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Head and neck free flap

D Pauchet, J-L Pigot, F Chabolle, C-A Bach
Free fibula transplant is routinely used for mandibular reconstruction in head and neck cancer. Dental rehabilitation, the objective of mandibular reconstruction, requires the use of dental implants as supports for fixed or removable dentures. Positioning of fibular bone grafts and implants determines implant osseointegration and the possibilities of dental rehabilitation. Prefabrication of a fibula free flap with dental implants prior to harvesting as a free flap can promote implant osseointegration. The position of the implants must then be precisely planned...
March 2, 2018: European Annals of Otorhinolaryngology, Head and Neck Diseases
Leslie E Cohen, Kerry A Morrison, Erin Taylor, Julia Jin, Jason A Spector, Salvatore Caruana, Christine H Rohde
BACKGROUND: Traditional free flap reconstruction of complex intraoral defects often uses large lip-splitting incisions. To reduce morbidity and preserve aesthetics, we have adopted a more technically demanding visor technique obviating an incision through the lower lip through which the resection and reconstruction are performed. METHODS: A retrospective review was performed of patients who underwent free flap reconstruction of intraoral defects over 7 years by a single plastic surgeon (C...
February 28, 2018: Annals of Plastic Surgery
Markus Pirlich, Iris-Susanne Horn, Christian Mozet, Mandy Pirlich, Andreas Dietz, Miloš Fischer
BACKGROUND: The use of the radial forearm-free flap is a well-established and reliable reconstruction method in head and neck surgery. Usually, the defect of the donor site is covered with full or split-thickness skin grafts. Since 09/2013, a direct closure of the radial forearm donor site has been performed at the ENT University Hospital Leipzig to avoid secondary donor site morbidity. However, few data are available in the literature on long-term cosmetic and functional results compared to the established indirect donor site defect coverage...
February 26, 2018: European Archives of Oto-rhino-laryngology
Max J H Witjes, Rutger H Schepers, Joep Kraeima
PURPOSE OF REVIEW: This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. RECENT FINDINGS: Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning...
February 20, 2018: Current Opinion in Otolaryngology & Head and Neck Surgery
Koichiro Kiya, Tateki Kubo, Shien Seike, Ko Hosokawa
Microvascular free tissue transfer is one of the most common techniques of reconstruction for complex head and neck surgical defects. Generally, venous thrombosis is more likely to occur than arterial thrombosis in vascular anastomosis. Thus, recipient veins must be chosen carefully. Although the internal jugular vein is preferred as a recipient vein by many microsurgeons, internal jugular vein thrombosis is a potential complication, as shown in our report. Therefore, we consider that the external jugular vein still is an option as a recipient for venous anastomosis and that it is better to perform multiple vein anastomoses with 2 different venous systems, such as the internal and external jugular systems, than anastomoses within the same venous system...
January 2018: Plastic and Reconstructive Surgery. Global Open
Ian R Wisecarver, Gerhard S Mundinger, Michael S Tarakji, Hugo St Hilaire
Squamous cell carcinoma (SCC) of the head and neck affects a significant number of people around the world every year. Treatment generally entails surgical resection, radiotherapy, chemotherapy, or some combination of the three. Following resection, microsurgical reconstruction can provide definitive coverage, replace many tissue types simultaneously, and bring healthy tissue to irradiated wound beds. Microsurgical engineering, the manipulation and reorganization of native vascular tissue, can further augment the adaptability of free tissue transfer to complex, compromised wound beds...
January 2018: Plastic and Reconstructive Surgery. Global Open
Nobuhiro Hanai, Hoshino Terada, Hitoshi Hirakawa, Hidenori Suzuki, Daisuke Nishikawa, Shintaro Beppu, Yasuhisa Hasegawa
Objectives: The purpose of this study is to evaluate whether a nutritional supplement with a high blend ratio of ω-3 fatty acids can minimize weight loss and attenuate increases in inflammatory marker levels during the perioperative period in patients undergoing surgery for head and neck carcinoma. Methods: Patients with ≥5% weight loss within 6 months were considered as targets for aggressive nutritional intervention. Among these patients, those with head and neck squamous cell carcinoma, who underwent major invasive surgery with free flap reconstruction were included in the present study...
