Microvascular free tissue transfer and cochlear implants: A case series and literature review

Defects of the scalp and lateral temporal bone (LTB) represent a unique challenge to the reconstructive surgeon. Simple reconstructive methods such as skin grafts, locoregional flaps, or tissue expanders are often not feasible due to a myriad of reasons. Vascularized free tissue transfer coverage offers distinct advantages in managing these defects. A retrospective case series was performed on all patients at the University of Washington Medical Center who had scalp or LTB defects reconstructed with free tissue transfer from May 1996 to July 2009. Cases were analyzed for defect characteristics, flap type, vessel selection, radiation status, dural exposure, complications, and outcomes. Sixty-eight free flaps were performed in 65 patients with scalp or LTB defects. Twenty-two resections included craniotomy, and 48 patients had pre- or postoperative radiation. Defects ranged from 6 to 836 cm2. All flaps (46 latissimus, 11 rectus, 4 radial forearm, 6 anterolateral thigh, and 1 omental) were transferred successfully. Vein grafts were required in five cases. Complications included delayed flap failure requiring secondary reconstruction, neck hematoma, venous thrombosis, skull base infection, large wound dehiscence, small wound dehiscence, donor site hematoma and seroma, and cerebrospinal fluid leak. Cosmetic results were consistent and durable. Microvascular free tissue transfer is a safe, reliable method of reconstructing scalp and LTB defects and offers favorable cosmetic results. We favor the use of latissimus muscle-only flap with skin graft coverage for large scalp defects and rectus or anterolateral thigh free flaps for lateral temporal bone defects.

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637 Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose and Throat Defects: A Case Series

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.287 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S174-S175

Author(s):

Jake Laun ◽

Julian Pribaz

Keyword(s):

Head And Neck ◽

External Auditory Canal ◽

Case Series ◽

Free Tissue Transfer ◽

External Auditory Meatus ◽

Cancer Resection ◽

Stoma Creation ◽

Tissue Transfer ◽

Reconstructive Ladder ◽

Radial Forearm

Abstract Introduction Head and neck defects, whether from burns or cancer resections, are complex and often require free flap reconstruction. Radial forearm and anterolateral thigh (ALT) flaps are commonly used due to their thin and versatile nature. However, abdominal based free tissue transfer is one valuable alternative that can cover large defects and may become a more appropriate option on the reconstructive ladder when the defect includes reconstruction of a tubular structure, such as the external auditory canal, a neck tracheostomy/stoma site or an external nasal opening. We present a novel utilization of abdominal free tissue transfer for coverage of large ear and scalp burn defects as well as neck and midface defects with usage of the umbilical stalk for tubed reconstruction. Methods Four patients presented for reconstruction: two patients had sustained large ear and scalp burns resulting in complete ear loss; one had a large neck defect resulting from recurrent cancer resection which necessitated a laryngectomy and stoma creation; and one patient had a large central face defect post-cancer resection. All four patients underwent an abdominal based free tissue transfer with reconstruction of the external auditory canal in the ear and scalp burns, stoma creation in the neck defect, and the external nasal opening in the central face defect, all utilizing the vascularized umbilical stalk for the tubed reconstruction. Results All patients recovered post-operatively without any reported complications such as tubular stenosis or contracture while maintaining umbilical stalk tubular patency. Conclusions Reconstruction of a tubed structure in head and neck defects, whether the external auditory meatus, an external nasal opening or a neck stoma post burn or cancer resection, can be a difficult and challenging operation fraught with potential complications. We present a novel method of reconstruction of large defects employing the use of the uniquely thin and vascularized umbilical stalk for tubular reconstruction.

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Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1393725 ◽

2015 ◽

Vol 8 (3) ◽

pp. 179-189 ◽

Cited By ~ 11

Author(s):

Michael Sosin ◽

Arif Chaudhry ◽

Carla De La Cruz ◽

Branko Bojovic ◽

Paul N. Manson ◽

...

Keyword(s):

Donor Site ◽

Case Series ◽

Perforator Flap ◽

Free Tissue Transfer ◽

The Elderly ◽

Lessons Learned ◽

Soft Tissue Coverage ◽

Scalp Reconstruction ◽

Tissue Transfer ◽

The Mean

This article aims to demonstrate an individualized approach to an elderly patient requiring scalp reconstruction, to describe the methodology in flap selection, lessons learned, and report outcomes. A retrospective review of a single surgeon's experience of scalp reconstruction (E. D. R.) using free tissue transfer from 2005 to 2011, in patients older than 70 years, was completed. A total of eight patients met the inclusion criteria, five males and three females, with a mean age of 80.4 years (range, 73–92). Free tissue transfer achieved 100% soft tissue coverage. Six of the eight patients required cranioplasty. The mean size calvarial defect was 92 cm2 (range, 35–285 cm2). The mean flap size was 117.6 cm2 (range, 42–285 cm2). Free flaps included three ulnar, three anterolateral thigh, one latissimus dorsi, and one thoracodorsal perforator flap. The mean follow-up time was 18.4 months (range, 3–46 months). Donor site morbidity was minimal. Mortality was 0%. Immediate flap failure was 0%. Other complications occurred in six of the eight patients. Mean revisionary procedures were 1.25 procedures per patient. It was concluded that chronological age does not increase mortality or catastrophic flap complications; however, morbidity is increased in the elderly and revisionary surgery is likely.

