Flap Failure (flap + failure)

Distribution by Scientific Domains


Selected Abstracts


Analysis of free flap viability based on recipient vein selection

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2009
David O. Francis MD
Abstract Background. Venous anastomotic failure is the primary reason for microvascular free tissue transfer failure. Donor and recipient veins can be oriented in the same longitudinal axis (end-to-end anastomosis), or the donor vein can be anastomosed to the internal jugular vein in an end-to-side configuration. No consensus on the optimal anastomosis configuration exists. We sought to evaluate whether type of venous anastomosis impacts flap survival rate. Methods. Data were collected on all patients undergoing microvascular free flap reconstruction of head and neck defects at the University of Washington between August 1993 and April 2007. Flaps with a single venous anastomosis were analyzed. Flaps were stratified into those with end-to-end and end-to-side anastomoses. Survival rates were compared between groups using bivariate and multivariate techniques. Results. Inclusion criteria were met by 786 free flaps; 87% performed in an end-to-end and 13% in an end-to-side configuration. Flap re-exploration and failure rate were 4.3% and 1.1%, respectively. In multivariate analysis, there was no difference in odds of flap re-exploration (OR .70, 95% CI .23,2.18) or flap failure whether or not an end-to-end or end-to-side anastomosis was performed (OR 2.09, 95% CI .38,11.5). Conclusions. In this large cohort of patients, we found no difference in the odds of flap re-exploration or failure based on venous anastomotic configuration. Reconstructive surgeons should have both anastomotic techniques in their repertoire to optimize the success of every flap. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]


Postoperative monitoring of lower limb free flaps with the Cook,Swartz implantable Doppler probe: A clinical trial

MICROSURGERY, Issue 5 2010
B.Med.Sc., P.G.Dip.Surg.Anat., Ph.D., Warren M. Rozen M.B.B.S.
Background: Free flaps to the lower limb have inherently high venous pressures, potentially impairing flap viability, which may lead to limb amputation if flap failure ensues. Adequate monitoring of flap perfusion is thus essential, with timely detection of flap compromise able to potentiate flap salvage. While clinical monitoring has been popularized, recent use of the implantable Doppler probe has been used with success in other free flap settings. Methods: A comparative study of 40 consecutive patients undergoing microvascular free flap reconstruction of lower limb defects was undertaken, with postoperative monitoring achieved with either clinical monitoring alone or the use of the Cook-Swartz implantable Doppler probe. Results: The use of the implantable Doppler probe was associated with salvage of 2/2 compromised flaps compared to salvage of 2/5 compromised flaps in the group undergoing clinical monitoring alone (salvage rate 100% vs. 40%, P = 0.28). While not statistically significant, this was a strong trend toward an improved flap salvage rate with the use of the implantable Doppler probe. There were no false positives or negatives in either group. One flap loss in the clinically monitored group resulted in limb amputation (the only amputation in the cohort). Conclusion: A trend toward early detection and salvage of flaps with anastomotic insufficiency was seen with the use of the Cook,Swartz implantable Doppler probe. These findings suggest a possible benefit of this technique as a stand-alone or adjunctive tool in the clinical monitoring of free flaps, with further investigation warranted into the broader application of these devices. © 2009 Wiley-Liss, Inc. Microsurgery 30:354,360, 2010. [source]


Free flap failure in an anticardiolipin antibody-positive patient with neoplasm,A case report

MICROSURGERY, Issue 3 2010
Emiko Asai M.D.
We present herein a case of massive arterial thrombosis of a free rectus abdominal musculocutaneous flap used for reconstructive surgery of gingival carcinoma that could not be rescued. A 54-year-old woman underwent the operation. She had experienced two miscarriages in her 20s, but medical history was otherwise uneventful. Intraoperatively, the anastomosed artery often showed massive arterial thrombosis, and the flaps had become necrotic after bilateral flaps were used. Laboratory findings, 7 days postoperatively, showed high levels of immunoglobulin G anticardiolipin antibody. This value normalized by 2 months postoperatively after using chemotherapy. This case does not match the criteria for antiphospholipid syndrome, but some English-language reports have shown rising antiphospholipid antibody levels, particularly anticardiolipin antibodies, in patients with neoplasm. In those cases, levels have normalized after successful therapy. Antiphospholipid antibody levels should be examined before surgery to identify risks of hypercoagulability. © 2010 Wiley-Liss, Inc. Microsurgery, 2010. [source]


