of Godina reported that reconstruction within the first three days after injury was more advantageous than surgery at later times, but different views about the best day for reconstruction have also been described in the literature. With developments in the field of microsurgery, plastic surgeons have become more experienced, shortened the times needed for surgery, and achieved flap success. We have also become more experienced with surgical times, and reconstruction on the day of injury has been performed as an emergency reconstruction (ER) procedure since 2018. However, despite the disadvantages of a delayed wait period, patients still experience delayed reconstruction (DR) due to their pre-operative conditions and dispatches from peripheral centers over delayed time periods. This study aimed to present our experiences with lower extremity reconstruction in emergency situations and after delayed periods with descriptions of technical tips for each situation. Methods: Between 2018 and 2021, patients who underwent lower extremity reconstructions were examined as retrospective case-control study. Twenty-four patients (17 male and seven female) underwent lower extremity reconstructions with microsurgical free flap coverage. Patients’ ages ranged from 6 to 75 years old. Ten patients underwent ERs (on the day of injury), and 14 patients underwent DRs. Twenty anterolateral thigh, two medial sural artery perforator, one latissimus dorsi, and one radial forearm flaps were chosen for reconstructions. Flaps were chosen for one-third of the distal lower extremity reconstructions (n=11) and Gustilo type 3B injuries (n=11), Gustilo type 3C injuries (n=1), and one-third for middle lower extremity soft tissue reconstructions (n=1). Infections, length of hospital stays, time spent during the reconstructive surgery, vascular complications, and additional debridement necessity counts were recorded and compared with previous statistical analyses. Results: One venous thrombosis in the emergency group and three venous and one arterial thrombosis in the delayed group were reported. The patients were taken to the operating room immediately after which re-anastomoses were performed successfully, and all flaps survived. The hospital stay was between 4 and 60 days in the emergency group and 20 and 99 days in delayed group. Infections (P=0.03), vascular complications (P=0.04), and hospital stays (P=0.01) were statistically significantly lower in the emergency group than in the delayed group. Conclusion: ER has many advantages, such as preventing time consuming surgeries and providing short hospital stays and low complication rates, over DR. However, DR is inevitable for some reasons, and despite its more complicated nature, meticulous flap follow-up and salvage procedures may provide the same flap success as found with ERs.
IntroductionDue to 3D defects after resection of hypopharyngeal cancers, free flaps have become as first option for reconstruction and the anterolateral thigh flap (ALT) has been chosen frequently for soft tissue defects. Chimerization of the skin island of the ALT is also possible which can result in reconstruction of multiple defects simultaneously and monitorization of buried flaps. However, ALT can be bulky in some patients. The superthin ALT is well established by some authors especially for extremities but there is no study about the use of this modification in pharyngoesophageal defects. We present our experience of using chimeric‐superthin ALT for pharyngoesophageal reconstructions.Patients and MethodsBetween 2019 and 2022, six patients (one female and five male) underwent hypopharyngeal tumor resection and experienced chimeric‐superthin ALT flap reconstructions. Patients' ages were ranged between 53 and 71 (mean: 64) years old. The type of tumor was squamous cell carcinoma (SCC) for all patients. Three patients had total and three patients had 75% of pharyngoesophageal defects. Defect size was between 10 × 7 cm and 12 × 8.5 cm (mean: 87.08 cm2). All flaps were harvested as 5 mm thickness with two skin perforators. All flaps were divided into two individual skin islands as chimeric fashion. One of the skin islands was used for esophageal reconstruction and the other was used for both flap monitorization and tensionless closure of anterior neck skin.ResultsTotal flap size was between 18 × 9 cm and 21 × 11 cm (mean: 200 cm2). In two patients, anastomoses were performed to pectoral branch of thoracoacromial vessels. Neck vessels were chosen as recipient for remaining patients. Wound dehiscence occurred in two patients between the neck skin and monitor island and was re‐sutured without any problems. There was no partial or total flap necrosis and all flaps survived. The follow up period was between 4 and 9 months (mean: 5.6). All patients had a successful functional outcome as swallowing.ConclusionThe superthin‐chimeric ALT flap is a useful option when classical ALT is bulky in defects of hypopharyngeal cancer.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.