Prelamination of the latissimus dorsi flap for reconstruction in head and neck surgery

Jehn, Philipp; Zimmerer, Rüdiger; Dittmann, Jürgen; Winterboer, Jan; Gellrich, Nils‐Claudius; Tavassol, Frank; Spalthoff, Simon

doi:10.1016/j.ijom.2019.02.004

Cited by 8 publications

(9 citation statements)

References 26 publications

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“…A total of 19 studies was included in this systematic review, as showed by the PRISMA flow diagram (Figure 1 ) (Alves et al, 2020 ; Chiarini et al, 2002 ; Collar & Byrne, 2013 ; Colletti et al, 2012 ; Jehn et al, 2019 ; Kilinc & Aytekin, 2014 ; Kim et al, 2013 ; Lauer et al, 2001 ; Maruccia et al, 2020 ; Nehrer‐Tairych et al, 2002 ; Poeschl et al, 2003 ; Rath et al, 1999 ; Sadigh & Jeng, 2015 ; Schlenz et al, 2001 ; Teng et al, 2005 ; Upton et al, 1994 ; Wolff et al, 1996 ; Ziegler & Oyer, 2021 ). Seven out of the selected 19 articles were case reports (Alves et al, 2020 ; Collar & Byrne, 2013 ; De Santis et al, 2020 ; Maruccia et al, 2020 ; Sadigh & Jeng, 2015 ; Teng et al, 2005 ; Ziegler & Oyer, 2021 ), while the remaining 12 articles were case series (with five out of them including less than five cases) (Chiarini et al, 2002 ; Colletti et al, 2012 ; Jehn et al, 2019 ; Kilinc & Aytekin, 2014 ; Kim et al, 2013 ; Lauer et al, 2001 ; Nehrer‐Tairych et al, 2002 ; Poeschl et al, 2003 ; Rath et al, 1999 ; Schlenz et al, 2001 ; Upton et al, 1994 ; Wolff et al, 1996 ). The whole study population was represented by 102 patients (63 males, 30 females, 9 not specified) undergoing reconstruction of an anatomical defect secondary to oncological ablative surgery with a prelaminated flap, over the last 27 years (1994–2021).…”

Section: Resultsmentioning

confidence: 99%

“…To date prelamination of different flaps has been reported as a suitable method to improve flap design, enhance functional aspects and reduce donor‐site morbidity (Jehn et al, 2019 ). According to the present systemic review, prelamination was mostly employed in oral cavity reconstruction and the RFFF resulted the most commonly flap to be prelaminated to reconstruct the oral cavity, similarly to the literature on not‐prelaminated free flap reconstructive options for oral cavity (Urken et al, 1994 ).…”

Section: Discussionmentioning

confidence: 99%

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Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review

et al. 2021

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Background: Prelamination is a reconstructive technique providing fasciomucosal or composite flaps with low donor-site morbidity. We conducted a systematic review of retrospective studies to assess the application of prelaminated flaps in reconstructive surgery of head and neck cancer patients, and to evaluate the advantages and disadvantages of this technique. Methods: This systematic review adhered to the recommendations of the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analysis) 2009 guidelines. A computerized MEDLINE search was performed using the PubMed service of the U.S. National Library of Medicine (www.pubmed.org) and Scopus database (www. scopus.com), running the following search string: "prelamination OR prelaminated AND flap." Two authors screened the articles, then selected and extracted data on malignancies characteristics, reconstructive techniques, outcomes and complications.Results: A total of 19 articles were selected and reviewed from 128 identified. Seven of 19 articles were case reports, 12 articles were case series. One-hundred-two patients underwent reconstructive treatment by prelamination technique using a wide variety of flaps (92 free, 10 pedicled). The sites of reconstruction were oral cavity (66 floor of the mouth, 3 retromolar trigone, 6 hard palate, 4 cheek, 4 tongue), 8 facial skin (5 of them sited on the nose), 4 oropharyngeal defects, 1 laryngotracheal region. No case of total flap loss was reported. Partial flap loss or shrinkage requiring minor surgical revisions was observed in 18 patients (17.6%). Primary closure of the donor site was achieved in 97 cases (97%) and 3 (3%) required revision surgery of the donor site. Conclusion:Prelamination is an effective and versatile technique, with low donor-site morbidity. Further studies would be needed to investigate the impact on the patient's oncologic outcome. More comparative studies with standard reconstructive techniques are essential to understand when it is worth performing this sophisticated procedure.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review

et al. 2021

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“…Free flap prelamination for intraoral and extraoral defect reconstruction has been described in several previous studies. [10][11][12][13][14][15][16][17] In this context, prelamination of the radial forearm free flap has gained interest as a technique to reduce donor site morbidity and increase the quality of transferred tissue at the recipient site, and the application of mucosa grafts, instead of split-or full-thickness skin grafts, for prelamination has mainly been the focus of investigation. [13][14][15][16][17]23 Kim et al 13 reported good outcomes FIGURE 2.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, prelamination of the radial forearm free flap using free full-thickness eyelid skin grafts (obtained through blepharoplasty) was performed for the first time to cover tumor-related intraoral defects while simultaneously treating upper or lower eyelid dermatochalasis. Free flap prelamination for intraoral and extraoral defect reconstruction has been described in several previous studies 10–17 . In this context, prelamination of the radial forearm free flap has gained interest as a technique to reduce donor site morbidity and increase the quality of transferred tissue at the recipient site, and the application of mucosa grafts, instead of split- or full-thickness skin grafts, for prelamination has mainly been the focus of investigation 13–17,23 .…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Therefore, previous studies have attempted to identify new surgical approaches in free flap prefabrication to improve flap design and minimize donor site morbidities, and free flap prelamination has been identified as a promising technique in this regard. [10][11][12] For prelamination of the radial forearm free flap, the use of mucosal grafts has been reported to be a feasible method to reduce donor site morbidity and the esthetic impairments caused by shrinkage or scarring of secondary skin grafts at the flap's donor site and to align the transplanted tissue to the recipient site while avoiding undesirable intraoral hair growth. [13][14][15][16] However, the use of free split-or full-thickness skin grafts for prelamination may be a suitable alternative in this context because skin (compared with mucosa) may be both dimensionally more stable and easily available from various anatomical regions.…”

