Considerations in Free Flap Reconstruction of the Midface

2021 ◽  
Author(s):  
Daniel Hammer ◽  
Aurora G. Vincent ◽  
Fayette Williams ◽  
Yadranko Ducic
Keyword(s):  
Free Flap ◽  
Preoperative Assessment ◽  
Free Flaps ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Pedicle Flap ◽  
Free Flap Surgery ◽  
Management Of Complications ◽  
Flap Design ◽  
Midface Reconstruction

AbstractMidface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is required to properly assess the defect or anticipated defect, determine proper reconstructive surgical plan, and discuss expected functional and aesthetic outcomes with the patient. For years we have employed local flaps, regional flaps, obturators, alloplastic implants, free flaps, or a combination of the previously mentioned techniques to address complex midface reconstruction. Free flap reconstruction in the midface requires special considerations for the pedicle, flap selection, and flap design to ensure an optimal outcome. The introduction of virtual surgical planning for reconstruction has enhanced patient outcomes to include advances in immediate dental rehabilitation at the time of free flap surgery. Postoperative considerations including quality of life, functional and aesthetic outcomes, and management of complications will also be discussed.

scholarly journals Current evidence for outcomes of free-flap reconstruction in factor V Leiden patients

2019 ◽  
Vol 2 (2) ◽  
pp. 58-66
Author(s):  
Isobel Yeap ◽  
Chris Ahn ◽  
Stuart Hoffman ◽  
Rowan Gillies ◽  
John Vandervord
Keyword(s):  
Free Flap ◽  
Factor V Leiden ◽  
Free Flaps ◽  
Current Evidence ◽  
Factor V ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Surgery ◽  
Flap Failure ◽  
Free Flap Surgery

Background: Factor V Leiden is the most common form of inherited thrombophilic syndrome, affecting five per cent of caucasians. While increased rates of venous thromboembolic complications have been regularly reported in factor V Leiden patients, little is known about their risk of microvascular complications or flap failure rates in free-flap surgery. The aim of this review is to qualitatively review the published literature on outcomes of free-flap surgery in patients with factor V Leiden. Methods: MEDLINE®, PubMed, EMBASE and Cochrane were searched from their dates of inception to March 2017. Nine studies of level IV evidence were included in this qualitative review. In total, these studies included 22 patients who underwent 24 free-flap operations. Results: Nine flap failures were reported due to thrombotic complications. Even heterozygous factor V Leiden patients had a relatively high risk of free-flap failure (3/15 free flaps), and patients who were heterozygous for factor V Leiden and had other coexistent thrombophilias had an even higher failure rate (5/6 free flaps). However, the small sample size across the nine studies, as well as the inevitable publication bias, means that definitive conclusions cannot be drawn. Conclusion: Despite factor V Leiden being a relatively common condition in Australia, current evidence for outcomes of free-flap reconstruction in this patient population is lacking.

scholarly journals Use of the Anterolateral Thigh in Cranio-Orbitofacial Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
William J. Parkes ◽  
Howard Krein ◽  
Ryan Heffelfinger ◽  
Joseph Curry
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tissue Loss ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Anterolateral Thigh ◽  
The Many ◽  
Soft Tissue Loss

Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.

Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

2018 ◽  
Vol 159 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Meghan M. Crippen ◽  
Jacob S. Brady ◽  
Alexander M. Mozeika ◽  
Jean Anderson Eloy ◽  
Soly Baredes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

scholarly journals Reconstruction with free flaps in robotic head-and-neck onco-surgeries

2018 ◽  
Vol 51 (03) ◽  
pp. 283-289 ◽  
Author(s):  
Rajan Arora ◽  
Vinay Kumar Verma ◽  
Kripa Shanker Mishra ◽  
Hemant Bhoye ◽  
Rahul Kapoor
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
Free Flap ◽  
Free Flaps ◽  
Cancer Surgery ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Good Outcome

ABSTRACT Aims and Objective: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. Materials and Methods: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. Results: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. Conclusion: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

The Role of the Visor Flap in Scalp Reconstruction: A Case Series of 21 Patients

2018 ◽  
Vol 15 (6) ◽  
pp. 651-655 ◽  
Author(s):  
Marco Ellis ◽  
Lisa Hwang ◽  
Ni-Ka Ford ◽  
Konstantin Slavin
Keyword(s):  
Free Flap ◽  
Advancement Flap ◽  
Soft Tissue Coverage ◽  
Preoperative Radiation ◽  
Local Flaps ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Recipient Site ◽  
Scalp Defects ◽  
Flap Design

