scholarly journals Tunneling Technique for Expedited Fibula Free Tissue Harvest

2013 ◽  
Vol 6 (4) ◽  
pp. 233-236
Author(s):  
Yadranko Ducic ◽  
Robert DeFatta ◽  
Erik M. Wolfswinkel ◽  
William M. Weathers ◽  
Larry H. Hollier
Keyword(s):  
Retrospective Chart Review ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Harvest Time ◽  
Tourniquet Time ◽  
Flap Loss ◽  
Free Fibula ◽  
Free Tissue Transfer Flap ◽  
Ankle Function ◽  
Oromandibular Reconstruction

Free fibula transfer can be associated with a slow and tedious dissection/harvest due to difficulty in visualizing the deeper structures. The purpose of this article is to review the first author's (Y.D.) experience with a novel technique for expedited harvest of fibula free flaps for mandibular reconstruction. A retrospective chart review was performed using the first author's clinical practice using chart data from September 1997 to August of 2007. All patients with available chart data who had undergone free fibular transfer for oromandibular reconstruction were included in this study. Charts that met the specified inclusion criteria were reviewed for patient demographic information, reason for free tissue transfer, flap loss rates (partial and total) and reasons for flap loss, average fibula harvest time (tourniquet time), and foot and ankle function postoperatively. During this time, a total of 283 fibula free flaps were performed in 276 patients. The average fibula harvest time (tourniquet time) for all cases was 22.6 minutes, with a range of 14 to 29 minutes. A total of 13 flaps were unsuccessful (failure rate of 4.6%, with 5 total and 8 partial flap losses). This newly described technique will allow for expedited and simplified harvest of fibula free flaps.

scholarly journals Oromandibular reconstruction with free fibula osteocutaneous flap after oncologic resection: retrospective analysis of surgical experience and operative outcome of 56 cases

2019 ◽  
Vol 6 (10) ◽  
pp. 3674
Author(s):  
Shobhit Sharma ◽  
Sudipta Bera
Keyword(s):  
Free Tissue Transfer ◽  
Free Flaps ◽  
Aesthetic Outcome ◽  
Food Tolerance ◽  
Oncologic Resection ◽  
Aesthetic Results ◽  
Reconstructive Option ◽  
Free Fibula ◽  
Osteocutaneous Flap ◽  
Oromandibular Reconstruction

Background: Reconstruction of post oncologic resection oromandibular defect is challenging and it provides the base for subsequent radiotherapy and oromaxillary rehabilitation for functional and aesthetic outcome. Multiple reconstructive options including different free flaps exist in the present time of greater awareness, facility and expertise in the field of free tissue transfer surgery. But free fibula osteocutaneous flap (FFOCF) has been the state of art in this area. FFOCF is technically difficult but believed to be reliable even to start with and has a progressively comprehensive surgical technique and learning curve. We are presenting here our experience of FFOCF reconstruction of 56 cases over the last 3 years.Methods: 56 patients operated between 2015 to 2018 were assessed retrospectively for operative and surgical outcome.Results: Flap was successful in 54 (96.43%) cases. Re-exploration was done in 4 cases and was successful in 2 cases. Jaw shape and contour was satisfactory in 70.37% and solid food tolerance was noted in 80.35% cases. Recurrence was seen in 5 cases.Conclusions: FFOCF is a reliable reconstructive option for complex oromandibular defect with a predictable outcome. Flap harvest is reliable and contouring is comprehensive. It gives good functional and aesthetic results with high success rate. Thus this flap is truly the preferred reconstructive option for all type of oncologic oromandibular defect with micro vascular surgery facilities.

Safety of Coupled Arterial Anastomosis in Autologous Breast Reconstruction

2020 ◽  
Author(s):  
Mariel McLaughlin ◽  
Brooke E. Porter ◽  
Rachel Cohen-Shohet ◽  
Mark M. Leyngold
Keyword(s):  
Breast Reconstruction ◽  
Operating Room ◽  
Retrospective Chart Review ◽  
Free Flaps ◽  
Recipient Site ◽  
Flap Loss ◽  
Increased Risk ◽  
Significant Difference ◽  
Internal Mammary ◽  
Arterial Anastomosis

Abstract Background This study compares the outcomes of coupled versus hand-sewn arterial anastomosis in microvascular breast reconstruction. Methods Retrospective chart review of breast reconstruction free flaps performed between 2013 and 2018 was conducted. Primary end points included flap loss, intraoperative arterial anastomosis revision, and operating room takeback. The decision to couple the arterial anastomosis was based on patient's age, surgeon's preference, history of radiation, and vessel quality. All anastomoses were performed under ×3.5 loupe magnification to internal mammary or thoracodorsal vessels. Results Authors reviewed 104 free flaps; two were lost in hand-sewn group; no flaps were lost in coupled group. There was no significant difference in anastomotic revision rate between coupled and hand-sewn arterial anastomosis (p = 0.186) or return to operating room (OR) between coupled and hand-sewn flaps (p = 1.000). Reasons for takeback included venous congestion and hematoma. Conclusion This study reflects that coupled arterial anastomosis in breast reconstruction may be safely performed without increased risk in anastomotic revision, takeback, or flap loss. Decision to couple should be based on surgeon skill, patient age and history, and assessment of flap and recipient site vasculature.