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Retrospective case series of primary and secondary microvascular free tissue transfer reconstruction of midfacial defects

Journal of Prosthetic Dentistry ◽

10.1067/mpr.2001.118875 ◽

2001 ◽

Vol 86 (4) ◽

pp. 369-376 ◽

Cited By ~ 20

Author(s):

Neal D. Futran

Keyword(s):

Case Series ◽

Free Tissue Transfer ◽

Retrospective Case ◽

Tissue Transfer ◽

Retrospective Case Series

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Bedside Neck Exploration for Venous Flow Coupler Signal Loss in Postoperative Free Tissue Transfer Monitoring

Otolaryngology ◽

10.1177/01945998211052938 ◽

2021 ◽

pp. 019459982110529

Author(s):

Kyle P. Davis ◽

James Reed Gardner ◽

Quinn A. Dunlap ◽

Emre A. Vural ◽

Jumin Sunde ◽

...

Keyword(s):

Operating Room ◽

Tertiary Care ◽

Clinical Signs ◽

Case Series ◽

Free Tissue Transfer ◽

Hospital Charges ◽

Neck Exploration ◽

Signal Loss ◽

Venous Anastomosis ◽

Tissue Transfer

Objective To describe the role and efficacy of bedside neck exploration following free tissue transfer. Study Design Retrospective case series. Setting Single tertiary care institution. Methods A retrospective chart review was conducted of 353 patients who underwent free tissue transfer between January 2017 and April 2021. Bedside exploration was performed under mild sedation in patients who had loss of venous Doppler signal with equivocal clinical signs of venous insufficiency. Results A total of 11 patients underwent bedside assessment of the microvascular pedicle. In 6 cases, a return to the operating room was avoided. Five of these patients had coupler malfunction, and in 1 patient a venous kink was discovered and remedied at the bedside. Five patients required return to the operating room. Venous thrombosis requiring thrombectomy and revision of the venous anastomosis was discovered in 3 patients. One patient had a developing hematoma necessitating evacuation in the operating room, and 1 returned to the operating room due to sternocleidomastoid muscular compression of the venous pedicle. There were no flap failures within the study group. In all cases, broad-spectrum intravenous antibiotic coverage was prophylactically used, and no instances of wound infection were observed. Avoidance of returning to the operating room prevented an estimated $9222 of hospital charges per event. Conclusion Bedside neck exploration can be incorporated as a safe and cost-effective intermediary for definitive determination of need for return to the operating room.

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Free tissue transfer for necrotizing fasciitis reconstruction: A case series

Burns ◽

10.1016/j.burns.2017.04.007 ◽

2017 ◽

Vol 43 (7) ◽

pp. 1561-1566 ◽

Cited By ~ 8

Author(s):

Justin Peter Gawaziuk ◽

Tianyi Liu ◽

Leif Sigurdson ◽

Edward Buchel ◽

Thomas Edward Jo Hayakawa ◽

...

Keyword(s):

Necrotizing Fasciitis ◽

Case Series ◽

Free Tissue Transfer ◽

Tissue Transfer

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Free Flap Reconstruction after Complications of Total Ankle Arthroplasty: Case Series and Review of the Literature

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0038-1641733 ◽

2018 ◽

Vol 03 (01) ◽

pp. e13-e20

Author(s):

Jocelyn Lu ◽

Tammer Elmarsafi ◽

John Steinberg ◽

Paul Kim ◽

Christopher Attinger ◽

...

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Case Series ◽

Free Tissue Transfer ◽

Total Ankle Arthroplasty ◽

Anterior Tibial Artery ◽

Ankle Arthroplasty ◽

Tissue Transfer ◽

Anterior Tibial

Background Postoperative complications of total ankle arthroplasty (TAA) include anterior surgical site dehiscence, hardware failure, infection, and amputation. Early intervention with free flap may provide TAA salvage. We report the largest series of failed TAA require microsurgical free tissue transfer, identify risk factors, and examine the long-term post-free flap outcomes. Materials and Methods This is a case series of consecutive patients from a single institution dedicated to limb salvage. Inclusion criteria included patients who underwent TAA with complications related to the index surgery and underwent microsurgical free tissue transfer. Nine patients were identified within the inclusion parameters. Results Patients presented with osteomyelitis 4 (44%), soft tissue infections 4 (44%), and wound dehiscence 1 (11%) following TAA. Three (33%) radial forearm free flaps and six (67%) anterolateral thigh flaps were used, with a 100% microsurgical success rate. Preoperative angiography revealed six (67%) patients with anterior tibial artery occlusion at the level of the ankle or below. Patients required an average of 2.7 ± 1 (range 1–4) operative débridements prior to free flap, with successful flap outcome and return to full weight bearing status in nine (100%) patients. The mean long-term lower extremity functional scale score was 62 out of 80 points. Conclusion Microsurgical free tissue transfer is an effective and favorable strategy to attain a stable soft tissue envelope for patients presenting with surgical site complications following TAA. We recommend early involvement with plastic surgery and endovascular angiography to evaluate the integrity of the anterior tibial artery.

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Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction

Plastic Surgery International ◽

10.1155/2016/2841816 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8

Author(s):

Adrian Ooi ◽

Jonathan Ng ◽

Christopher Chui ◽

Terence Goh ◽

Bien Keem Tan

Keyword(s):

Soft Tissue ◽

Case Series ◽

Free Tissue Transfer ◽

Soft Tissue Coverage ◽

Soft Tissue Reconstruction ◽

Flap Reconstruction ◽

Case Review ◽

Tissue Transfer ◽

Tissue Reconstruction ◽

Elbow Reconstruction

Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n=5), regional pedicled (n=7), and free (n=8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.

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