Abstract BACKGROUND Full-thickness scalp defects pose a reconstructive problem, especially in the setting of infection, chemotherapy/radiation, and underlying cranial defects. Current options include dermal matrices, skin grafts, and local flaps. Local flaps often fail, requiring subsequent microvascular free flap reconstruction. OBJECTIVE To describe the visor flap, a novel bipedicled advancement flap design, and its role in reconstruction of scalp defects. METHODS A retrospective review of 21 adult patients who developed scalp defects reconstructed using the visor flap from 2013 to 2017. The visor flap is a large bipedicled advancement flap design with a triangular extension at the base, which allows redistribution of a large surface area of the scalp. RESULTS All 21 patients achieved complete and viable soft tissue coverage of the recipient site, but 19.0% developed complications unrelated to flap viability, requiring reoperation (infected bone flap, epidural hematoma, and recurrent glioblastoma with subdural abscess). Only 1 patient required conversion to free flap reconstruction due to cerebrospinal fluid leak. Etiologies included cancer (76.1%), cerebrovascular disease (19.0%), and traumatic brain injury (4.8%). Preoperative radiation (42.9%), bone/hardware exposure (57.1%), and previous craniotomy (85.7%) were widely prevalent. Defect size ranged from 3 to 50 cm2 (mean, 16.9 cm2), and flap size ranged from 90 to 500 cm2 (mean, 222 cm2). CONCLUSION The visor flap provides an innovative solution for closure of scalp defects. This technique optimizes immediate closure of tissue compromised by infection or chemotherapy/radiation without burning bridges to more complex reconstructive options.

O147 The use of free flaps based on the thoracodorsal artery for free flap reconstruction

2007 ◽  
Vol 2 (1) ◽  
pp. 109
Author(s):  
R. Anand ◽  
M. Ethunandan ◽  
P. Ramchandani ◽  
V. Ilankovan
Keyword(s):  
Free Flap ◽  
Free Flaps ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Thoracodorsal Artery

498 The Bristol Sign - A Technical Tip to Confirm Skin Flap Vascularity

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Timothy Schrire ◽  
Ahmed Emam ◽  
Giulia Colavitti ◽  
Umraz Khan
Keyword(s):  
Free Flap ◽  
Gold Standard ◽  
Skin Flap ◽  
Free Flaps ◽  
Modern Medicine ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Central Tenet ◽  
Tissue Defects

Abstract Introduction In modern medicine, free flap reconstruction has become the gold standard when faced with soft tissue defects. The impressive cosmesis, and adaptability of free flaps means that we can securely state that we are in the era of Plastic Surgery defined by free flap reconstruction. However, as part of free flap reconstruction, clinical monitoring of the flap is a central tenet post-operatively. Different departments have different protocols for this. Method In our unit, it is practice to insert a single interrupted stitch overlying the Doppler site just before dressings. This localises the site of the pedicle for Doppler monitoring, and allows the surgeon to examine the quality of the blood droplets, demonstrating flap perfusion. Results The use of the stitch is considered practical, replicable, and safe, and aids in providing gold standard monitoring post-operatively. The additional analysis of the blood droplet is another sign, in itself, of a healthy flap, and excludes venous congestion. Conclusions The Bristol stitch is a useful adjunct to free flap reconstruction. It’s localisation of the Doppler signal allows medical and nursing staff to confidently approach post-operative monitoring, and the blood elicited by the stitch insertion is a useful sign of flap vascularity and venous status.

Does Cigarette Smoking Harm Microsurgical Free Flap Reconstruction?

2018 ◽  
Vol 34 (07) ◽  
pp. 492-498 ◽  
Author(s):  
Paul Heidekrueger ◽  
Elisabeth Haas ◽  
Michaela Coenen ◽  
Riccardo Giunta ◽  
Milomir Ninkovic ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Free Flap ◽  
Smoking Status ◽  
Free Flaps ◽  
Negative Influence ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Wide Range ◽  
American Society ◽  
The Impact

Background Free tissue transfers can successfully address a wide range of reconstructive requirements. While the negative influence of cigarette smoking is well documented, its effects in the setting of microsurgical free flap reconstruction remain debated. This study evaluates the impact of cigarette smoking on microsurgical reconstructions. Methods Over a 7-year period, 897 patients underwent 969 microvascular free flap reconstructions at a single surgical center. The cases were divided into “smoker” (S) and “nonsmoker” (NS) groups according to their cigarette smoking status. The data were retrospectively screened for patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and overall outcomes. Results Both groups were comparable regarding comorbidities including hypertension, peripheral artery disease, diabetes, American Society of Anesthesiologists scores, types of performed free flaps, and recipient sites. While patients in the NS group were significantly older and had a higher prevalence of obesity (p < 0.05), there were no significant differences regarding the rate of major or minor complications during our 3-month follow-up period (p > 0.05). Conclusion While minor and major complications were increased regarding virtually all examined parameters, cigarette smoking did not have significant effects on the overall outcomes of microsurgical free flap reconstructions.

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