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confidence: 99%

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Prelamination of the Radial Forearm Free Flap Using Free Full-Thickness Eyelid Skin Grafts

et al. 2022

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Free flap transfer for reconstruction of intraoral defects is a common procedure in oral and maxillofacial surgery. For tumor-related defects, the radial forearm flap is widely used for soft tissue restoration. However, transfer of free skin grafts to the donor site region is often required for wound closure after free flap harvesting, resulting in esthetic disturbances due to shrinkage of the grafted skin, attendant scarring, or mismatches in skin texture or color. Furthermore, free flap transfer may result in hair follicle transfer into the oral cavity, causing unfavorable intraoral hair growth in adult men in particular. Free flap prelamination can help reduce the potential disadvantages of free flaps, in terms of both flap design and size and donor site morbidity. For surgical treatment of oral cancer in middle-aged and elderly patients, eyelid dermatochalasis may present as a comorbidity leading to esthetic impairments or, in cases involving the upper eyelid, even a reduced field of view. In these cases, bilateral blepharoplasty can reduce the excess eyelid skin. The present study is the first to attempt to use excised skin after bilateral blepharoplasty as full-thickness skin grafts for radial forearm free flap prelamination. This approach combined surgical therapy of eyelid dermatochalasis with free flap prelamination, thereby avoiding the need to harvest free skin grafts from other anatomically healthy regions to close the donor site defect and preventing the accompanying disadvantages. The reconstruction results and clinical outcomes of patients revealed that radial forearm free flap prelamination using bilateral free full-thickness eyelid skin grafts was an easy and feasible method for intraoral defect reconstruction. In particular, this approach could avoid intraoral hair growth and additional skin grafting from other healthy anatomical regions, yielding good esthetic and functional results at the flap's recipient and donor sites.

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The use of the chimeric conjoint flap technique for complex defects reconstruction throughout the body: Clinical experience with 28 cases

et al. 2022

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Background Large soft tissue defects reconstruction represents a frequent and complex challenge in plastic surgery. A critical point regards the equilibrium between the need of large amount of tissue, while minimizing donor site morbidity. This is a common issue that plastic surgeons face in their clinical practice. In this context, the chimeric conjoint flap technique can be a valuable option, allowing to better exploit many well‐known procedures. The purpose of the present work is to show the reconstructive efficacy and reliability of this technique resorting to many different well‐known flaps. No such a comprehensive collection of cases is available so far dealing with this procedure. Patients and Methods Twenty‐eight patients presenting large defects throughout the body were treated by means of different flaps, designed according to the chimeric conjoint flap concept. Patients' mean age was 61.9 years old (range 18–82 years), 20 were males and 8 females. The size of the defects ranged from 7 cm × 6 cm to 25 cm × 18 and presented shapes or localizations that were complex to be covered with a regular flap. The defects were located in 11 cases in the lower limbs, in 9 cases in the head and neck region, in 5 cases in the groin, and in 2 cases in the thorax. Cause of the defect was tumor resection in 20 cases, trauma‐induced necrosis in 5 cases, Fournier's gangrene in 2 cases, and a chronic ulcer in 1 case. Fourteen flaps were free flaps while 14 were pedicled flaps. The chimeric conjoint flap technique consists in splitting the skin paddle a flap into two smaller island that can be rearranged in order to match the particular requirements of the recipient site. Different flaps were employed: the anterolateral thigh (ALT) flap was used in 19 cases, latissimus dorsi (LD) musculocutaneous flap in 4 cases, deep inferior epigastric (DIEP) in 3 cases, medial sural artery perforator (MSAP) in 1 case, free radial forearm flap (RFFF) in 1 case. Results All the 28 patients were successfully treated. In 6 cases minor complications were encountered, 5 at recipient site and 1 at donor site, who were all managed conservatively. No second procedures were required. The mean follow‐up period was 8.4 months (range 3–12 months). At the last follow‐up evaluation all the patients reached an acceptable cosmetic result and, when limbs were affected, complete range of motion restoration. Conclusions The present case series provide promising evidence regarding the reliability and versatility of the chimeric conjoint flap technique for large and delicate defect reconstructions throughout the body.

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Prelamination of the latissimus dorsi flap for reconstruction in head and neck surgery

Cited by 8 publications

References 26 publications

Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review

Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review

Prelamination of the Radial Forearm Free Flap Using Free Full-Thickness Eyelid Skin Grafts

The use of the chimeric conjoint flap technique for complex defects reconstruction throughout the body: Clinical experience with 28 cases

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