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 Combined Free Flap Reconstruction Following Head And Neck Cancer Resection: Chimeric And Double Free Flap Reconstruction

2019 ◽  
Vol 5 (1) ◽  
pp. 188-194
Author(s):  
Parintosa Atmodiwirjo ◽  
Tasya Anggrahita
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Free Flaps ◽  
Cancer Resection ◽  
Free Fibular Flap ◽  
Radial Forearm ◽  
Mandibular Defect ◽  
Fibular Flap

Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.

Repair of Recurrent Cleft Palate with Free Vastus Lateralis Muscle Flap

2012 ◽  
Vol 49 (2) ◽  
pp. 245-248 ◽  
Author(s):  
Jose G. Christiano ◽  
Amir H. Dorafshar ◽  
Eduardo D. Rodriguez ◽  
Richard J. Redett
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Vastus Lateralis ◽  
Muscle Flap ◽  
Free Flaps ◽  
Vastus Lateralis Muscle ◽  
Oronasal Fistula ◽  
Lateralis Muscle ◽  
Palate Repair

A 6-year-old girl presented with a large recalcitrant oronasal fistula after bilateral cleft lip and palate repair and numerous secondary attempts at fistula closure. Incomplete palmar arches precluded a free radial forearm flap. A free vastus lateralis muscle flap was successfully transferred. No fistula recurrence was observed at 18 months. There was no perceived thigh weakness. The surgical scar healed inconspicuously. Free flaps should no longer be considered the last resort for treatment of recalcitrant fistulas after cleft palate repair. A free vastus lateralis muscle flap is an excellent alternative, and possibly a superior option, to other previously described free flaps.

scholarly journals Sequela de cirurgia para reconstrução mandibular após ressecção de ameloblastoma

2019 ◽  
Vol 8 (8) ◽  
Author(s):  
Allancardi dos Santos Siqueira ◽  
Luiz Henrique Soares Torres ◽  
Jiordanne Araújo Diniz ◽  
Éwerton Daniel Rocha Rodrigues ◽  
Caio Pimenteira Uchôa ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Platelet Rich Plasma ◽  
Treatment Algorithm ◽  
Free Flaps ◽  
Mandibular Reconstruction ◽  
Benign Tumors ◽  
New Classification ◽  
Oromandibular Reconstruction ◽  
Head Neck

