Transferring pectoral muscle flap to depleted neck to create a new recipient source for free flaps in head and neck reconstruction

Gur, Ersin; Tiftikçioğlu, Yiğit Özer; Öztürk, Kerem

doi:10.1002/micr.30953

Cited by 3 publications

(1 citation statement)

References 22 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We have previously had experience using the pedicle of pectoral muscle flaps (Gur et al, 2023). Similarly in this report, we used the pectoral flap pedicle as the recipient for free flaps in vascularly problematic necks, but differently, pectoral flaps and free flaps were harvested simultaneously.…”

Section: Discussionmentioning

confidence: 99%

Use of the pedicle of previously harvested pectoral myocutaneous flap as a recipient for free flaps in head and neck reconstruction

Gur,

Tiftikcioglu,

Kuybulu

et al. 2024

Microsurgery

Self Cite

View full text Add to dashboard Cite

IntroductionThe pectoral myocutaneous flap (PMF) is a workhorse regional reconstructive option for head and neck defects. It is commonly used for primary reconstructions due to its advantages or as a life‐boat flap in the salvage of failed reconstructions of free flaps. However, it also has intrinsic drawbacks, such as perfusion problems and partial or complete flap loss. Although there are many studies about the advantages and use of PMF in the literature, the number of studies about salvage of this workhorse flap is inadequate. We aimed to present the use of the pedicle of previously performed PMF as a recipient for free flaps in head and neck reconstruction.MethodsBetween January 2022 and August 2023, 10 free flaps were used in nine patients (three females and six males) who had previously undergone head and neck reconstruction with PMF. The age of the patients ranged from 54 to 74 years. Seven out of the nine PMFs were previously performed by different surgical teams. Squamous cell carcinoma (SCC) was the reason for primary surgeries in all patients and the PMFs were used for right lower lip and right submandibular defect, left lower lip and mentum defect, lower lip defect, right lower lip and right submandibular defect, right retromolar trigone defect, right buccal defect, left anterolateral esophageal defect, right retromolar trigone defect and left anterolateral pharyngoesophageal defect reconstructions. The problems were partial skin island necrosis and wound dehiscence in six patients and total skin necrosis in three patients. The partial skin island necroses already showed that the pedicles were unproblematic. For patients with total skin island necrosis the muscle stalks so the pedicles were also unproblematic which were confirmed by physical examination and Doppler device. After complications, the finally defects were located in the lower lip, left lower lip and mentum, right lower lip and right submandibular area, left anterolateral esophageal area and left neck, right buccal area, right retromolar trigon, left anterolateral pharyngoesophageal fistula and left neck. The sizes of the defects were between 3 × 4 cm and 11 × 17 cm. For all patients, the pedicle of the previously harvested PMF was used as a recipient for free flaps. Since the PMF was flipped over the clavicula for the reconstruction previously, the pedicle was so close to skin or skin graft which was used for coverage of the muscle stalk. The Doppler device was used first over the clavicle where the PMF was flipped for vessel identification. After marking the vessels, a vertical zigzag incision was made on the skin or skin graft. The perivascular fatty tissue and the pedicle were encountered with minimal dissection by the guidance of Doppler. After meticulous microscopic dissection, the pedicle of PMF was prepared for anastomoses as usual. Six radial forearm free flap (RFFF) and four anterolateral thigh flap (ALT) flaps were used in the head and neck reconstructions for the nine patients.ResultsThe sizes of the flaps were between 4 × 5 cm and 12 × 17 cm. The diameters of the recipient arteries were between 0.9 and 1.2 mm. Recipient veins were approximately the same diameter as the arteries. In one patient, two vein grafts were used for lengthening both the artery and vein to reach recipient vessels. End‐to‐end anastomoses without vein grafts were performed in the remaining patients. One arterial thrombosis that manifested on the first postoperative day was salvaged successfully. Hematoma was seen in two patients and wound dehiscence was seen in three patients. There was no partial or total flap necrosis and all flaps survived. The follow‐up period ranged from 2 to 12 months. Despite successful reconstructions, two patients died during the follow‐up period due to unrelated conditions. Functional results were acceptable in the remaining patients.ConclusionThe pedicle of previously used pectoral myocutaneous flaps may be a useful alternative option as the recipient for free flaps in head and neck reconstruction.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of the pedicle of previously harvested pectoral myocutaneous flap as a recipient for free flaps in head and neck reconstruction

