Chimeric anterolateral thigh free flap for reconstruction of complex cranio-orbito-facial defects after skull base cancers resection

Cherubino, Mario; Turri‐Zanoni, Mario; Battaglia, Paolo; Giudice, Marco; Pellegatta, Igor; Tamborini, Federico; Maggiulli, Francesca; Guzzetti, Luca; Giovanna, Danilo Di; Bignami, Maurizio; Calati, Carolina; Castelnuovo, Paolo; Valdatta, Luigi

doi:10.1016/j.jcms.2016.10.017

Cited by 34 publications

(25 citation statements)

References 20 publications

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“…A chimeric free flap can be used in cases of complex defects involving multiple subsites. 12 Chimeric flaps, which have better mobility, may be inset easily even into complex defects.…”

Section: Discussionmentioning

confidence: 99%

Increased Defect Size is Associated with Increased Complication Rate after Free Tissue Transfer for Midanterior Skull-Base Reconstruction

et al. 2019

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Objective Complications after skull-base reconstruction are often problematic. We consider that local factors, for example, localization of defect areas are possible risk factors. This study aimed to investigate our case series of skull-base reconstructions in our institution and to identify local risk factors that predispose to wound complications. Design This study is presented as a retrospective study. Setting Research work was took place at Nagoya University Hospital. Participants Forty-eight patients who had undergone reconstruction after midanterior skull-base resection between January 2004 and December 2015 were included in this study. Defects apart from the skull-base were categorized into nasal and paranasal cavity (N), orbit (O), palate (P), and facial skin (S). Postoperative local complications including cerebrospinal fluid (CSF) leakage, local infection, wound dehiscence (fistula in face or palate), and flap necrosis (partial or total) were investigated. Main Outcome Measures Main outcome measures were postoperative complications in patients with each defect. Results Apart from the skull-base, defects included 28 ONP (58.3%), 10 ONPS (20.8%), 3 ON (6.3%), 3 ONS (6.3%), 1 NP (2.1%), and 1 OS (2.1%). Comparison based on numbers of resected regions revealed that a significantly higher complication rate was seen in patients with four resected regions than in those with three regions (90.0% vs. 45.2%, p < 0.05). Conclusion There was a trend suggesting that more resected regions corresponded to a greater risk of complications in midanterior skull-base reconstruction. Reconstructive surgeons need to carefully consider the reconstruction of such complicated defects.

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“…A chimeric free flap can be used in cases of complex defects involving multiple subsites. 12 Chimeric flaps, which have better mobility, may be inset easily even into complex defects.…”

Section: Discussionmentioning

confidence: 99%

Increased Defect Size is Associated with Increased Complication Rate after Free Tissue Transfer for Midanterior Skull-Base Reconstruction

et al. 2019

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“…In case of orbital exenteration and in the orbital preservation group where the orbital floor support was partially or totally removed, the surgical defect was reconstructed using various flaps such as anterolateral thigh (ALT) free flap, radial forearm free flap (RFFF), transverse rectus abdominis myocutaneous free flap (TRAM), scapular tip free flap (STFF), or temporalis muscle pedicled flap (TMF) …”

Section: Methodsmentioning

confidence: 99%

Multidisciplinary treatment algorithm for the management of sinonasal cancers with orbital invasion: A retrospective study

et al. 2019

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Background Sinonasal cancers frequently involve the orbit with resulting controversies on whether to remove or preserve the orbital contents. Methods Retrospective review of patients with primary sinonasal cancer involving the orbit, treated according to a multidisciplinary protocol tailored to tumor histology and extent of orbital invasion in two tertiary care referral centers over a 20‐year period. Results The oncological and functional outcomes of 163 patients were analyzed. The degree of orbital involvement significantly affected both overall (P < .0001) and disease‐free (P < .0001) survival. Orbital apex invasion was an independent negative prognostic factor (5‐year overall survival, 14.6% ± 7.5%), with dismal prognosis regardless of the treatment adopted. An appropriate use of induction chemotherapy and endoscopic‐assisted surgery allowed for orbital preservation in 76.6% of cases; 96% of patients treated using an orbit‐sparing approach maintained a functional eye after treatment. Conclusion The multimodal treatment algorithm herein proposed was able to maximize orbital preservation rates with acceptable oncological and functional outcomes.

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“…It is challenging to reconstruct the oral and submandibular defects simultaneously [10,11]. In recent decades, free anterolateral thigh flap (ALT) has become one of the main choices for reconstruction due to its high reliability and versatility [11]. The traditional ALT carries redundant subcutaneous tissue, fascia lata, and muscle, with a high volume of tissue volume that is far beyond the needs of the surgery.…”

Section: Introductionmentioning

confidence: 99%

Application of chimerical ALT perforator flap with vastus lateralis muscle mass for the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective cohort study

Yang

Wu²,

Kumar

et al. 2020

BMC Oral Health

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Background: Patients with tongue carcinoma who undergo combined tongue and neck radical resection often have simultaneous oral and submandibular defects. Due to its high flexibility, the anterolateral thigh (ALT) perforator flap is gradually being adopted by surgeons for oral reconstruction. However, the tissue volume of perforator flaps is insufficient for the reconstruction of both the oral and submandibular regions. In this retrospective cohort study, we compared the postoperative outcomes and complications between patients reconstructed with using the classical ALT perforator flap and patients reconstructed using the chimeric ALT perforator flap with vastus lateralis muscle mass. Methods: From August 2017 to August 2019, 25 patients underwent reconstructive therapy using a classical ALT perforator flap (classical group), while 26 patients were reconstructed with the chimeric ALT perforator flap (chimeric group) after radical resection of tongue cancer in Xiangya Hospital, Central South University. The flap survival rate, incidence of submandibular infection, lateral appearance, lower extremity function, and quality of life were compared between the two groups. Results: There were no differences in flap survival rate and postoperative lower extremity function between the two groups. The incidence of submandibular infection was 15.4 and 40% in the chimeric and classical group, respectively. The duration of recovery was 12.20 ± 2.69 and 15.67 ± 4.09 days in the chimeric and classical group, respectively. The submandibular region fullness was satisfactory in the chimeric group. The postoperative quality of life in the chimeric group was better than that in the classical group (P < 0.05). Conclusions: The chimerical ALT perforator flap with muscle mass reconstructs both the oral and submandibular defects accurately. It maintains the profile and fullness of the submandibular region and may reduce the incidence of submandibular infection.

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Chimeric anterolateral thigh free flap for reconstruction of complex cranio-orbito-facial defects after skull base cancers resection

Cited by 34 publications

References 20 publications

Increased Defect Size is Associated with Increased Complication Rate after Free Tissue Transfer for Midanterior Skull-Base Reconstruction

Increased Defect Size is Associated with Increased Complication Rate after Free Tissue Transfer for Midanterior Skull-Base Reconstruction

Multidisciplinary treatment algorithm for the management of sinonasal cancers with orbital invasion: A retrospective study

Application of chimerical ALT perforator flap with vastus lateralis muscle mass for the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective cohort study

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