Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children

Markiewicz, Michael R.; Ruiz, Ramon L.; Pirgousis, Phillip; Bell, R. Bryan; Dierks, Eric J.; Edwards, Sean P.; Fernandes, Rui

doi:10.1097/scs.0000000000002515

Cited by 25 publications

(16 citation statements)

References 157 publications

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“…27,28 However, the free fibula flap is not without drawbacks, having been shown to cause patient morbidity and a high frequency of complications. 29,30 Innovation in biomedical technology and the growing popularity of virtual surgical planning, such as Computer-Aided Design & Computer-Aided Manufacturing and 3D printing, have made way for the introduction of customized prosthetic implants to replace a large segment of the mandibular body, ramus, and TMJ. These implants may be used on their own or in conjunction with free flaps in mandibular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection

Horen

Hansdorfer

Seu

et al. 2021

Journal of Craniofacial Surgery

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Ameloblastomas are benign tumors that most commonly affecting the mandible. The current standard of treatment for ameloblastomas is resection followed by reconstruction that has historically been accomplished through the use of a microsurgical vascularized flaps taken from the iliac crest or fibula. Alloplastic reconstruction methods have gained popularity over recent years with success reported in the reconstruction of many pathologies, including ankylosis, condylar fracture, neoplasia involving extensive resection, severe inflammatory/degenerative temporomandibular joint (TMJ) disease, and congenital TMJ abnormalities. The authors present a patient who successfully underwent ameloblastoma resection and TMJ reconstruction with a custom TMJ Concepts alloplastic implant. The authors also present a review of the literature on alloplastic TMJ reconstruction following ameloblastoma resection. To our knowledge, this is the second report in the literature on the use of a TMJ Concepts implant after ameloblastoma resection.

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Section: Discussionmentioning

confidence: 99%

Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection

Horen

Hansdorfer

Seu

et al. 2021

Journal of Craniofacial Surgery

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“…However, most of these studies were heterogeneous on the age of the patients (4)(5)(6)(7)(8). The youngest patient was less than 4-month-old while the oldest patient in these studies was more than 18 years old (6,(10)(11)(12). In one study on pediatric microsurgery, the oldest patient was even 21 years old (13).…”

Section: Discussionmentioning

confidence: 99%

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Li¹,

Xiong²,

Li³

et al. 2021

Handchir Mikrochir Plast Chir.

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Background Microsurgical reconstruction of extremity defects with free flaps has been carried out for many years. The aim of this retrospective study is to characterize free flap surgery on children of 1 to 7 years old by evaluating a series of 20 cases of free flap surgeries that have been performed in pediatric patients. Methods From February 2014 to January 2018, 20 patients, 10 boys and 10 girls aged from 1 to 7 years (average, 4.6 years), were engaged in this study. Several types of free flaps were used, including anterolateral thigh flaps (ALT), inferior ulnar collateral artery flap, latissimus dorsi flap, medial plantar flap, fibular osteocutaneous flap and hallux toenail flap. After operations, follow-up period was at least for 2 years and the average follow-up period was 48.5 months. The long-term outcomes were estimated by questionnaires derived from the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI). Results A total of 21free-flap reconstructions were performed on 20patients, including 15 ALT, 3 composite flaps, and 3 other cutaneous flaps. The size of the tissue flap ranged from 1.5 to 280 cm2 (average, 74.1cm2). The diameter of the anastomosed artery of the flap ranged from 0.7 to 1.2 mm. Among the 21 flaps, 20 survived and the success rate was about 95 %. Contour adaption was achieved in all flaps. Fifteen children received a secondary operation for debulking or functional improvement. Secondary deformity was present in 3 children, among which ankle joint valgus was seen in two children and a flexion deformity of injured toe occurred in one child. The mean global functioning score of PODCI was 94 (ranging from 81 to 98, maximum 100). Conclusion The success rate of free-flap surgery in pediatric patients was comparable to that achieved in adults. Post-operative caring for pediatric patients was easier than expected. For pediatric patients, the final outcomes were not varied remarkably from different types of free tissue transfer.

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“…The large proportion of patients who underwent SRPT (54%) as a core of initial therapy can be explained by improvements in perioperative management as well as surgical techniques in children in the last few years. Postoperative morbidity has also been reduced-thanks to the development of combined minimally invasive endoscopic and transcranial or transfacial approaches and free-flap reconstructive possibilities, which limit functional and cosmetic sequelae (34)(35)(36). In the retrospective study of 92 HN-RMS (both ERMS and ARMS) by Dombrowski et al (16), surgery was associated with a reduced risk of mortality after adjusting for TNM staging and location of the tumor (p = 0.05).…”

Section: Survival and Prognostic Factorsmentioning

confidence: 99%

Locoregional Control and Survival in Children, Adolescents, and Young Adults With Localized Head and Neck Alveolar Rhabdomyosarcoma—The French Experience

et al. 2022

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IntroductionThe head and neck (HN) are the most frequent sites of pediatric rhabdomyosarcoma (RMS). Alveolar RMS (ARMS) represents ~20% of all RMS cases and frequently spread to lymph nodes (LNs). The aim was to report locoregional control, event-free survival (EFS), and overall survival (OS), according to clinical and pathological features, LN staging, and treatment modalities.MethodsThe study included all patients prospectively enrolled in EpSSG RMS 2005 study under 21 years of age with localized HN ARMS and diagnosed between 2005 and 2016 in France. Medical data including imaging, surgical report, and radiation therapy planes were analyzed.ResultsForty-eight patients (median age 6 years; range 4 months−21 years), corresponding to 30 parameningeal and 18 non-parameningeal ARMS, were included. There were 33 boys (69%). Tumor locations included the following: orbit (n = 7) among which four cases had bone erosion, paranasal sinuses and nasal cavity (n = 16), deep facial spaces (n = 10), nasolabial fold (n = 8), and other non-parameningeal HN sites (n = 7). A fusion transcript of PAX3-FOXO1 or PAX7-FOXO1 was expressed in 33 of the 45 cases (73%) with molecular analysis. At diagnosis, 10 patients had primary resection of the primary tumor (PRPT) (none with microscopic complete resection) and 9 had LN staging. After induction chemotherapy, 26 patients (54%) had secondary resection of the primary tumor (SRPT) and 13 patients (27%) had cervical LN dissection. A total of 43 patients (90%) were treated with radiation therapy.With a median follow-up of 7 years (range 2–13 years), 5-year OS and EFS were 78% (95% CI, 63–88%) and 66% (95% CI, 51–78%), respectively. We observed 16 events (10 deaths): 4 local, 4 regional, 1 local and regional, and 7 metastatic. In univariate analysis, OS was only superior for patients under 10 years of age (p = 0.002), while FOXO1-negative ARMS, SRPT for parameningeal ARMS, and LN surgery were associated with significantly better EFS.ConclusionOur study confirms a better outcome for fusion-negative ARMS and ARMS in children under 10 years. Moreover, LN surgery and SRPT of parameningeal tumor may improve EFS of ARMS. Larger studies are needed to confirm our findings.

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Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children

Abstract: Free tissue transfer is highly successful in children. Although data are limited, there appears to be no difference in survival among various free flaps used for head and neck reconstruction in children.

Cited by 25 publications

References 157 publications

Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection

Alloplastic Temporomandibular Joint Reconstruction Following Recurrent Ameloblastoma Resection

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Locoregional Control and Survival in Children, Adolescents, and Young Adults With Localized Head and Neck Alveolar Rhabdomyosarcoma—The French Experience

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