Gur,

Tiftikcioglu,

Kuybulu

et al. 2024

Microsurgery

Self Cite

View full text Add to dashboard Cite

show abstract

Free Flap Reconstruction of the Lower Lip: A Systematic Review and Meta-Analysis

Murray-Douglass,

Romeo,

Fox

2024

J Reconstr Microsurg

View full text Add to dashboard Cite

Background Large defects of the lower lip often require free tissue coverage. Fasciocutaneous free flaps have been traditionally used, but innervated muscular free flaps may fundamentally address orbicularis oris deficiency and improve dynamic competence. This review aimed to determine if innervated muscular free flaps provided benefit over fasciocutaneous free flaps for reconstruction of defects of more than 50% of the lower lip. Outcomes of interest included functional oral outcomes including oral competence, aesthetic outcomes, and patient-reported outcome measures. Methods Five databases (PubMed, Embase, Web of Science, CINAHL, and CENTRAL) were searched for variations of “lip” and “free flap.” Two authors screened articles and included primary research of free flap reconstruction of more than 50% of the lower lip from any etiology in living humans with an English full-text available. Composite bony flaps were excluded. Oral competence and aesthetic satisfaction, reconstruction details, and complications were extracted. Proportional meta-analyses were used to synthesize results for fasciocutaneous free flaps, which were compared with those for muscular free flaps. Results Fifty-nine articles describing 242 patients were included. Muscular free flaps reported significantly higher proportional oral competence than fasciocutaneous free flaps (98 vs. 83%, p = 0.01). Aesthetic outcomes (98 vs. 97%, p = 0.22) and complications (17 vs. 18%, p = 0.79) were equivalent between fasciocutaneous and muscular free flaps. Conclusion Muscular free flaps may address the fundamental orbicularis oris defect that causes oral incompetence and seem to provide better functional results. Aesthetic outcomes and complications seem to be equivalent.

show abstract

Reconstruction of Scalp Defects with Free Flaps

GUR,

KUYBULU,

BEKİR

et al. 2023

Ege Tıp Dergisi

Self Cite

View full text Add to dashboard Cite

Amaç: Skalp; kalvaryal kemiklerin üzerini örtmesi ve saç içermesi gibi önemli görevlere sahiptir. Fonksiyonel ve estetik önemi nedeniyle skalp rekonstrüksiyonu plastik cerrahların sıklıkla ilgilendiği özel bir konu haline gelmiştir. Serbest flepler skalp rekonstrüksiyonu için uzun zamandır güvenli bir şekilde kullanılmasına rağmen ideal flep konusunda literatürde bir fikir birliğine ulaşılamamıştır. Çalışmamızda skalp rekonstrüksiyonlarındaki serbest flep tecrübelerimizi sunmayı amaçladık. Gereç ve Yöntem: 2018-2021 yılları arasında toplam 7 hastada (3 kadın, 4 erkek ) 8 serbest flep ile skalp rekonstrüksiyonu uygulandı. Hastaların yaşları 8 – 73 arasındaydı. Serbest flep tercihlerimiz arasında 4 latissimus dorsi flebi, 3 anterolateral uyluk flebi ve 1 vertikal rektus abdominis muskulokutan flebi yer almaktaydı. Alıcı damar olarak olarak temporalis süperfisiyalis, temporalis süperfisiyalisin frontal dalı, oksipital damarlar, fasiyal damarlar ve trapezius kasının uygun çapta perforatörü kullanıldı. Bulgular: Latissimus dorsi serbest flebi yapılan 1 hastada venöz tromboz görüldü. Tüm girişimlere rağmen flep kurtarılamadı. Komplikasyon olarak 1 hastada donör alanda seroma ve 1 hastada alıcı alanda dehisans görüldü. Ek komplikasyon veya flep kaybı gözlenmedi. Sonuç: Serbest flepler geniş ve/veya kompozit skalp defektlerinde kullanışlı seçeneklerdir. Teknik zorluklarına rağmen, perforatör fleplerin avantajlarından dolayı skalp rekonstrüksiyonunda ilk tercih olabileceğini düşünmekteyiz. Latissimus dorsi flebi, ilk flebin başarısızlığı durumunda kurtarıcı bir alternatif olarak kullanılabilir. Not: Çalışmamız 18-21 Mayıs 2022 tarihinde Bodrum, Muğla’da gerçekleştirilen 9. Ulusal Rekonstrüktif Mikrocerrahi ve 2. Ulusal Acil El Cerrahisi ve Mikrocerrahi Kongresinde sözlü bildiri olarak sunulmuştur.

show abstract

Transferring pectoral muscle flap to depleted neck to create a new recipient source for free flaps in head and neck reconstruction

Cited by 3 publications

References 22 publications

Use of the pedicle of previously harvested pectoral myocutaneous flap as a recipient for free flaps in head and neck reconstruction

Use of the pedicle of previously harvested pectoral myocutaneous flap as a recipient for free flaps in head and neck reconstruction

Free Flap Reconstruction of the Lower Lip: A Systematic Review and Meta-Analysis

Reconstruction of Scalp Defects with Free Flaps

Contact Info

Product

Resources

About