scholarly journals Dynamic Oromandibular Reconstructions Using Chimeric Fibular and Gracilis or Vastus Lateralis Free Flaps

2020 ◽  
Vol 05 (02) ◽  
pp. e36-e42
Author(s):  
Min Ji Kim ◽  
Jong Woo Choi ◽  
Woo Shik Jeong ◽  
Soon Yuhl Nam ◽  
Seung Ho Choi
Keyword(s):  
Free Flap ◽  
Vastus Lateralis ◽  
Retrospective Chart Review ◽  
Free Flaps ◽  
Control Group ◽  
Vastus Lateralis Muscle ◽  
Free Fibular Flap ◽  
Dynamic Group ◽  
Fibular Flap ◽  
Oromandibular Reconstruction

Abstract Background Despite efforts of head and neck functional reconstruction, anatomic restoration has been used until now. This article describes our experience of using a chimeric free fibular osteocutaneous flap conjoined with a functional muscle free flap, defined as dynamic oromandibular reconstruction. Methods Through a retrospective chart review, four consecutive patients who underwent reconstruction with a total fibular free flap were included. The former two patients underwent reconstruction using a conventional osteocutaneous free fibular flap. The latter two patients had an oromandibular defect after cancer resection and underwent dynamic oromandibular reconstruction with a chimeric free fibular flap conjoined with a gracilis free flap or vastus lateralis muscle free flap. Results In the speech analysis, the dynamic group revealed a satisfactory tongue movement. Protrusion and lateralization were the most different movement changes. The tongue range of motion score was 62.5 in the dynamic group and 25.0 in the control group. On the dynamic magnetic resonance imaging, the contact of the soft palate with the tongue was excellent, and the epiglottis closure during deglutition was complete. In the three-dimensional volumetric analysis of mandibular aesthetic contouring, the dynamic group showed a much smaller difference in hemifacial volume, with a difference of 73.7 mL in the dynamic group and 101.76 mL in the control group. Conclusion This study is a preliminary trial of dynamic oromandibular reconstruction using chimeric free fibular flaps with functional muscle transfer. We demonstrated the possibility of dynamic oromandibular reconstruction, which enhanced more functional aspects in the patients in this study.

scholarly journals Recipient Vessel Thrombectomy and Anastomosis within the Zone of Injury in Microvascular Extremity Reconstruction

2020 ◽  
Vol 05 (01) ◽  
pp. e15-e21
Author(s):  
Jeremy M. Powers ◽  
Jaime H. Choi ◽  
Santosh S. Kale
Keyword(s):  
Success Rate ◽  
Vein Graft ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Senior Author ◽  
Fogarty Catheter ◽  
Vein Grafts ◽  
Recipient Vessel ◽  
Flap Loss ◽  
Extremity Reconstruction

Abstract Background In traumatic extremity reconstruction, it is preferable to perform microvascular anastomoses outside the zone of injury. Alternatively, a recipient-vessel thrombectomy can be performed to improve the arterial inflow, potentially avoiding further proximal dissection and the use of a vein graft. The objective of this study was to evaluate the outcomes of microvascular anastomosis after thrombectomy in the zone of injury. Methods A retrospective review of patients who underwent free tissue transfer for traumatic extremity reconstruction by the senior author from 2013 to 2017 was conducted. Patient demographic and clinical data were gathered as well as use of vein grafts, recipient-vessel thrombectomy, postoperative anticoagulation, and flap outcomes. Results A total of 23 patients underwent 24 free flap procedures for traumatic extremity reconstruction. Ten patients underwent recipient-vessel thrombectomy with 2-Fr Fogarty catheter and were placed on postoperative anticoagulation. In this group overall, there was one case of flap loss due to late wound infection resulting in a 90% success rate. A total of 13 patients underwent 14 free flaps without the use of thrombectomy and vein grafts were performed for 3/14 (21%) patients. In this group, there were four cases of flap loss, resulting in a 71% overall success rate. Conclusion In traumatic extremity reconstruction, if the artery appears to be visibly appropriate with weak inflow, one may consider attempting thrombectomy to restore pulsatile flow prior to harvesting a vein graft. This study suggests this may be effective and safe with no anastomosis-related flap loss in the thrombectomy group. Further research is required to confirm our results.

scholarly journals Combining free tissue transfer with pedicled flap in reconstruction of extensive oromandibular malignancy defects: a clinical study

2020 ◽  
Vol 7 (2) ◽  
pp. 376
Author(s):  
Naveen Narayan ◽  
Kamal Kumar Manakchand
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Team Approach ◽  
One Stage ◽  
Free Flap Surgery ◽  
Ablative Surgery ◽  
Free Fibula ◽  
Radial Forearm