Management strategies following microsurgical flap failure

MICROSURGERY, Issue 1 2010
F.A.C.S., William Lineaweaver M.D.
Although increasingly rare, failed microsurgical flaps are a complicated clinical problem when they occur. Review of reports of management following microsurgical flap failure offers an outline of options. A substantial number of breast and extremity patients elect abandonment of reconstruction. The majority of head and neck, breast, and extremity patients proceed to nonmicrosurgical reconstructive options. Head and neck patients (38%) and 35% of extremity patients elect to have second microsurgical flaps, and 84% of these procedures were successful.Patient management following microsurgical flap failure includes strategic abandonment of reconstruction in some cases, use of conventional procedures in a majority of cases, and further microsurgical procedures in one-third of cases. The reconstructive surgeon should have this range of possibilities available for these difficult cases. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source]


Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: A preliminary study

MICROSURGERY, Issue 7 2009
Charlotte Holm M.D., Ph.D.
Background: Technical problems at the site of the anastomosis compromise an underappreciated proportion of microsurgical free tissue transfers. Intraoperative identification of technical errors may be able to prevent reexploration surgery and early flap failure. We report the first human study on a new microscope-integrated fluorescence angiography technique, which allows for intraoperative imaging of the anastomotic site. Methods: Fifty consecutive patients undergoing reconstructive microsurgical procedures were enrolled in the study. Intraoperative near infrared indocyanine green videoangiography (ICGA) was performed on all microsurgical anastomoses, after they had been assessed by the operating surgeon by conventional clinical patency tests. Anastomoses deemed to be occluded by the ICG-angiography were intraoperatively revised, and the result of revision was compared with angiographic findings. Results: In 11/50 (22%) of patients, where the surgeon had classified the anastomoses as patent, microangiography identified a total luminal occlusion (six) and/or significant alterations in blood flow (five), potentially predisposing toward postoperative flap failure. Intraoperative revision confirmed angiographic findings in 100% of cases, and was always associated with flap survival. The decision not to revise despite anastomotic occlusion by the intraoperative angiogram was always followed by flap loss or early reexploration. A delayed return of venous blood from the flap predisposed toward postoperative flap failure. Conclusions: Hand-sewn anastomoses are subject to technical errors, and conventional patency tests have a low sensitivity for revealing anastomotic failure. Microscope integrated microangiography is an excellent method for identifying significant anastomotic problems, which would have otherwise gone unnoticed. The potential impact on early flap failure and reexploration surgery is considerable. © 2009 Wiley-Liss, Inc. Microsurgery 2009. [source]


Compound flap from the great toe and vascularized joints from the second toe for posttraumatic thumb reconstruction at the level of the proximal metacarpal bone

MICROSURGERY, Issue 3 2009
Tsu-Min Tsai M.D.
The purpose of this study is to describe the harvesting technique, anatomic variations, and clinical applications of a compound flap from the great toe and vascularized joint from the second toe used for thumb reconstruction. Five fresh cadaver dissections were studied, focusing attention on the dorsal or plantar vascular dominance, position of the communicating branch between the dorsal and plantar system, the Gilbert classification, and the size of the first dorsal metatarsal artery (FDMA) and first plantar metatarsal artery (FPMA) to the great toe and second toe. Five compound flaps were performed on five patients with traumatic thumb amputation at the level of proximal metacarpal bone. The patients' ages ranged from 14 to 47. Follow-up period was 11,24 months. The anatomic study showed that FPMA had larger caliber in 40% of dissections, FDMA in 40%, and had the same caliber in 20%. The Gilbert classification of FDMA was 40% class I and 60% class III. In the clinical applications, four patients achieved good functional opposition and motion of transferred joints with good pinch and grip strength. There was one flap failure, and donor-site morbidity was minimal. The compound flap offers advantages over traditional toe transfer by providing two functional joints. It can be used for amputation of the thumb at carpometacarpal joint level. Finally, the compound flap maintains growth potential in children through transfer of vascularized epiphyses. The disadvantages of this compound flap include a technically challenging harvest and a longer operative time. © 2008 Wiley-Liss, Inc. Microsurgery, 2009. [source]


