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https://www.readbyqxmd.com/read/28203499/sandwich-fascial-anterolateral-thigh-flap-in-head-and-neck-reconstruction-evolution-or-revolution
#1
Mario Cherubino, Jens Berli, Mario Turri-Zanoni, Paolo Battaglia, Francesca Maggiulli, Martina Corno, Federico Tamborini, Edoardo Montrasio, Paolo Castelnuovo, Luigi Valdatta
INTRODUCTION: The anterolateral thigh perforator flap (ALT) represents the workhorse for most reconstructive efforts in the head and neck regions. The main advantages of this flap are its versatility, the length of the pedicle, and the low morbidity of the donor site. The major drawback is the bulkiness of this flap with the frequent need for secondary revisions. To overcome this, we have developed a novel way to harvest and inset the ALT, called the sandwich fascial ALT flap (SALT). METHODS: All patients undergoing head and neck reconstruction using the SALT flap from January 2013 to March 2016 were included in this retrospective analysis...
January 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28195002/coverage-of-tendon-exposure-after-radial-forearm-free-flap-by-the-dorsoulnar-artery-perforator-flap
#2
Rémi Foissac, Marc Benatar, Olivier Dassonville, Alexandre Bozec, Gilles Poissonnet, Olivier Camuzard
Objective This study was designed to assess the effectiveness of an alternative technique using a perforator flap to manage secondary tendon exposure after a radial forearm free flap in head and neck oncologic surgery. Study Design Prospective cohort study. Setting Plastic Reconstructive Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, France. Subjects and Methods Despite its numerous advantages, the radial forearm free flap is associated with significant donor site morbidity and the risk of secondary tendon exposure...
February 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28183429/successful-facial-artery-pseudoaneurysm-coiling-and-pedicle-preservation-following-free-tissue-transfer
#3
Andrew T Day, Dane J Genther, Ferdinand Hui, Wojciech K Mydlarz, Gillian Griffith, Shaun C Desai
Patients undergoing free tissue reconstruction are at risk for development of an anastomotic pseudoaneurysm, which may present as delayed neck hemorrhage or a pulsatile neck mass. Diagnosis may be achieved by noninvasive imaging, angiography, and exploration. Management strategies for head and neck pseudoaneurysms have included open vessel ligation, open direct vessel repair, endovascular parent vessel embolization, and, most recently, endovascular pseudoaneurysm embolization. In patients with anastomotic pseudoaneurysms where adequate flap inosculation is doubted, endovascular pseudoaneurysm embolization with pedicle preservation may be an appropriate primary treatment approach...
January 2017: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/28177337/free-flap-loss-caused-by-heparin-induced-thrombocytopenia-and-thrombosis-hitt-a-case-report-and-literature-review
#4
E Segna, A R Bolzoni, C Baserga, A Baj
Heparin-induced thrombocytopenia and thrombosis (HITT) represents a dramatic condition that is difficult to diagnose because of nuanced clinical presentation. Therefore, in every case of microvascular thrombosis during heparin-therapy prompt suspicion about HITT is necessary to avoid flap necrosis. We present a case of HITT which, as the 8 other articles reviewed, clearly shows that HITT is difficult to diagnose and complex to manage. Microvascular reconstruction is the first choice in head and neck reconstruction; unfortunately, dramatic outcomes in free flap surgery due to unpredictable thrombotic events are still reported in the English literature...
December 2016: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/28177329/fibular-osteofasciocutaneous-flap-in-computer-assisted-mandibular-reconstruction-technical-aspects-in-oral-malignancies
#5
M Berrone, E Crosetti, P L Tos, M Pentenero, G Succo
Virtual surgical planning technology in head and neck surgery is witnessing strong growth. In the literature, the validity of the method from the point of view of accuracy and clinical utility has been widely documented, especially for bone modelling. To date, however, with its increased use in head and neck oncology, and consequently the increased need for bone and soft tissue reconstruction, is important to carry out the virtual programme considering not only bone reconstruction but also all aspects related to the reconstruction of soft tissue using composite flaps...
December 2016: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/28177328/head-and-neck-reconstruction-with-pedicled-flaps-in-the-free-flap-era
#6
R Mahieu, G Colletti, P Bonomo, G Parrinello, A Iavarone, G Dolivet, L Livi, A Deganello
Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed...
