Free tissue transfer versus pedicled flap reconstruction of head and neck malignancy defects

2010 ◽  
Vol 179 (3) ◽  
pp. 337-343 ◽  
Author(s):  
J. P. O’Neill ◽  
N. Shine ◽  
P. A. Eadie ◽  
E. Beausang ◽  
C. Timon
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Pedicled Flap ◽  
Flap Reconstruction ◽  
Head And Neck Malignancy ◽  
Tissue Transfer ◽  
Neck Malignancy

Simultaneous reconstruction of large skin and mucosal defect following head and neck surgery with a single skin paddle pectoralis major myocutaneous flap

2005 ◽  
Vol 119 (4) ◽  
pp. 303-305 ◽  
Author(s):  
P Chaturvedi ◽  
P S Pai ◽  
K A Pathak ◽  
D A Chaukar ◽  
M S Deshpande ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Pedicled Flap ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Skin Defect ◽  
Skin Paddle ◽  
Tissue Transfer ◽  
Mucosal Lining ◽  
Large Skin

The pectoralis major myocutaneous (PMMC) flap is commonly used for head and neck reconstruction especially in impoverished nations. PMMC is a sturdy pedicled flap with relatively fewer complications, the learning curve is short and no specialized training in microvascular surgery is needed in order to use this flap. In a defect that requires a large skin and mucosal lining the authors routinely use either a bi-paddle PMMC or a combination of PMMC (for the mucosal lining) and a delto-pectoral flap (for the skin defect). It is indisputable that free tissue transfer is a better way of reconstruction for the majority of most such defects. Unfortunately, not all patients can be offered this form of reconstruction due to the cost, time, expertise and infrastructural constraints in high volume centres such as ours. Bi-paddling of PMMC is hazardous in obese males and most female patients. In such patients the skin defect is reconstructed usually by the delto-pectoral (DP) flap but this, for obvious reasons, is less welcomed by the patients. The authors suggest a technique wherein mucosal lining is created by the myofascial lining (inner surface) of the flap and the skin defect is reconstructed by the skin paddle of the single paddle PMMC. It should be considered wherever a DP flap is unacceptable, or bi-paddling or free tissue transfer is not possible.

Defining the Role of Free Flaps in Partial Breast Reconstruction

2017 ◽  
Vol 34 (03) ◽  
pp. 185-192 ◽  
Author(s):  
Bianca Molina ◽  
Erez Dayan ◽  
Eric Jablonka ◽  
Michelle Okwali ◽  
Julie Kim ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Breast Conservation ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Flap Reconstruction ◽  
Breast Cancer Patients ◽  
Pedicled Flaps ◽  
Donor Tissue ◽  
Tissue Transfer

Background Free flaps have a well-established role in breast reconstruction after mastectomy; however, their role in partial breast reconstruction remains poorly defined. We reviewed our experience with partial breast reconstruction to better understand indications for free tissue transfer. Methods A retrospective review was performed of all patients undergoing partial breast reconstruction at our center between February 2009 and October 2015. We evaluated the characteristics of patients who underwent volume displacement procedures versus volume replacement procedures and free versus pedicled flap reconstruction. Results There were 78 partial breast reconstructions, with 52 reductions/tissue rearrangements (displacement group) and 26 flaps (replacement group). Bra cup size and body mass index (BMI) were significantly smaller in the replacement group. Fifteen pedicled and 11 free flaps were performed. Most pedicled flaps (80.0%) were used for lateral or upper pole defects. Most free flaps (72.7%) were used for medial and inferior defects or when there was inadequate donor tissue for a pedicled flap. Complications included hematoma, cellulitis, and one aborted pedicled flap. Conclusion Free and pedicled flaps are useful for partial breast reconstruction, particularly in breast cancer patients with small breasts undergoing breast-conserving treatment (BCT). Flap selection depends on defect size, location, and donor tissue availability. Medial defects are difficult to reconstruct using pedicled flaps due to arc of rotation and intervening breast tissue. Free tissue transfer can overcome these obstacles. Confirming negative margins before flap reconstruction ensures harvest of adequate volume and avoids later re-operation. Judicious use of free flaps for oncoplastic reconstruction expands the possibility for breast conservation.