Customized reconstruction with the free anterolateral thigh perforator flap

MICROSURGERY, Issue 7 2008
Holger Engel M.D.
From April of 2003 through September of 2006, 70 free anterolateral thigh (ALT) flaps were transferred for reconstructing soft-tissue defects. The overall success rate was 96%. Among 70 free ALT flaps, 11 were elevated as cutaneous ALT septocutaneous vessel flaps. Fifty-seven were harvested as cutaneous ALT myocutaneous "true" perforator flaps. Two flaps were used as fasciocutaneous perforator flaps based on independent skin vessels. Fifty-four ALT flaps were used for lower extremity reconstruction, 11 flaps were used for upper extremity reconstruction, 3 flaps were used for trunk reconstruction, and 1 flap was used for head and neck reconstruction. Total flap failure occurred in 3 patients (4.28% of the flaps), and partial failure occurred in 5 patients (7.14% of the flaps). The three flaps that failed completely were reconstructed with a free radial forearm flap, a latissimus dorsi flap and skin grafting, respectively. Among the five flaps that failed partially, three were reconstructed with skin grafting, one with a sural flap, and one with primary closure. The free ALT flap has become the workhorse for covering defects in most clinical situations in our center. It is a reliable flap with consistent anatomy and a long, constant pedicle diameter. Its versatility, in which thickness and volume can be adjusted, leads to a perfect match for customized reconstruction of complex defects. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source]


Autologous fat grafting: A technique for stabilization of the microvascular pedicle in DIEP flap reconstruction

MICROSURGERY, Issue 7 2008
Eran D. Bar-Meir M.D.
Proper orientation of the microvascular pedicle is essential to ensure a high success rate in microvascular surgery. The inset of a deep inferior epigastric perforator (DIEP) flap breast reconstruction can sometimes be problematic given the long vascular pedicle, the acute takeoff from an internal mammary anastomosis, and the positioning of the flap on top of the vascular pedicle. In the postoperative period, the flap can also shift as the patient's activity level increases. We present a technique where nonvascularized autologous fat grafts are used to stabilize and cushion the vascular pedicle. Over a 14-month period, 117 consecutive DIEP flaps were performed to the internal mammary vessels with autologous fat grafting to the microvascular pedicle. Six flaps (5.1%) were explored during the immediate postoperative period for anastomotic compromise. Only one total flap failure (0.8%) was observed during this time. We had no direct complications related to the fat grafts. The use of nonvascularized autologous fat grafts is a simple and safe technique for stabilization of a microvascular pedicle. It should be considered in DIEP flap breast reconstruction and other microvascular cases where the vascular pedicle might be compressed by adjacent structures. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source]


Asymptomatic lower extremity deep venous thrombosis resulting in fibula free flap failure,

THE LARYNGOSCOPE, Issue 6 2009
Adam S. Jacobson MD
Abstract Objectives/Hypothesis: The successful harvest and transplant of a fibular flap depends on many factors, including healthy inflow and outflow systems. A contraindication to harvesting a fibular flap is disease of the lower extremity arterial system; therefore, preoperative evaluation of the arterial system is routine. Preoperative evaluation of the venous system is not routine, unless there is clinical suspicion of venous disease. Methods: Retrospective chart review. Results: Two cases of occult deep venous thrombosis (DVT) were encountered intraoperatively resulting in nontransplantable flaps. Conclusions: This finding represents a serious concern, and we believe that venous imaging should be considered in patients with significant risk factors for harboring an occult DVT. Laryngoscope, 2009 [source]


Etiology of Late Free Flap Failures Occurring After Hospital Discharge,

THE LARYNGOSCOPE, Issue 11 2007
Mark K. Wax MD
Abstract Objectives: Vascular compromise of free flaps most commonly occurs in the immediate postoperative period in association with failure of the microvascular anastomosis. Rarely do flaps fail in the late postoperative period. It is not well understood why free flaps can fail after 7 postoperative days. We undertook a case review series to assess possible causes of late free flap failure. Study Design: Retrospective review at two tertiary referral centers: Oregon Health Sciences University and University of Alabama at Birmingham. Methods: A review of 1,530 flaps performed in 1,592 patients between 1998 and 2006 were evaluated to identify late flap failure. Late flap failure was defined as failure occurring after postoperative day 7 or on follow-up visits after hospital discharge. A prospective database with the following variables was examined: age, medical comorbidities, postreconstructive complications (fistula or infection), hematoma, seroma, previous surgery, radiation therapy, intraoperative findings at the time of debridement, nutrition, and, possibly, etiologies. Results: A total of 13 patients with late graft failure were identified in this study population of 1,530 (less than 1%) flaps; 6 radial forearm fasciocutaneous flaps, 2 rectus abdominis myocutaneous flaps, 4 fibular flaps, and 1 latissimus dorsi myocutaneous flap underwent late failure. The time to necrosis was a median of 21 (range, 7,90) days. Etiology was believed to possibly be pressure on the pedicle in the postoperative period in four patients (no sign of local wound issues at the pedicle), infection (abscess formation) in three patients, and regrowth of residual tumor in six patients. Loss occurring within 1 month was more common in radial forearm flaps and was presented in the context of a normal appearing wound at the anastomotic site, as opposed to loss occurring after 1 month, which happened more commonly in fibula flaps secondary to recurrence. Conclusion: Although late free flap failure is rare, local factors such as infection and possibly pressure on the pedicle can be contributing factors. Patients presenting with late flap failure should be evaluated for residual tumor growth. [source]


