Multiple Free Flap Reconstructions of Head and Neck Defects Due to Oral Cancer

Mochizuki, Yumi; Harada, Hiroyuki; Shiba, Hiroaki; Tomioka, Hirofumi; Hirai, Hideaki

doi:10.1097/gox.0000000000001337

Cited by 9 publications

(11 citation statements)

References 17 publications

(25 reference statements)

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“…This makes closure of the external defect difficult, if not impossible, to reconstruct with the same flap. In these types of cases, some authors have advocated the use of two simultaneous free flaps, such as the fibula and radial forearm flap or fibula with anterolateral thigh flap combination [1–9]. This allows for reconstruction of all bony and soft tissue components and gives sufficient bulk for esthetics.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction for Complex Oromandibular Facial Defects: The Fibula Free Flap and Pectoralis Major Flap Combination

Qaisi

Dee

Eid³

et al. 2019

Case Reports in Surgery

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Background. Extensive through-and-through oromandibular defects after advanced oral carcinoma excision pose a reconstructive challenge for the head and neck surgeon. These complex oromandibular wounds often involve the mandible, oral and/or aerodigestive mucosa, and the external skin. As a result, these defects are often not amenable to reconstruction with a single flap due to the volume of soft tissue needed and the three-dimensional reconstructive requirement. The use of two free flaps has often been suggested to overcome this reconstructive challenge. A simpler and less technically demanding way to deal with this may involve the use of a free flap in combination with a pedicled regional flap. We present our experience of the use of a simultaneous microvascular fibula free flap (FFF) with a pectoralis major myocutaneous flap (PMMC) for addressing these defects. Methods. A retrospective chart review was performed of patients treated with a FFF and PMMC combination for the reconstruction of oromandibular defects at the University of Mississippi Medical Center (Jackson, MS) between October 2013 and February 2016. A minimum follow-up of 12 months was required. Data collected included the extent and location of tumor involvement, size of the postablative defect, tumor histology, clinical and pathological staging, length of follow-up, functional outcomes, and associated complications. Results. A total of three patients were identified to have been treated with the above technique. Defects repaired involved through-and-through mandibular defects with associated oral mucosa and external skin defects. In all cases, the FFF was used for restoring bony continuity with the skin paddle used to reconstruct the intraoral lining. The PMMC was used for reconstruction of the external skin defect and for providing soft tissue bulk. The average size of the fibula skin paddle used for intraoral reconstruction was 7.7 cm×11.7 cm. The average size of the PMMC paddle was 7.3×9 cm. The mean follow-up was 21.7 months. Both the FFF and PMMC survived in all cases, although postoperative wound healing complications occurred in two of the three patients. There was one partial flap loss. Two patients regained good oral intake while one patient tolerated oral intake but was PEG tube-dependent. Conclusions. The combination of pectoralis major myocutaneous flap and a vascularized free fibular flap is a viable option for the reconstruction of complex through-and-through oromandibular defects. This technique may be useful when a single microvascular free flap is not sufficient for reconstruction of such defects.

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Section: Introductionmentioning

confidence: 99%

Reconstruction for Complex Oromandibular Facial Defects: The Fibula Free Flap and Pectoralis Major Flap Combination

Qaisi

Dee

Eid³

et al. 2019

Case Reports in Surgery

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“…Thus it may be advisable to avoid the use of vessels exposed to high levels of radiation. Previous radiation may also adversely affect the success of microvascular reconstruction [35,36]. Other studies showed equivalent free flap success rates but an increased incidence of complications [37,38].…”

Section: Reconstructive Surgery After Resection For Salvagementioning

confidence: 99%

Salvage Surgery in Head and Neck Cancer

Weert

Parmar

Leemans

2021

Critical Issues in Head and Neck Oncology

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Salvage surgery (SS) in head and neck cancer is considered a last resort treatment after failure of organ preservation treatments. It offers challenges to the patients and the surgeon. The outcome of SS is often uncertain in terms of survival and quality of life. This paper offers an overview of evolution in SS, tumor and patient factors to be considered, challenges in reconstructive surgery, complications of SS and the changing landscape with regard to increasing incidence of human papillomavirus positive tumours, the role of transoral robotic surgery, the importance of multidisciplinary management and shared decision making.