Os defeitos mandibulares devido à ressecção de lesão óssea interferem a harmonia e estética facial comprometendo a qualidade de vida dos pacientes. Grandes defeitos exigem planejamento minucioso, principalmente quando lançamos mão de enxertos e placas de reconstrução, evitando assim resultados insatisfatórios ou até mesmo sequelas. Apesar de algumas classificações dos defeitos mandibulares vêm sendo discutidas ao longo dos anos, ainda não há um protocolo definido para reconstrução mandibular. O uso de prototipagem na Cirurgia Bucomaxilofacial tem se tornado cada vez mais frequente; a precisão da reconstrução, diminuição do tempo de cirurgia reflete em recuperação mais rápida do paciente. Mesmo com a ferramenta da prototipagem, grandes lesões e perdas ósseas permanecem como grande desafio ao cirurgião.  O objetivo deste trabalho é relatar um caso clínico de reconstrução mandibular no qual houve a necessidade de ser tratado com remoção de placa de reconstrução e nova reabilitação cirúrgica do paciente.Descritores: Mandíbula; Reconstrução Mandibular; Modelos Biológicos.ReferênciasSantos LCS, Seixas AM, Barbosa B, Cincura RNS. Adaptação de placas reconstrutivas: uma nova técnica. Rev Cir Traumatol Buco-Maxilo-Fac. 2011;11(2):9-14.Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: the history, operative options and strategies, and our experience. ISRN Surg. 2011;2011:824251.Martins Jr. JC, Keim FS. Uso de prototipagem no planejamento de reconstrução microcirúrgica da mandíbula. Rev Bras Cir Craniomaxilofac. 2011;14(4):225-28.Montoro JR, Tavares MG, Melo DH, Franco Rde L, Mello-Filho FV, Xavier SP, Trivellato AE, Lucas AS. Mandibular ameloblastoma treated by bone resection and imediate reconstruction. Braz J Otorhinolaryngol. 2008;74(1):155-57.Nóia CF, Ortega-Lopes R, Chaves Netto HDM, Nascimento FFAO, Sá BCM. Desafios na reconstrução mandibular devido a lesões extensas ou traumatismos. Rev Assoc Paul Cir Dent. 2015;69(2):158-63.Cohen A, Laviv A, Berman P, Nashef R, Abu-Tair J. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):661-6.Rana M, Warraich R, Kokemüller H,  Lemound J,  Essig H, Tavassol F et al. Reconstruction of mandibular defects - clinical retrospective research over a 10-year period. Head Neck Oncol. 2011;3:23.Fariña R, Alister JP, Uribe F, Olate S, Arriagada A. Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm. Plast Reconstr Surg Glob Open. 2016;4(8):e845.Fariña R, Plaza C, Martinovic G. New transference technique of position of mandibular reconstructing plates using stereolithographic models. J Oral Maxillofac Surg. 2009;7(11):2544-48.Mooren RE, Merkx MA, Kessler PA, Jansen JA, Stoelinga PJ. Reconstruction of the mandible using preshaped 2.3-mm titanium plates, autogenous cortical bone plates, particulate cancellous bone, and platelet-rich plasma: a retrospective analysis of 20 patients. J Oral Maxillofac Surg. 2010;68(10):2459–67.Brown JS, Barry C, Ho M, Shaw R.A new classification for mandibular defects after oncological resection. Lancet Oncol. 2016;17(1):23-30Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg. 1991;117(7):733-44.Shnayder Y, Lin D, Desai SC, Nussenbaum B, Sand JP, Wax MK. Reconstruction of the Lateral Mandibular Defect: A Review and Treatment Algorithm. JAMA Facial Plast Surg. 2015;17(5):367-73.Wei FC, Celik N, YangWG, Chen IH, Chang YM, Chen HC. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast Reconstr Surg. 2003;112(1):37-42.Li BH, Jung HJ, Choi SW, Kim SM, Kim MJ, Lee JH. Latissimus dorsi (LD) free flap and reconstruction plate used for extensive maxillo-mandibular reconstruction after tumour ablation. J Craniomaxillofac Surg. 2012;40(8):293-300.

Short-Term Training, Muscle Glycogen, and Cycle Endurance

1995 ◽  
Vol 20 (3) ◽  
pp. 315-324 ◽  
Author(s):  
Howard J. Green ◽  
Marg Ball-Burnett ◽  
Steve Symon ◽  
Sue Grant ◽  
Greg Jamieson
Keyword(s):  
Vastus Lateralis ◽  
Endurance Performance ◽  
Control Group ◽  
Vastus Lateralis Muscle ◽  
Short Term ◽  
Exercise Time ◽  
Glycogen Concentration ◽  
Prolonged Fatigue ◽  
Performance Adaptation ◽  
Cycle Endurance

The objective of this study was to test the hypothesis that the increased glycogen concentration found in the working muscles following short-term training would result in an increase in endurance performance. Endurance performance was examined in 8 active but untrained males who cycled until fatigue at 65% [Formula: see text]max prior to and following 3 consecutive days of training. Training consisted of cycling for 2 hrs a day at the same power output used in the prolonged fatigue trials. A 39% increase in cycle time, from 103 ± 7.7 to 143 ± 14 min (p < 0.05), was observed following training. At fatigue prior to training, glycogen concentration in the vastus lateralis muscle was depleted by 75% (317 ± 17 to 78.8 ± 32 mmol∙glucosyl units∙kg−1 d.w). Following training, glycogen concentration at a comparable work time was 2.3 times higher. The elevated glycogen level following training was due both to higher glycogen at rest and during exercise. The energy cost of the activity as measured by the [Formula: see text] at selected intervals was unchanged with training. No change (p > 0.05) in exercise time was observed in a control group who were subjected to similar exercise protocols approximately 1 to 2 weeks apart. It is concluded that short-term training at least in untrained individuals ([Formula: see text]max averaging 43.6 ± 2.9 ml∙kg−1∙min−1) substantially elevates submaximal exercise tolerance and that the increase in resistance to fatigue is related to the elevated availability of glycogen. Key words: endurance performance, adaptation, carbohydrate, vastus lateralis