Radial Forearm Osteocutaneous Free Flap in Maxillofacial and Oromandibular Reconstructions

THE LARYNGOSCOPE, Issue 9 2005
J H. Kim MD
Abstract Objectives/Hypothesis: The radial forearm osteocutaneous free flap is an excellent reconstructive modality for oromandibular and maxillofacial reconstruction in certain well-defined circumstances. The initial concern over donor site morbidity and the ability of the bone to reconstruct mandibular defects have led to only a few published series. Study Design: Retrospective study of the experience of two tertiary medical centers with radial forearm osteocutaneous free flap. Methods: Retrospectively, 52 patients were studied who underwent radial forearm osteocutaneous free flap reconstruction for cancer (49 cases) and trauma (3 cases). Bone length and skin paddle harvested, general morbidity (hematoma, wound infection, and dehiscence), recipient site morbidity (nonunion of neomandible, flap failure, and bone or plate exposure), and donor site morbidity (radius bone fracture, plate exposure, and skin graft failure) were reviewed. Results: The average skin paddle size was 55.1 cm2 (range, 15,112 cm2). The average radius bone harvest length was 6.3 cm (range, 2.5,11 cm). Donor site complications included tendon exposure (3 cases), radius bone fracture (1 case), and exposure of the plate (0). Recipient site complications included nonunion of the mandible (4), exposed mandible (1), exposed mandibular plates (2), exposed maxillary plates or bone (0), venous compromise (1), and flap failure (1). Two patients had perioperative deaths. Conclusion: Radial forearm osteocutaneous free flap is a valuable and viable option for oromandibular and maxillofacial reconstruction. [source]


The Platysma Myocutaneous Flap: Underused Alternative for Head and Neck Reconstruction,

THE LARYNGOSCOPE, Issue 7 2002
Wayne M. Koch MD
Abstract Objectives The use, advantages, and disadvantages of the platysma flap were assessed. Study Design Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001. Methods Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the ,2 test. Results Thirty-four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions. Conclusions The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects. [source]


Increasing Use of the Scapula Osteocutaneous Free Flap ,

THE LARYNGOSCOPE, Issue 9 2000
Sean C. Coleman MD
Abstract Objectives To determine the appropriate use of the scapula osteocutaneous free flap (SOFF) and to document donor site morbidity. Study Design Retrospective review and prospective physical therapy evaluation. Methods A computer database of all free flap procedures performed at a single institution was created. Specific clinical and operative details from cases involving a bone flap were extracted from the database. Rates of usage of the various osteocutaneous flaps were compared over four successive 2-year intervals (1992,1999). A single physical therapist performed a structured evaluation of the donor site. Results Overall, 64 bone flap procedures were performed, of which 24 (37.5%) were SOFF procedures. The SOFF utilization has increased from 6.6% to 63.6%, while fibula and iliac crest utilization has fallen significantly. This is in part because of the greater versatility of the SOFF, with the possibility of separate skin paddles and adequate bone length. The mean cutaneous area harvested with the SOFF was 110 cm2 (range, 48,200 cm2) compared with 55.4 cm2 (range, 25,102 cm2) and 77.6 cm2 (range, 50,120 cm2) for the fibula and iliac crest, respectively. Mean bone flap lengths were 8.37, 7.65, and 10.1 cm, respectively, for the SOFF, fibula, and iliac crest. Dual skin paddles were used in 50% of the SOFF procedures versus 2.8% for the fibula flap procedures. There were no significant complications of the donor site in any patient, and there was only one flap failure (4.1%). Related to the SOFF, donor site morbidity was subjectively judged as "mild," for pain, mobility, and strength. There were no complaints of poor appearance of the donor site. Activities of daily living were judged as "not limited" or "limited a little" in the majority of patients. Objective measurements of range of motion revealed an average reduction of 1° to 12° in five different shoulder functions. Elbow and arm ranges of motion were not limited. Strength was minimally reduced in the shoulder, while the arm and forearm showed no reduction in strength. Conclusions The SOFF is a versatile osteocutaneous free flap that can be used for a multitude of reconstructive problems. This and its relative lack of significant donor site morbidity have caused its use to increase significantly. [source]


