Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review

Abstract

Background: Prelamination is a reconstructive technique providing fasciomucosal or composite flaps with low donor-site morbidity. We conducted a systematic review of retrospective studies to assess the application of prelaminated flaps in reconstructive surgery of head and neck cancer patients, and to evaluate the advantages and disadvantages of this technique. Methods: This systematic review adhered to the recommendations of the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analysis) 2009 guidelines. A computerized MEDLINE search was performed using the PubMed service of the U.S. National Library of Medicine (www.pubmed.org) and Scopus database (www. scopus.com), running the following search string: "prelamination OR prelaminated AND flap." Two authors screened the articles, then selected and extracted data on malignancies characteristics, reconstructive techniques, outcomes and complications.Results: A total of 19 articles were selected and reviewed from 128 identified. Seven of 19 articles were case reports, 12 articles were case series. One-hundred-two patients underwent reconstructive treatment by prelamination technique using a wide variety of flaps (92 free, 10 pedicled). The sites of reconstruction were oral cavity (66 floor of the mouth, 3 retromolar trigone, 6 hard palate, 4 cheek, 4 tongue), 8 facial skin (5 of them sited on the nose), 4 oropharyngeal defects, 1 laryngotracheal region. No case of total flap loss was reported. Partial flap loss or shrinkage requiring minor surgical revisions was observed in 18 patients (17.6%). Primary closure of the donor site was achieved in 97 cases (97%) and 3 (3%) required revision surgery of the donor site. Conclusion:Prelamination is an effective and versatile technique, with low donor-site morbidity. Further studies would be needed to investigate the impact on the patient's oncologic outcome. More comparative studies with standard reconstructive techniques are essential to understand when it is worth performing this sophisticated procedure.

Prelamination of the Radial Forearm Free Flap Using Free Full-Thickness Eyelid Skin Grafts

“…In the present study, prelamination of the radial forearm free flap using free full-thickness eyelid skin grafts (obtained through blepharoplasty) was performed for the first time to cover tumor-related intraoral defects while simultaneously treating upper or lower eyelid dermatochalasis. Free flap prelamination for intraoral and extraoral defect reconstruction has been described in several previous studies 10–17 . In this context, prelamination of the radial forearm free flap has gained interest as a technique to reduce donor site morbidity and increase the quality of transferred tissue at the recipient site, and the application of mucosa grafts, instead of split- or full-thickness skin grafts, for prelamination has mainly been the focus of investigation 13–17,23 .…”

“…8,9 Therefore, previous studies have attempted to identify new surgical approaches in free flap prefabrication to improve flap design and minimize donor site morbidities, and free flap prelamination has been identified as a promising technique in this regard. [10][11][12] For prelamination of the radial forearm free flap, the use of mucosal grafts has been reported to be a feasible method to reduce donor site morbidity and the esthetic impairments caused by shrinkage or scarring of secondary skin grafts at the flap's donor site and to align the transplanted tissue to the recipient site while avoiding undesirable intraoral hair growth. [13][14][15][16] However, the use of free split-or full-thickness skin grafts for prelamination may be a suitable alternative in this context because skin (compared with mucosa) may be both dimensionally more stable and easily available from various anatomical regions.…”

Prelamination of Anterolateral Thigh Osseocutaneous Flap With Fibula for the Reconstruction of Zygomatic Arch Defects After Facial Trauma

“…The most reported indication of prelamination in the literature is the reconstruction of complex defects of the central face,4,6 in our case we used this technique to reconstruct a lateral face defect, especially the post-traumatic right zygomatic arch defect. Among studies reporting prelaminated flaps in the literature, only the study of Sadigh and colleagues reported the prelamination of the anterolateral thigh flap with a fibula graft for mandibular reconstruction 4,6. There are many differences between this study and our study.…”

“…After a gap of at least 2 or 3 weeks, this structure with a new axial blood supply will be transplanted to the recipient area 8. Flap prelamination is widely used in reconstructive surgery, as well as flap prefabrication, a parallel but different term, which is commonly mistaken as the former 4,8,9. In fact, prefabrication is more used to describe a transfer of a tissue with a vascular pedicle into a well blood supply bed to vascularize the periphery tissues, which creates a new vascular territory 3,8,10.…”

“…Complex facial trauma often implies a challenging reconstruction 1–3. Prelamination of flap is commonly used for difficult reconstructions, especially when the traditional treatments might result in unsatisfactory final surgical outcomes 4,5. The prelamination offers the advantages of improving flap design, enhancing functional aspects, and reducing donor-site morbidity 4.…”