scholarly journals Innervated Free Flap Abdominal Wall Reconstruction: A Systematic Review

2017 ◽  
Vol 02 (02) ◽  
pp. e118-e123
Author(s):  
Paul Therattil ◽  
Stephen Viviano ◽  
Edward Lee ◽  
Jonathan Keith
Keyword(s):  
Abdominal Wall ◽  
Free Flap ◽  
Vastus Lateralis ◽  
Abdominal Wall Reconstruction ◽  
Free Flaps ◽  
Fascia Lata ◽  
Sensory Innervation ◽  
Abdominal Wall Defects ◽  
Tensor Fascia Lata ◽  
Anterolateral Thigh

Background Reconstruction of large abdominal wall defects provides unique challenges to the plastic surgeon. Reconstruction with innervated free flaps has been described and allows for true functional replacement of “like with like.” The authors sought to determine the frequency and outcomes of such reconstructions. Methods A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for research articles related to innervated free flaps in abdominal wall reconstruction. Results Nine case series (16 patients) were included who underwent free flap reconstruction of the abdominal wall with motor and/or sensory innervation. Reconstruction was performed with latissimus dorsi (n = 5), tensor fascia lata (n = 4), rectus femoris (n = 2), combined tensor fascia lata-anterolateral thigh (n = 2), combined vastus lateralis-tensor fascia lata-anterolateral thigh flaps (n = 2), and vastus lateralis-anterolateral thigh (n = 1). All but one reconstruction had motor neurotization performed (n = 15), while only 12.5% (n = 2) had sensory neurotization performed. At least 66.6% of patients (n = 10) who had motor neurotization regained motor function as evidenced by documented clinical examination findings while 93.3% (n = 14) had “satisfactory” motor function on author's subjective description of the function. Both flaps that had sensory innervation were successful with Semmes–Weinstein testing of 3.61. Conclusion A majority of neurotized free flap reconstructions for abdominal wall defects have been performed for motor innervation, which is almost invariably successful. Sensory neurotization has been carried out for a small number of these reconstructions, and also has been successful. Improvements in techniques and outcomes in innervated free flap abdominal wall reconstruction are important to advancing efforts in abdominal wall transplantation.

scholarly journals How to Harvest The Free Fibula Flap

2020 ◽  
Vol 7 (1) ◽  
pp. 4-6
Author(s):  
Parintosa Atmodiwirjo ◽  
Mohamad Rachadian Ramadan ◽  
Sara Ester Triatmoko ◽  
Nadhira Anindita Ralena
Keyword(s):  
Free Flaps ◽  
Free Fibula Flap ◽  
Skin Paddle ◽  
Advantages And Disadvantages ◽  
Free Fibular Flap ◽  
Free Fibula ◽  
Physical Examinations ◽  
Fibular Free Flap ◽  
Fibular Flap ◽  
Composite Flap

Summary: Free fibular flap (FFF) is a composite flap consisting of fibular bone and skin paddle. Muscle may be added to the flap. It has several advantages and disadvantages. The fibular free flap is well suited for any reconstruction of the head and neck. It is suitable for defects of the anterior mandibular arch or lateral defects in patients who wish to undergo osseointegrated dental reconstruction. Meanwhile, its contraindications are related to significant atherosclerotic diseases the patient has or congenital variants of the arteries. Preparations for FFF procedure consist of history taking, physical examinations and supporting examinations, like other free flaps procedure in general. Several intraoperative preparations should also be done.