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“…Reconstructive microsurgery is characterized by an emphasis on the problems of the modern techniques effectiveness in using local tissues for the restoration of extensive defects of the head, neck and upper extremities with lesions of various origins and determining the most promising directions for the development of these technologies [1,2]. A number of authors associate the occurrence of such complications as microanastomosis thrombosis, marginal flap necrosis, sub-flap suppuration, suture divergence and rejection with changes in the properties of autologous tissue after implantation and come to the conclusion that the use of musculocutaneous displaced flaps on the vascular pedicle is limited by the length of the vascular pedicle and their large thickness [2,3,4]. Free flaps on microvascular anastomoses are devoid of these drawbacks, which contributes to the wider introduction of microsurgical techniques into clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…The standard in our country and abroad is reconstructive and restorative operations, which are carried out only after the complete formation of scar tissue, i.e. 8-12 months or more after injury [2,3,4]. Injuries to the soft tissues of the head and neck, for the most part, are extensive, therefore, in order to avoid disruption of forms and functions, and the possibility of recovery with the help of local flaps, some type of regional flap is used [2,4].…”

Section: Introductionmentioning

confidence: 99%

“…8-12 months or more after injury [2,3,4]. Injuries to the soft tissues of the head and neck, for the most part, are extensive, therefore, in order to avoid disruption of forms and functions, and the possibility of recovery with the help of local flaps, some type of regional flap is used [2,4]. Depending on the defect, the type of regional flap is selected, its size, location, and DOI: https://dx.doi.org/10.51145/jlsb.2021.14 also the internal properties of the regional flap are taken into account.…”

Section: Introductionmentioning

confidence: 99%

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Results of head and neck burn reconstructive plastic surgery

Kayumkhodjaev¹,

Khalmuratova²

2021

jlsb

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Aim. The present research aimed to analyze the results of all reconstruction types (microsurgical and axial flaps) in head and neck post-burn cicatricial defects. Methods. The study included 114 patients who underwent flaps autotransplantation with microvascular anastomoses, options for plasty with axial flaps on a preserved (natural) vascular pedicle, plasty with displaced flaps, and free skin plasty for the period from 1995 to 2021. According to the formed groups for comparative analysis, all patients were divided into a comparison group included of 51 patients (1995-2008 year) and the main group with 63 patients (2009-2021 year). Women predominated with 55.6% and 58.8% in the main and comparison groups, respectively. Medium defects (50-120 cm²) of the upper face and neck area prevailed in equal numbers (11.8%). Most of the patients had a median-lateral unilateral post-burn cicatricial deformity. In terms of functional impairments, grade I up to an angle of 90º and degree II up to an angle of 45º was prevailed. Results. The consolidated long-term results of plastic surgery in the functional value were good in the main group in 69.9% of cases, while in the comparison group it was in 47.1%. The aesthetic indicators of the consolidated long-term results of plastic surgery were good in 57.5% of cases of the main group and significantly was lower in the comparison group (33.3% of cases). Unsatisfactory results were observed in 1.4% of cases in the main group and 17.6% in the comparison group. Conclusion. Improvement in head and neck burn reconstructive plastic surgery with various variants of axial flaps made it possible to increase the proportion of uncomplicated postoperative course, shorten the hospital stay and the total duration of all stages of plasty, and, in general, ensured a decrease in the frequency of unsatisfactory functional and aesthetic results.

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Multiple Free Flap Reconstructions of Head and Neck Defects Due to Oral Cancer

Cited by 9 publications

References 17 publications

Reconstruction for Complex Oromandibular Facial Defects: The Fibula Free Flap and Pectoralis Major Flap Combination

Reconstruction for Complex Oromandibular Facial Defects: The Fibula Free Flap and Pectoralis Major Flap Combination

Salvage Surgery in Head and Neck Cancer

Results of head and neck burn reconstructive plastic surgery

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