February 6, 2018: Japanese Journal of Clinical Oncology
Sunil Rajan, Soumya Srikumar, Pulak Tosh, Lakshmi Kumar
Background and Aims: Use of lactated intravenous fluids during long surgeries could cause lactate accumulation and lactic acidosis. Acetate-based solutions could be advantageous as they are devoid of lactate. The primary aim of the study was to assess the effect of use of an acetated solution or Ringer's lactate (RL) as intraoperative fluid on lactate levels in patients without hepatic dysfunction undergoing prolonged surgeries. Material and Methods: This was a prospective, randomized, controlled trial involving sixty patients belonging to American Society of Anesthesiologists Physical Status I to II undergoing major head and neck surgeries with free flap reconstruction...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
Priyesh N Patel, Asitha D L Jayawardena, Rachel L Walden, Edward B Penn, David O Francis
Objective To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Data Sources PubMed, Embase (OVID), and CINAHL (EBSCO). Review Methods English-language, original research (systematic reviews/meta-analyses, randomized control trials, prospective or retrospective cohort studies, case-control studies, or case series) studies that evaluated the role of perioperative antibiotic use in common otolaryngology surgeries were systematically extracted using standardized search criteria by 2 investigators independently...
January 1, 2018: Otolaryngology—Head and Neck Surgery
J A LoGiudice, J G Yan, B L Massey, J Neilson, N Flugstad, J Mann
The anterolateral thigh flap (ALT) is a workhorse for a spectrum of reconstructive problems including head and neck defects. Its versatility as a chimeric flap employing a variety of soft tissues with a robust pedicle is useful for three-dimensional defects. The authors investigated the anatomical relationship between the vascular supply to the ALT and anterior femur. We studied 16 fresh cadaver limbs to identify the typical branching patterns to the femur off the descending branch of the lateral circumflex femoral artery...
December 20, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
S Christianto, A Lau, K Y Li, W F Yang, Y X Su
Venous compromise is still the most common cause of free flap failure. The use of two venous anastomoses has been advocated to reduce venous compromise. However, the effectiveness of this approach remains controversial. A systematic review and cumulative meta-analysis was performed to assess the effect of one versus two venous anastomoses on venous compromise and free flap failure in head and neck microsurgical reconstruction. A total of 27 articles reporting 7389 flaps were included in this study. On comparison of one versus two venous anastomoses, the odds ratio (OR) for flap failure was 1...
January 29, 2018: International Journal of Oral and Maxillofacial Surgery
Shawn T Joseph, B S Naveen, Mihir Mohan T, Jose Tharayil T
BACKGROUND: Restoring the anatomy and function of a partial laryngopharyngectomy with hemicricoid defect is an extremely challenging area in head and neck cancer surgery. Procedures such as tracheal autotransplantation described for these defects are complex and attempted in very few centers. Therefore, the purpose of this article was to share our technique of reconstructing such defects with tracheal advancement with myomucosal island flap for laryngopharyngeal defect (TAMMIL), which allows functional reconstruction of the larynx...
February 1, 2018: Head & Neck
Markus Lilja, Mari Markkanen-Leppänen, Sanna Viitasalo, Kauko Saarilahti, Andrew Lindford, Patrik Lassus, Antti Mäkitie
BACKGROUND: The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population. PATIENTS AND METHODS: This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland...