scholarly journals Functional and Muscle-Size Effects of Flywheel Resistance Training with Eccentric-Overload in Professional Handball Players

2017 ◽  
Vol 60 (1) ◽  
pp. 133-143 ◽  
Author(s):  
Sergio Maroto-Izquierdo ◽  
David García-López ◽  
José A de Paz
Keyword(s):  
Resistance Training ◽  
Muscle Power ◽  
Vastus Lateralis ◽  
T Test ◽  
Muscle Size ◽  
Test Time ◽  
Control Group ◽  
Vastus Lateralis Muscle ◽  
Leg Press ◽  
Eccentric Overload

AbstractThe aim of the study was to analyse the effects of 6 week (15 sessions) flywheel resistance training with eccentric-overload (FRTEO) on different functional and anatomical variables in professional handball players. Twenty-nine athletes were recruited and randomly divided into two groups. The experimental group (EXP, n = 15) carried out 15 sessions of FRTEO in the leg-press exercise, with 4 sets of 7 repetitions at a maximum-concentric effort. The control group (CON, n = 14) performed the same number of training sessions including 4 sets of 7 maximum repetitions (7RM) using a weight-stack leg-press machine. The results which were measured included maximal dynamic strength (1RM), muscle power at different submaximal loads (PO), vertical jump height (CMJ and SJ), 20 m sprint time (20 m), T-test time (T-test), and Vastus-Lateralis muscle (VL) thickness. The results of the EXP group showed a substantially better improvement (p < 0.05-0.001) in PO, CMJ, 20 m, T-test and VL, compared to the CON group. Moreover, athletes from the EXP group showed significant improvements concerning all the variables measured: 1RM (ES = 0.72), PO (ES = 0.42 - 0.83), CMJ (ES = 0.61), SJ (ES = 0.54), 20 m (ES = 1.45), T-test (ES = 1.44), and VL (ES = 0.63 - 1.64). Since handball requires repeated short, explosive effort such as accelerations and decelerations during sprints with changes of direction, these results suggest that FRTEO affects functional and anatomical changes in a way which improves performance in well-trained professional handball players.

scholarly journals Rekonstruksi defek mandibula menggunakan jabir bebas fibula

2015 ◽  
Vol 44 (2) ◽  
pp. 146
Author(s):  
Dini Widiarni ◽  
Indah Saraswati
Keyword(s):  
Iliac Crest ◽  
Microvascular Surgery ◽  
Mandibular Reconstruction ◽  
Free Fibular Flap ◽  
Iliac Crest Flap ◽  
Facial Defects ◽  
Fibular Flap ◽  
The Right ◽  
Oromandibular Reconstruction ◽  
Scapula Flap

Latar belakang: Perkembangan teknik pembedahan mikrovaskular telah menghasilkan jabir bebas fibula yang dapat digunakan untuk rekonstruksi oromandibular.  Jabir bebas fibula merupakan salah satu jabir tulang yang sering digunakan untuk mengatasi defek pada daerah wajah, terutama dalam rekonstruksi mandibula. Jabir ini memiliki banyak keunggulan dibandingkan dengan jabir tulang lainnya, seperti jabir skapula dan jabir iliaka. Jabir ini memiliki angka kesuksesan yang cukup tinggi yaitu mencapai 95%, namun untuk mencapai angka keberhasilan tersebut diperlukan perencanaan yang tepat sebelum dilakukannya pengambilan jabir mulai dari preoperatif, perioperatif, intraoperatif, dan pascaoperatif. Tujuan: Para ahli THT dapat mengetahui perencanaan yang tepat sebelum melakukan rekonstruksi mandibula. Tinjauan pustaka: Jabir bebas fibula memiliki angka keberhasilan yang tinggi dan merupakan jabir pilihan untukrekonstruksi mandibula. Kesimpulan: Perencanaan yang tepat mulai dari preoperatif sampai pascaoperatif sebelum dilakukan pengambilan jabir bebas fibula sangat diperlukan untuk mendapatkan hasil yang optimal.Kata kunci: Jabir bebas fibula, pembedahan mikrovaskular, rekonstruksi mandibula ABSTRACTBackground: Development in microvascular surgery technique has created a flap that can be used for oromandibular reconstruction. Free fibular flap is one of the bone flaps that frequently use for facial defects, especially mandibular reconstruction. This flap has lots of advantages than other bone flaps, such as scapula flap and iliac crest flap. Free fibular flap has a high successful rate up to 95%, but it needs meticulous planning before harvesting the bone; preoperative, perioperative, intraoperative, and postoperative is needed to get the high successful rate. Purpose: To inform ENT specialists about the appropriate planning before mandibular reconstruction. Literature review: Free fibular flap has a high successful rate and one of the excellent choices for mandibular reconstruction. Conclusion: The right preoperative to postoperative planning before doing the free fibularflap is very important to obtain optimal outcome. Keywords: Free fibular flap, microvascular surgery, mandibular reconstruction