Background: Extensive composite defects of the oromandibular site involve skin, mandible, soft tissue and oral mucosa. Though many opine that with the coming on of free flap surgery, the pedicled flap is an outdated surgical option, the latter still has its uses. Free flaps are criticized as being medically risky, expensive, and time-consuming. Combining both these flaps in a single surgery would bring in the baggage of all negatives along with the benefits of these flaps.Methods: Over a period of 3 years, 13 patients with expected large composite oral defects after ablative surgery for malignancy were included in the study requiring both skin cover and mucosal lining. A one-stage reconstructive procedure employing combination of free and pedicled flaps was used. Data was abstracted pertaining to cancer demography and surgical outcome.Results: The free fibula osteocutaneous flap (FFOCF)- deltopectoral fasciocutaneous flap (DPF) combination was most commonly used (n=5), secondly by free radial forearm flap (FRAFF)-DPF combination (n=4), FRAFF- pectoralis major myocutaneous flap (PMMF) amalgamation and FFOCF-PMMF (n=2). The complete flap survival rate was 88.5 percent with 3.8% percent total (1 of 26 flaps) and 7.7% partial (2 of 26 flaps) flap failures. Minimum follow-up period was 6 months with 2 (7.7%) recurrences and 2 (7.7%) mortalities.Conclusions: We believe that in combined use of free-flap and pedicled flap procedure for one-stage reconstruction of massive mandibular defects with through-and-through cheek defects is justified because it is safe and effective and improves the quality of life for these patients albeit a bit prolonged surgery which can effectively be shortened with 2 reconstructive team approach as in our study.

scholarly journals Free Tissue Transfer in Pressure Ulcer Reconstruction: A Systematic Review

2021 ◽  
Vol 06 (01) ◽  
pp. e35-e39
Author(s):  
Chelsi Robertson ◽  
Charles Patterson ◽  
Hugo St. Hilaire ◽  
Frank H. Lau
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Final Analysis ◽  
The United States ◽  
Local Flap ◽  
Recurrence Rates ◽  
Tissue Transfer ◽  
Cochrane Database

Abstract Background Pressure ulcers (PUs) affect 2.5 million people in the United States annually and incur health-care costs of 11 billion dollars annually. Stage III/IV PU often require local flap reconstruction. Unfortunately, PU recurrence is common following reconstruction; recurrence rates as high as 82% have been reported. When local flap options are inadequate, free tissue transfer may be indicated but the indications have yet to be delineated. To develop evidence-based guidelines for the use of free flaps in PU reconstruction, we performed a systematic review. Methods A systematic review of the available English-language, peer-reviewed literature was conducted using PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. Articles were manually reviewed for relevance. Results Out of 272 articles identified, 10 articles were included in the final analysis. Overall, this systematic review suggests that free-flap PU reconstruction yields fewer recurrences compared with local flaps (0–20 vs. 13–82%). Further, several types of free flaps for PU reconstruction were identified in this review, along with their indications. Conclusion Free tissue transfer should be considered for recurrent PU. We offer specific recommendations for their use in PU reconstruction.

A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction

2021 ◽  
Author(s):  
Amit Walia ◽  
Joshua Mendoza ◽  
Craig A. Bollig ◽  
Ethan J. Craig ◽  
Ryan S. Jackson ◽  
...  
Keyword(s):  
Free Flaps ◽  
Comprehensive Analysis ◽  
Oromandibular Reconstruction

scholarly journals Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction—An Analysis of 1694 Venous Anastomoses

2021 ◽  
Vol 54 (02) ◽  
pp. 118-123
Author(s):  
Rajan Arora ◽  
Kripa Shanker Mishra ◽  
Hemant T. Bhoye ◽  
Ajay Kumar Dewan ◽  
Ravi K. Singh ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Head And Neck ◽  
Free Tissue Transfer ◽  
Effective Alternative ◽  
Head And Neck Reconstruction ◽  
Venous Anastomosis ◽  
Neck Reconstruction ◽  
Coupling Device ◽  
Tissue Transfer ◽  
Flap Loss

Abstract Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

Principles of Wound Management and Soft Tissue Repair II

2018 ◽  
Author(s):  
Jonathan S. Friedstat ◽  
Michelle R Coriddi ◽  
Eric G Halvorson ◽  
Joseph J Disa
Keyword(s):  
Soft Tissue ◽  
Tissue Repair ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Wound Management ◽  
Soft Tissue Coverage ◽  
Soft Tissue Repair ◽  
Healing Wound ◽  
Contour Defects ◽  
Tissue Flaps

Wound management and soft-tissue repair can vary depending on the location. The head and neck, chest and back, arm and forearm, hand, abdomen, gluteal area and perineum, thigh, knee, lower leg, and foot all have different local options and preferred free flaps to use for reconstruction. Secondary reconstruction requires a detailed analysis of all aspects of the wound including any scars, soft tissue and/or skin deficits, functional defects, contour defects, complex or composite defects, and/or unstable previous wound coverage. Careful monitoring of both the patient and reconstruction is necessary in the postoperative period to ensure long-term success.   This review contains 2 figures and 17 references. Key Words: free tissue transfer, pedicle flaps, soft-tissue coverage, wound closure, wound healing, wound management, wound reconstruction, tissue flaps

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