Free Segmental Vastus Lateralis Muscle Flap for Reconstruction of Recalcitrant Defects of the Cleft Hard Palate

Acartürk, Tahsin Oğuz

doi:10.1055/s-0032-1315770

Cited by 6 publications

(5 citation statements)

References 20 publications

(32 reference statements)

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“…Possibility of pedicle injury during mastication so using bite blocks are other drawbacks for this approach 15. The inability to close large defects and flap inset and orientation problems have also been descripted as limitations of local and regional flaps in the literature2,16,17 so, some authors preferred to choose free flaps as first option to overcome these drawbacks especially for large palatal defects with the advance in microsurgery 16…”

Section: Discussionmentioning

confidence: 99%

“…15 The inability to close large defects and flap inset and orientation problems have also been descripted as limitations of local and regional flaps in the literature 2,16,17 so, some authors preferred to choose free flaps as first option to overcome these drawbacks especially for large palatal defects with the advance in microsurgery. 16 Studies related to palatal reconstructions with free flaps are generally due to ablative surgeries of tumors. [18][19][20] Considering the reconstructive algorithm, the major difference between ablative surgery and cleft patients is the localization of the defect.…”

Section: Discussionmentioning

confidence: 99%

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Free Flap Reconstruction of Recalcitrant Defects in Cleft Palate Patients

Gur

Tiftikçioğlu

2023

Journal of Craniofacial Surgery

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Introduction: Defects of the palate can be as a result of oronasal fistula of cleft patients and the ablative surgery of tumors. There are many studies about reconstruction of the defects of plate in the literature and most of them are related to tumor surgery. Despite the use of free flaps in cleft patients being not a new approach, the articles in the literature are very few. The authors describe the experience of oronasal fistula reconstructions with free flaps with a new modification of tensionless inset of the free flap's pedicle. Patients and Methods: Between 2019 and 2022, 2 males and 1 female, 3 consecutive cleft patients underwent free flap surgery because of recalcitrant palatal defects. One patient had 5 and each of remain had 3 unsuccessful reconstructive attempts previously. The age of patients was ranged from 20 to 23 years old. Radial forearm flap was the option of oral lining reconstruction for all patients. In 2 patients, the flap was modified as a skin tail was linked to the flap for covering the pedicle as tensionless closure.Results: There was a mucosal swelling in first patient who underwent classical pedicle inset as mucosal tunneling. In 1 patient there was a spontaneous bleeding from the anterior side of the flap and it stopped without medical interventions, spontaneously. There was no additional complication. All flaps survived without anastomosis problems. Conclusion: Incision of the mucosa rather than tunneling provides good surgical exposure and bleeding control and modified flap design may be beneficial and reliable for tensionless pedicle inset and covering.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Free Flap Reconstruction of Recalcitrant Defects in Cleft Palate Patients

Gur

Tiftikçioğlu

2023

Journal of Craniofacial Surgery

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“…11,[13][14][15][16][17] Vastus Lateralis and ALT flaps have been utilized for this purpose as well. 11,18,19 The dorsalis pedis flap has also been reported with good outcomes in a few case series. [20][21][22] Free scapular bone has also been described as a flap utilized for management of the palatal fistula.…”

Section: Discussionmentioning

confidence: 99%

“…The most common flap utilized for this purpose is the radial forearm flap 11,13–17 . Vastus Lateralis and ALT flaps have been utilized for this purpose as well 11,18,19 . The dorsalis pedis flap has also been reported with good outcomes in a few case series 20–22 .…”

Section: Discussionmentioning

confidence: 99%

Craniofacial Microsurgery: An Integrated Approach to Management of Cleft and Craniofacial Syndromes, Surgical Experience, and Insights

Sachanandani

Powers

Issa

et al. 2021

Journal of Craniofacial Surgery

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I n this study, the Sachnandani et al review their experience with performing microsurgical reconstruction in 17 patients with cleft and craniofacial syndromes, conditions that are usually treated by those with craniofacial fellowship training using local and regional flaps as well as bone and cartilage grafts. While the idea of using free flaps for congenital craniofacial defects is not necessarily a new From the

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“…10,20,21,24,25,28 The facial artery and vein are robust recipient vessels because they possess the caliber required to avoid gross mismatch in vessel diameter and are easily accessible without deep dissection or risk of compromising essential structures in the neck. Access to the facial vessels is typically approached through a submandibular incision or an incision in the nasolabial fold, which, though well hidden between facial aesthetic subunits, nevertheless results in a visible scar.…”

Section: Discussionmentioning

confidence: 99%

Avoiding Facial Incisions with Midface Free Tissue Transfer

Stalder

Sosin

Urbinelli

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions.Methods:Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions.Results:The pathology included palatal defects due to mucoepidermoid carcinoma and ischemic necrosis from cocaine abuse, maxillary defects secondary to fibrous dysplasia and avascular necrosis from traumatic blast injury, and a residual posttraumatic bony deformity of the zygoma. Reconstructions were performed with a free ulnar forearm flap, a free vastus lateralis muscle flap, a deep circumflex iliac artery myoosseous flap, a free fibula flap, and a deep circumflex iliac artery osseous flap, respectively. The facial artery and vein were used as recipient vessels for microvascular anastomosis for all cases. Mean follow-up was 12.2 months. All free tissue transfers were successful, and each patient had a satisfactory aesthetic outcome with no associated facial scars.Conclusion:This technique can be employed during reconstruction of an array of bony or soft-tissue midface deficits with minimal morbidity. This small series effectively demonstrates the varied pathologies and tissue deficiencies that can be successfully reconstructed with free tissue transfer using an entirely intraoral approach to the recipient facial vessels, resulting in no visible scars on the face and an improvement in the overall aesthetic outcome.

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Free Segmental Vastus Lateralis Muscle Flap for Reconstruction of Recalcitrant Defects of the Cleft Hard Palate

Abstract: Free segmental vastus lateralis muscle offers easy harvest, a two-team approach, long pedicle length, a highly vascularized flap, and no functional loss.

Cited by 6 publications

References 20 publications

Free Flap Reconstruction of Recalcitrant Defects in Cleft Palate Patients

Free Flap Reconstruction of Recalcitrant Defects in Cleft Palate Patients

Craniofacial Microsurgery: An Integrated Approach to Management of Cleft and Craniofacial Syndromes, Surgical Experience, and Insights

Avoiding Facial Incisions with Midface Free Tissue Transfer

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