December 2016: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/28166137/vascular-complications-and-free-flap-salvage-in-head-and-neck-reconstructive-surgery-analysis-of-150-cases-of-reexploration
#7
Yen-Hao Chiu, Dun-Hao Chang, Cherng-Kang Perng
INTRODUCTION: Despite the excellent reliability of free tissue transfer, flap failure is devastating, and in addition to patient morbidity, it may increase hospital stay and associated costs. Previous studies have evaluated factors related to flap salvage, regarding the operative strategy for flap salvage surgery. The present study aimed to share our experience of reexploration and describe operative standards dealing with vascular thrombosis. METHODS: We retrospectively reviewed 150 (of 1258) free flaps for head and neck reconstruction that showed signs of vascular compromise at our institution during a 13-year period between 2002 and 2015...
February 4, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28162053/cell-and-growth-factor-loaded-keratin-hydrogels-for-treatment-of-volumetric-muscle-loss-vml-in-a-mouse-model
#8
Hannah B Baker, Juliana A Passipieri, Mevan Siriwardane, Mary Ellenburg, Manasi Vadhavkar, Christopher R Bergman, Justin M Saul, Seth Tomblyn, Luke Burnett, George Joseph Christ
Wounds to the head, neck and extremities have been estimated to account for ~84% of reported combat injuries to military personnel. Volumetric muscle loss (VML), defined as skeletal muscle injuries in which tissue loss results in permanent functional impairment, are common among these injuries. The present standard of care entails the use of muscle flap transfers, which suffer from the need for additional surgery when using autografts or the risk of rejection when cadaveric grafts are used. Tissue engineering (TE) strategies for skeletal muscle repair have been investigated as a means to overcome current therapeutic limitations...
February 4, 2017: Tissue Engineering. Part A
https://www.readbyqxmd.com/read/28153563/perforator-free-flaps-in-head-and-neck-reconstruction-a-single-center-low-volume-experience
#9
Annelies Weckx, Natalie Loomans, Olivier Lenssen
OBJECTIVE: The aim of this article is to investigate the results of free-flap reconstructions in the head and neck area in a secondary low-volume institution and compare these with the literature. STUDY DESIGN: A retrospective study was performed of all patients who underwent free-flap reconstructive surgery in our institution from January 9, 2011, to July 12, 2015, by one young surgeon in a one-team approach. The types of flaps applied, defect sites, pathology, anastomotic details, success and complication rates, lengths of stay, and patients' ages and comorbidities were analyzed...
December 7, 2016: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
https://www.readbyqxmd.com/read/28152218/tailored-approach-to-oromandibular-reconstruction-in-patients-with-compromised-lower-limb-vessels
#10
Conor P Barry, James Brown, Rebecca Hanlon, Richard Shaw
BACKGROUND: The purpose of this study was to compare outcomes for segmental reconstruction of the mandible between patients who underwent reconstruction with a fibula flap (group 1), and those with an alternative osseous free flap in which the fibula flap was unsuitable either for defect reasons (group 2) or in which the fibula flap could not safely be harvested because of compromised leg vessels (group 3). METHODS: One hundred fifty-two patients who underwent osseous free flap reconstruction of a mandibular segmental defect between January 2008 and June 2014 were identified from operating records...
February 2, 2017: Head & Neck
https://www.readbyqxmd.com/read/28140835/comparison-of-video-and-in-person-free-flap-assessment-following-head-and-neck-free-tissue-transfer
#11
A Sean Alemi, Rahul Seth, Chase Heaton, Steven J Wang, P Daniel Knott
Objective Compare the efficiency of remote telehealth flap assessments with traditional in-person flap assessments. Study Design Observational study with retrospective review. Setting Tertiary academic medical center. Subjects and Methods All patients undergoing head and neck free tissue transfer were included in the study. All patients whose surgery was performed at hospital A underwent an in-person flap check overnight. Those at hospital B received a remote flap assessment. The primary outcome was total time spent performing the midnight flap assessment, including travel time...
January 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28138794/perforator-variability-in-the-anterolateral-thigh-free-flap-a-systematic-review
#12
REVIEW
Ross K Smith, James Wykes, David T Martin, Navin Niles
OBJECTIVES: The use of free flaps greatly improves reconstruction options and quality of life for patients undergoing oncological resections. The anterolateral thigh (ALT) free flap is frequently used in the head and neck. The aim of this review was to provide a summary of published evidence assessing perforator anatomy of this flap. METHODS: A broad search was undertaken through the PubMed database using the terms "anterolateral thigh free flap" and "perforator"...
January 30, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/28124630/cost-analysis-of-osteoradionecrosis
#13
L Park, N Lilic, B Addison, R Patel
OBJECTIVE: Osteoradionecrosis is a significant complication of head and neck cancer treatment, and its most severe form (grade III) necessitates radical surgery. This study aimed to compare the cost of free-flap reconstructive surgery for grade III osteoradionecrosis and similar non-osteoradionecrosis cases in order to assess the cost burden of osteoradionecrosis treatment. METHODS: All patients who underwent free-flap reconstructive surgery for osteoradionecrosis between July 2004 and July 2010 at Auckland City Hospital (19 patients) were identified, and relevant data were collected retrospectively...