Abstract 3795: Readjusting The Catabolic-anabolic Balance In Heart Failure: Beneficial Effects Of Physical Exercise On Protein Catabolism In The Skeletal Muscle

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stephan Gielen ◽  
Marcus Sandri ◽  
Volker Adams ◽  
Norman Mangner ◽  
Sandra Erbs ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Molecular Mechanisms ◽  
Vastus Lateralis ◽  
E3 Ligase ◽  
Tnf Alpha ◽  
Control Group ◽  
Vastus Lateralis Muscle ◽  
List Type ◽  
Ubiquitin Proteasome

Background: Progressive muscle wasting frequently occurs in the course of chronic heart failure (CHF) and has recently been identified as independent predictor of mortality in clincal studies. However, the molecular mechanisms that mediate muscle catabolism are still largely unknown and no specific pharmacological agents are available to antagonize the loss of muscle mass. We therefore tested the potential of an established anabolic intervention, i.e. exercise training, to prevent cytokine-induced ubiquitin-proteasome-mediated protein degradation in the skeletal muscle of stable patients with advanced CHF. Methods: 43 CHF-patients and 41 healthy subjects (HS) were prospectively randomized to 4 weeks of supervised bicycle ergometer training at 70% of the heart rate reserve 4 times 20 min/day or to a control group (C). Before and after the intervention a spiroergometry, echocardiography, and skeletal muscle biopsy from the vastus lateralis muscle were performed. Expression of TNF-alpha and the E3 ligase Murf-1, which tags proteins for degradation via the ubiquitin-proteasome system, were quantified by real-time PCR standardized for 18S-rRNA. Results: In CHF patients (age 60.3 ± 2.9 years, BMI 28.9 ± 1.7, LV-EF 27.4 ± 1.7%): training increased VO2max from 14.9 ± 3.3 to 18.1 ± 4.7 mL/min/kg (p<0.01 vs. C), and LV-EF from 26.8 ± 4.6 to 33.1 ± 5.5% (p=0.001 vs. C). At baseline Murf-1 expression was significantly higher as compared to HS. Training decreased Murf-1 expression from 0.49 ± 0.21 to 0.22 ± 0.07 rel. units (p<0.05) and TNF-alpha expression from 79 ± 7.1 to 44.7 ± 5.9 rel. units (p<0.001). In HS (age 64.7 ± 2.7 years, BMI 26.2 ± 0.5, LV-EF 63 ± 0.8%) training increased VO2 max from 20.3 ± 2.1 to 27.9.2 ± 1.3 mL/kg min (p=0.01 vs. C). Murf-1 and TNF-alpha expression remained unchanged versus untrained HS. Conclusions: CHF is associated with local inflammatory and catabolic activation in the skeletal muscle as indicated by higher baseline TNF-alpha and Murf-1 levels. Training cuts the elevated TNF-alpha and E3-ligase expressions by half within only four weeks of intervention. These findings emphasize the role of training for the prevention of muscle atrophy and may provide a novel explanation for the prognostic benefits of exercise in CHF.

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