Free Tissue Transfer versus Pedicled Flap Cost in Head and Neck Cancer

2002 ◽  
Vol 127 (3) ◽  
pp. 205-212 ◽  
Author(s):  
Gerry F. Funk ◽  
Lucy Hynds Karnell ◽  
Stacey Whitehead ◽  
Arnold Paulino ◽  
Joan Ricks ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Tissue Transfer ◽  
Pedicled Flap ◽  
Treatment Costs ◽  
Upper Aerodigestive Tract ◽  
Control Cost ◽  
Tissue Transfer ◽  
Significant Difference

OBJECTIVE: We sought to compare the overall 1-year management costs for patients receiving a free tissue transfer with those of patients receiving a pedicled flap reconstruction as a component of their primary head and neck cancer treatment. STUDY DESIGN AND SETTING: Case-control, cost identification analysis of 21 matched pairs of patients and multivariate analysis of variables associated with treatment costs was conducted in a tertiary referral academic institution. RESULTS: No significant difference in total 1-year charges between the pedicled and free tissue transfer groups was found. A structured measure of patient comorbidity was the only variable significantly associated with total 1-year charges. CONCLUSIONS: Total 1-year treatment costs of primary upper aerodigestive tract cancers are similar for patients reconstructed with free tissue transfer or a pedicled flap. SIGNIFICANCE: Within the context of overall 1-year management costs, the primary determinants of health care expense for these patients are comorbidity and extent of disease, not reconstructive technique.

scholarly journals Phlebitis Induced by Intravenous Prostaglandin E1 in Patients with Malignancy Following Flap Reconstruction: A Case Series Study

2020 ◽  
Vol 5 (11) ◽  
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Head And Neck ◽  
White Blood Cell Count ◽  
Prostaglandin E1 ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Blood Cell Count ◽  
Head And Neck Malignancy ◽  
Neck Malignancy

Background: Prostaglandin E1 (PGE1) is a vasodilator and smooth-muscle relaxant commonly used in patients with free flap reconstruction to increase the survival rate of the flap. However, phlebitis is the most common adverse event in patients who receive an intravenous solution of PGE1, and it will lead to more medical treatment. Objective: The incidence of PGE1-induced phlebitis has not been well examined. This study aimed to determine which patient characteristics increase the risk of PGE1-induced phlebitis. Methods: We retrospectively reviewed the medical records of patients with phlebitis caused by PGE1 in our hospital from May 2018 to May 2019. Among the records, we focused on patients with head and neck malignancy who received free flap reconstruction. Results: In total, 1026 patients were prescribed PGE1, and 13 patients developed PGE1-induced phlebitis. Among 78 patients with head and neck cancer, the incidence rate of phlebitis was 15.4% (12 patients). These patients’ mean age was 56 ± 9 years, and all were men. Their mean body weight, estimated glomerular filtration rate, serum creatinine level, white blood cell count, and neutrophil count were 69.6±12.6kg, 81± 18 mL/min/1.73 m2, 0.97 ± 0.19 mg/dL, 10.3 ± 4.4 103/μL, and 75% ± 12%, respectively, before PGE1 administration. The white blood cell count before PGE1 administration was significantly higher (p<0.05) in patients with phlebitis than in those without phlebitis. Conclusion: Prescribers of PGE1 should be aware that patients with head and neck malignancy who receive flap reconstruction may have an increased risk of phlebitis. These patients should be monitored upon admission to prevent PGE1-induced phlebitis.

Neutrophilic Dermatosis of Hands as Oncological Finding: Importance of Follow-Up

ORL ◽  
2021 ◽  
pp. 1-3
Author(s):  
Jérôme R. Lechien ◽  
Daphné Delplace ◽  
Mohamad Khalife ◽  
Sven Saussez
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Paraneoplastic Syndrome ◽  
Tobacco Consumption ◽  
Neutrophilic Dermatosis ◽  
Pharyngeal Cancer ◽  
Head And Neck Malignancy ◽  
Neck Malignancy

Neutrophilic febrile dermatosis (NFD) is a rare paraneoplastic syndrome that may be found in patients with head and neck cancer. NFD may appear before the neoplasia and may only concern the dorsal faces of the hands. This article reports the NFD findings of a patient with pharyngeal cancer, which was developed 2 years after the occurrence of NFD. The development of NFD in patient with alcohol and tobacco consumption should lead otolaryngologists and dermatologists to suspect head and neck malignancy. In cases of normal otolaryngological examination, patients have to be followed.

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