Early Wound Complications in Advanced Head and Neck Cancer Treated With Surgery and Ir192 Brachytherapy,,

THE LARYNGOSCOPE, Issue 1 2000
Richard V. Smith MD
Abstract Objectives: Brachytherapy, either as primary or adjuvant therapy, is increasingly used to treat head and neck cancer. Reports of complications from the use of brachytherapy as adjuvant therapy to surgical excision have been limited and primarily follow Iodine 125 (I125) therapy. Early complications include wound breakdown, infection, flap failure, and sepsis, and late complications may include osteoradionecrosis, bone marrow suppression, or carotid injuries. The authors sought to identify the early wound complications that follow adjuvant interstitial brachytherapy with iridium 192 (Ir192). Study Design: A retrospective chart review of all patients receiving adjuvant brachytherapy at a tertiary medical center over a 4-year period. Methods: Nine patients receiving Ir192 brachytherapy via afterloading catheters placed during surgical resection for close or microscopically positive margin control were evaluated. It was used during primary therapy in six patients and at salvage surgery in three. Early complications were defined as those occurring within 6 weeks of surgical therapy. Results: The overall complication rate was 55% (5/9), and included significant wound breakdown in two patients, minor wound dehiscence in three, and wound infection, bacteremia, and local tissue erosion in one patient each. All complications occurred in patients receiving flap reconstruction and one patient required further surgery to manage the complication. Complication rates were not associated with patient age, site, prior radiotherapy, timing of therapy, number of catheters, or dosimetry. Conclusions: The relatively high complication rate is acceptable, given the minor nature of most and the potential benefit of radiotherapy. Further study should be under-taken to identify those patients who will achieve maximum therapeutic benefit without prohibitive local complications. [source]


Refinements in the lotus petal flap repair of the vulvo-perineum

ANZ JOURNAL OF SURGERY, Issue 8 2004
Satish K. Warrier
Background: Many reconstructive techniques have been used to repair the vulval, vaginal and perianal areas after excision. These range from grafts to various types of flap repair. The authors have modified a procedure called the lotus petal flap repair to provide a simpler, equally reliable, yet aesthetically enhanced technique for vulvo-perineal reconstruction. Methods: Where primary closure was not possible the modified lotus petal flap was employed. The present flap design was based on the dense perforators supplying the perineum. The flap resembles the petals of a lotus flower as in the design of Yii and Niranjan. However, the present modification uses a thinned cutaneous flap without identification of the blood supply. The flap is sited over an area of dense perforators. Transpostion with this thinner design allows for easy coverage of the defects. Results: In the present series of eight patients and 12 flaps no cases of partial or complete flap failure were recorded. The only complications encountered in the series were one case of cellulitis after discharge from hospital, and a single case of urethral incontinence. Conclusions: The modified lotus flap repair is a reliable, simple, and aesthetically appealing alternative to those already available to the plastic surgeon for vulval repair. [source]


Reverse facial artery,submental artery mandibular osteomuscular flap for the reconstruction of maxillary defects following the removal of benign tumors

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2009
Wei-Liang Chen DDS
Abstract Background. Functional and aesthetic restoration in maxillary reconstruction remains a challenge. Although many free flap procedures have become popular in maxillary reconstruction, these microsurgical methods have certain limitations and risks. This study assessed the reliability of the reverse facial artery,submental artery mandibular osteomuscular flap for reconstructing maxillary defects. Methods. Eight maxillary defects following benign tumor ablation were repaired with reverse facial artery,submental artery mandibular osteomuscular flaps. The patients ranged in age from 16 to 33 years; 5 were male and 3 were female. Maxillary odontogenic myxoma was present in 3 cases, maxillary fibrous dysplasia and ameloblastoma in 2 cases each, and chondromyxoid fibroma in 1 case. The defects were classified as class 2a. Results. Primary reconstruction of the maxilla was carried out using a pedicled mandibular osteomuscular flap. No flap failures occurred. Dental reconstruction was successful in all patients. Proper aesthetics and complete functionality were obtained, and there were no donor-site problems. The patients were followed for 12 to 24 months, with an average of 18.6 months, and no recurrence was encountered. Conclusion. The reverse facial artery,submental artery mandibular osteomuscular flap is safe, quick, and simple to elevate. The flap can be used reliably for reconstructing maxillary defects. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]


Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2006
Sukru Yazar MD
Abstract Background. Composite maxillary defects often involve the maxilla, nasal mucosa, palate, and maxillary sinus. We presented the surgical techniques and outcome of the osteomyocutaneous peroneal artery perforator (PAP) flap for reconstruction of composite maxillary defects. Methods. Six patients underwent an osteomyocutaneous PAP flap reconstruction of composite maxillary defects. The average age was 52 years. The defects were Cordeiro type II in three patients and type IV midfacial defects in another three patients. Results. No total or partial flap failures occurred. At a mean 12-month follow-up, five patients had a normal speech and were able to eat a regular diet. One patient tolerated a soft diet and had intelligible speech. One patient had ectropion develop. Excellent cosmesis was found in five patients. Conclusions. The osteomyocutaneous PAP flap represents a further refinement of the fibula flap and increases its versatility, with multiple skin paddles, bone segments, and soleus muscle independently isolated. It is a comparable reconstruction option for composite maxillary defects. © 2005 Wiley Periodicals, Inc. Head Neck28: 297,304, 2006 [source]


Enhancing the outcome of free latissimus dorsi muscle flap reconstruction of scalp defects

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2004
FRCS(C), Joan E. Lipa MD
Abstract Background. Reconstruction of scalp and calvarial defects after tumor ablation frequently requires prosthetic cranioplasty and cutaneous coverage. Furthermore, patients often have advanced disease and receive perioperative radiotherapy. We evaluated the complications of scalp reconstruction with a free latissimus dorsi muscle flap in this setting. Methods. The complications and the oncologic and aesthetic outcomes of six consecutive scalp reconstructions with a free latissimus dorsi muscle flap and skin graft in five patients with advanced cancer were retrospectively evaluated. Patient, tumor, defect, reconstructive, and other treatment characteristics were reviewed. Reconstructive and perioperative techniques intended to improve flap survival and aesthetic outcome and reduce complications in these patients. Results. All patients (52,76 years old) had recurrent tumors (sarcoma, melanoma, or squamous cell carcinoma) and received postoperative radiotherapy. The mean scalp defect size was 367 cm2, and partial-thickness or full-thickness calvarial resection was required in all six cases. No vein grafts were needed. The mean follow-up period and disease-free survival time were 18 and 13 months, respectively. Three patients died of their disease, and two survived disease free. There were no flap failures or dehiscences. Complications consisted of donor site seroma in two patients; partial skin graft loss in one patient; and radiation burns to the flap, face, and ears in one patient. Scalp contour and aesthetic outcome were very good in all cases except for the one case with radiation burns. Conclusions. Good outcomes were achieved using a free latissimus dorsi muscle flap with a skin graft for flap reconstruction in elderly patients with advanced recurrent cancers who received perioperative radiotherapy. Several technical aspects of the reconstruction technique intended to enhance the functional and aesthetic outcome and/or reduce complications were believed to have contributed to the good results. © 2004 Wiley Periodicals, Inc. Head Neck26: 46,53, 2004 [source]


The use of integra artificial dermis to minimize donor-site morbidity after suprafascial dissection of the radial forearm flap

MICROSURGERY, Issue 7 2007
Andreas I. Gravvanis M.D., Ph.D.
In an effort to minimize the radial forearm flap donor-site morbidity, the flap was elevated using the suprafascial dissection technique, in six patients with various facial defects. The donor site was covered primarily with Integra artificial skin and secondarily with an ultrathin split-thickness skin graft. The mean time to wound healing of the forearm donor site was 24 days. There were no flap failures, and all flaps healed uneventfully. At the end of the follow-up, all patients showed normal range of motion of the wrist and the fingers, normal power grip, and power pinch. All patients evaluated the esthetic appearance of the forearm donor site as very good. In conclusion, suprafascial dissection of the forearm flap creates a superior graft recipient site, and the use of Integra artificial dermis is a valuable advancement to further minimize the donor-site morbidity, resulting in excellent functional and aesthetic outcomes. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source]