Chronological flap volume and distribution changes after reconstruction of total maxillectomy defect using a rectus abdominis myocutaneous flap

Kagaya, Yu; Arikawa, Masaki; Sekiyama, Takuya; Higashino, Takuya; Akazawa, Satoshi

doi:10.1016/j.bjps.2021.05.021

Cited by 8 publications

(12 citation statements)

References 23 publications

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“…Several studies have shown that the volume of the flap is further reduced when RT is performed. 11,16,17 In the present study, however, it is encouraging that the group that underwent RT had a significant volume loss, but this was not associated with loss of function. Dynamic reconstruction considering functional aspects is emerging, and our team has shown that the functional outcome is good when dynamic reconstruction is implemented in hemi-tongue reconstruction.…”

Section: Discussionsupporting

confidence: 47%

“…Several studies have shown that the volume of the flap is further reduced when RT is performed 11,16,17 . In the present study, however, it is encouraging that the group that underwent RT had a significant volume loss, but this was not associated with loss of function.…”

Section: Discussionsupporting

confidence: 46%

“…18 However, because half of the function is basically maintained in the case of hemi-tongue reconstruction, if the defect is not large, using only the cutaneous flap to lower the donor site morbidity is a good method. Kagaya et al 17 compared the volume change of muscle and fat when reconstructing a maxillectomy defect with rectus abdominis musculocutaneous flap, and overall, muscle shrank much more than fat, and both muscle and fat were affected by RT. Therefore, transferring of the functional muscle that is vulnerable to RT may not bring much benefit in the case of hemi-tongue reconstruction in which some function is maintained, especially if there is a possibility of postoperative RT.…”

Section: Discussionmentioning

confidence: 99%

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A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

et al. 2022

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BackgroundAn adequate volume of the tongue flap is essential to preserve speech and swallowing functions. However, it is generally known that the volume of the free flap tends to decrease over time because of various reasons. Especially in hemi-tongue reconstruction, as half of the normal tongue is retained, some functions are maintained; consequently, there are few studies related to the volume of the flap and function. This study investigated the relationship between flap volume change and function after hemi-tongue reconstruction.MethodsA retrospective chart review of 26 patients who underwent hemi-tongue reconstruction between 2003 and 2020 was performed. Patient demographic data, postoperative radiotherapy (RT), and data on flap types were collected. The volume of the flap was measured by converting the computed tomography and magnetic resonance images into 3 dimensions using the Mimics software. In addition, speech scores and feeding scores were collected.ResultsThe first follow-up computed tomography or magnetic resonance imaging (T1) was performed after an average of 2.09 months, and the second follow-up imaging study (T2) was performed at 16.58 months on average. On average, the T2 volume was 64% of the T1 volume (range, 45.75%–90.54%). Factors including speech and swallowing functions were compared by dividing the group into a group with a more than average decrease in volume (group 1) and a group with a less than average decrease in volume (group 2). In group 1, there were significantly more cases of postoperative RT than in group 2 (85.7%, 50.0%, in group 1 and group 2, respectively; P = 0.049). However, there was no difference in the functional aspects between the 2 groups.ConclusionsThe present study revealed that the flap volume decreased more when RT was performed. However, there was no association between the degree of volume loss and speech and swallowing functions. Regardless of the group, the loss of function was not severe, probably because the remaining half of the tongue was functioning.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

et al. 2022

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“…Kagaya et al [17] additionally observe the effects of gravity and volume distribution changes on large-volume rectus abdominus myocutaneous (RAMC) flaps in maxillectomy reconstructions amongst 20 patients. Performing multiple regression analysis, they found postoperative radiation therapy and weight loss greater than 5% to be independent factors in flap adipose volume loss.…”

Section: Factors Affecting Flap Volumementioning

confidence: 99%

Free flap volume changes: can we predict ideal flap size and future volume loss?

Dennis

Masheeb

Abouyared

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewUnder anticipating free flap volume may lead to deficits in functional and aesthetic outcomes. Alternatively, over anticipating may compromise airway patency, lead to prolonged tracheostomy dependence or poor oral intake, and cause poor cosmetic outcomes. Surgeons face a fine balance in creating a functional reconstruction that accounts adequately for volume changes in the future. Recent findingsRecent studies are elucidating the complex and multifactorial volume changes of free flaps that are dependent on postoperative radiation, flap composition, weight fluctuations, and site of reconstruction. Radial forearm free flaps typically lose about 40% of their volume, regardless of patient-dependent variables. Muscle flaps exhibit significant fluctuations with patient-dependent variables. Adipose-prevalent flaps are likely more resistant to radiation effects but are more dependent on postoperative weight changes in the patient. SummaryFree flap volume over anticipation recommendations range from 1.1 to 1.4 times the final volume to account for future atrophy but patient characteristics including postoperative radiation, anticipated weight loss, and flap composition should be incorporated into intraoperative decisions for final flap volume.

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“…Several studies have reported flap volume changes after free tissue transfer. [1][2][3] In addition, some studies have examined these volume changes in cases of pedicled flaps rather than free flaps. 4,5 Muscle or myocutaneous (MC) flaps were used often in the past, and reinnervation was usually not performed, because the muscle was only used to fill the volume.…”

mentioning

confidence: 99%

Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction

Woo,

Kim,

Jeong

et al. 2023

Journal of Craniofacial Surgery

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In general, flap volume decreases over time and further in the case of a denervated muscle flap. In our institution, dynamic reconstruction, including functional muscle flaps, has been used to aid functional recovery in the past 6 years. This study aimed to determine the effect of volume change of the fat and muscular sections of reconstructed tongue flaps after motor nerve reinnervation in dynamic total tongue reconstruction using 3-dimensional measurement and analysis. A retrospective chart review was performed on 21 patients who underwent total tongue reconstruction using an anterolateral thigh free flap from 2015 to 2020. The fat and muscle volumes of the flap were measured using computed tomography data obtained before surgery (T0), 2 weeks after surgery (T1), and 6 months after surgery (T2) using a 3-dimensional rendering software. Among the 21 patients that underwent tongue reconstruction, 10 underwent dynamic reconstruction, whereas 11 underwent conventional reconstruction using a fasciocutaneous flap. T2 volume compared with T1 was 69.08% in the conventional reconstruction group, and the fat and muscle portions in the dynamic reconstruction group were 77.04% and 69.06%, respectively. No significant difference was noted in the volume change between the 2 groups. After dynamic tongue reconstruction, the muscular volume of the flap had similar volume reduction rate as the fat volume. The dynamic reconstruction was effective not only for functional muscle transfer but also for maintaining the volume of the reconstructed muscle flap.

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Chronological flap volume and distribution changes after reconstruction of total maxillectomy defect using a rectus abdominis myocutaneous flap

Cited by 8 publications

References 23 publications

A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

Free flap volume changes: can we predict ideal flap size and future volume loss?

Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction

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