January 26, 2017: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/28121905/reply-suprafascial-anterolateral-thigh-flap-harvest-a-better-way-to-minimize-donor-site-morbidity-in-head-and-neck-reconstruction
#14
Yen-Chou Chen, Mario F Scaglioni
No abstract text is available yet for this article.
February 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28118198/microvascular-tissue-transfers-for-midfacial-and-anterior-cranial-base-reconstruction
#15
Ali Emre Aksu, Hakan Uzun, Ozan Bitik, Gökhan Tunçbilek, Tunç Şafak
Reconstruction of a midfacial defect can represent a difficult challenge for the plastic surgeon. Although many midfacial deformities have traumatic or congenital origins, the vast majority of head and neck defects occur after resection of malignant head and neck neoplasms. Autogenous reconstruction is now routinely performed for larger, complex defects resulting from surgical resection or trauma. In this study, the authors present 27 patients with midfacial defects reconstructed with free flaps. Twenty-two of the defects were created by surgical ablation of cancer (maxillectomy) and the others were traumatic...
January 23, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28117814/a-model-of-free-tissue-transfer-the-rat-epigastric-free-flap
#16
Diogo Casal, Diogo Pais, Inês Iria, Eduarda Mota-Silva, Maria-Angélica Almeida, Sara Alves, Cláudia Pen, Ana Farinho, Luís Mascarenhas-Lemos, José Ferreira-Silva, Mário Ferraz-Oliveira, Valentina Vassilenko, Paula A Videira, João Gory O'Neill
Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures...
January 15, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28109470/the-fate-of-the-free-flap-pedicle-after-free-tissue-transfer-to-the-head-and-neck-area
#17
Maarten L V Van Genechten, Martin D Batstone
OBJECTIVES: Little is understood about what happens to the vascular pedicle following free tissue transfer in the head and neck region. The viability of a free flap completely depends on the vascular supply by its vascular pedicle until neovascularization occurs from surrounding tissues. The aim of this study is to find out how long a vascular pedicle lasts following free tissue transfer in the head and neck region. MATERIALS AND METHODS: Patients were recruited from the Maxillofacial Unit at the Royal Brisbane & Women's Hospital...
February 2017: Oral Oncology
https://www.readbyqxmd.com/read/28092922/the-effectiveness-of-free-vascularized-fibular-flaps-in-osteonecrosis-of-the-femoral-head-and-neck-a-systematic-review
#18
Cassandra A Ligh, Jonas A Nelson, John P Fischer, Stephen J Kovach, L Scott Levin
Background Free vascularized fibular flaps (FVFFs) are accepted surgical options to treat osteonecrosis of the femoral head and neck (ONFHN) to prevent conversion to total hip replacement (THR), yet many studies are single institution cohorts, with little generalizability. Purpose The purpose of this study was to perform a systematic review examining the comparative effectiveness of FVFF to treat ONFHN, particularly preventing conversion to a THR and improving hip function/symptoms. Methods We searched PubMed and EMBASE databases using femoral head, free fibula, and femoral neck keywords...
January 16, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28067972/single-innervated-segmented-vastus-lateralis-for-midfacial-reanimation-during-radical-parotidectomy
#19
Lauren Sh Chong, Timothy J Eviston, Bruce Ashford, Ardalan Ebrahami, Jonathan R Clark
BACKGROUND: Innervated free muscle transfer using the gracilis muscle or temporalis myoplasty has been successfully utilized for facial reanimation in chronic facial palsy. These techniques are less suited to immediate facial reconstruction in the setting of radical parotidectomy, in which the complexity of the defect, patient age, postoperative radiotherapy, and limited life expectancy pose particular challenges. METHODS: We present a novel description of the use of a chimeric anterolateral thigh (ALT) flap and innervated vastus lateralis to achieve midface static suspension and dynamic reanimation in the setting of radical parotidectomy...
January 9, 2017: Head & Neck
https://www.readbyqxmd.com/read/28064382/early-assessment-of-feasibility-and-technical-specificities-of-transoral-robotic-surgery-using-the-da-vinci-xi
#20
Philippe Gorphe, Jean Von Tan, Sophie El Bedoui, Dana M Hartl, Anne Auperin, Quentin Qassemyar, Antoine Moya-Plana, François Janot, Morbize Julieron, Stephane Temam
The latest generation Da Vinci(®) Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci(®) Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62...
January 7, 2017: Journal of Robotic Surgery
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