January 27, 2018: European Archives of Oto-rhino-laryngology
Wan-Yu Hung, Cheng-Cheng Tung, Wan-Yun Fang, Wen-Pin Kao, Shih-Lung Lin, Yi Poon, Wai-Nang Chao
BACKGROUND: The incidence of skin cancer appearing on the head and neck areas is higher in elderly patients. Although free flap reconstruction is the mainstay after tumor excision, it is challenging to complete in elderly patients, owing to the high risk of complications and/or mortality rates associated with the use of general anesthesia. In this study, we used only local anesthesia in free tissue reconstruction of the head and neck in five elderly patients. MATERIALS AND METHODS: From 2013 to 2016, 5 elderly patients with high risk of general anesthesia underwent reconstruction with either anterolateral thigh free flaps or groin free flap under local anesthesia, after wide excision of malignant tumors at head and neck...
February 2018: Annals of Plastic Surgery
Yi-Fan Chen, Tian-Hsiang Wang, Yen-Hao Chiu, Dun-Hao Chang
BACKGROUND: Free tissue transfer has become a safe and reliable means for repairing soft tissue and bony defects of the head and neck region. Although the success rate is high, the incidence of postoperative complications is common. One significant complication is postoperative hematoma formation. However, few published studies have addressed its incidence, etiology, or outcome. We performed a retrospective analysis to investigate this issue. METHODS: A retrospective review was conducted of 293 consecutive microvascular free tissue transfers in the head and neck region in a single institute from January 2013 to December 2015...
January 25, 2018: Annals of Plastic Surgery
Wei-Chen Chen, Kuo-Shu Hung, Szu-Han Chen, Shyh-Jou Shieh, Jing-Wei Lee, Jenn-Ren Hsiao, Yao-Chou Lee
BACKGROUND: Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we used this opportunity to compare outcomes between these 2 care approaches. PATIENTS AND METHODS: Patients with oral cancer who underwent cancer ablation and immediate anterolateral thigh flap reconstruction from August 2010 to July 2014 were included in this retrospective study...
February 2018: Annals of Plastic Surgery
Hsin-Ti Lai, Pao-Jen Kuo, Chih-Hau Chang, Chung-Sheng Lai, Sin-Daw Lin, Yur-Ren Kuo
BACKGROUND: Bulky appearance after free flap reconstruction in patients with head and neck cancer is common and requires revision to achieve improved final outcomes. Although different delayed debulking methods have been reported, the procedure can be technically difficult in patients with severe scaring after adjuvant radiotherapy. The present study proposes a combined method of liposuction and arthroscopic shaving for delayed contouring of free flaps in head and neck reconstruction...
February 2018: Annals of Plastic Surgery
Ross Elledge, Satyesh Parmar
PURPOSE OF REVIEW: To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient. RECENT FINDINGS: Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity...
January 22, 2018: Current Opinion in Otolaryngology & Head and Neck Surgery
P Saenthaveesuk, S-E Zhang, G-S Zheng, Y-J Liang, Y-X Su, G-Q Liao
The medial upper arm has previously been proposed as a potential free flap donor site, but the clinical application of such flaps in head and neck reconstruction has not been popular. The preliminary results of the clinical application of medial upper arm free flaps in oral cavity reconstruction are reported here. Five patients with oral cancer underwent surgical resection and neck dissection, with simultaneous reconstruction using a medial upper arm free flap. Functional outcomes were investigated using the University of Washington Quality of Life Questionnaire...
January 20, 2018: International Journal of Oral and Maxillofacial Surgery
Alia Mowery, Tyler Light, Daniel Clayburgh
OBJECTIVE: Venous thromboembolism (VTE) may cause significant postoperative morbidity and mortality; research in other surgical fields suggests an elevated VTE risk persists up to 30 days after surgery, beyond hospital discharge. We performed a review of the Veteran's Affairs Surgical Quality Improvement Project (VASQIP) database to determine the 30-day incidence of VTE following head and neck surgery and assess the proportion of VTE that occur post-discharge. MATERIALS AND METHODS: A retrospective review was performed of all head and neck ablative procedures captured in the VASQIP database between 1991 and 2015...
February 2018: Oral Oncology
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