Assessment of post‐surgical donor‐site morbidity in vastus lateralis free flap for head and neck reconstructive surgery: An observational study

The lateral arm free flap has proved to be both a versatile and successful method of reconstruction. Since its introduction a decade ago, however, its application in head and neck reconstruction has been fairly limited. Dissection of the flap, based on the posterior radial collateral branch of the profunda brachli artery, is relatively simple and provides a thin, dependable flap that has the potential to be used as a osteocutaneous flap or as a fasclocutaneous flap alone. The flap contains a sensory nerve that is readily anastomosed and donor site morbidity is limited. Although the pedicle is short, several modifications exist that allow its extension. This flap has been used successfully to reconstruct various defects in the head and neck. Pertinent anatomy, Indications, and guidelines for clinical application will be discussed.

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The Vastus Lateralis Free Flap and Donor-Site Morbidity. A Systematic Review

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1177/24727512211033134 ◽

2021 ◽

Vol 6 ◽

pp. 247275122110331

Author(s):

Lyndel Hewitt ◽

Takako Yabe ◽

Jonathan R. Clark ◽

James Wykes ◽

Bruce Ashford

Keyword(s):

Systematic Review ◽

Head And Neck ◽

English Language ◽

Vastus Lateralis ◽

Donor Site ◽

Improve Patient Care ◽

Donor Site Morbidity ◽

Risk Of Bias ◽

Head And Neck Reconstruction ◽

Operative Care

Study Design: Systematic review. Objective: Vastus lateralis is used to reconstruct defects in the head and neck. While the advantages are documented, donor-site morbidity requires further investigation. Before an investigation can commence, a review of the literature is required. The aim of this study was to review the existing evidence regarding the use of the vastus lateralis flap and donor-site morbidity. The results from this study will assist to determine further research and need for preventative and post-operative options to improve patient care and health outcomes. Methods: Electronic databases were searched (in January-February 2020). Peer-reviewed, English language articles were included if they investigated the association between the vastus lateralis flap and donor-site related health outcome. Two reviewers independently screened and assessed the articles. The risk of bias of each individual study was assessed using the Cochrane risk of bias assessment for observational and intervention studies. Results: Five articles representing 97 participants from 4 countries were included. The vastus lateralis flap (head and neck reconstruction) was shown to have a neutral association with donor-site leg strength, ability to climb stairs, walking and activities of daily living. Minor negative associations was found for changes in sensation and bruising. Conclusion: Current research reports a neutral effect between the use of the vastus lateralis and donor-site morbidity. Further research is required using a more rigorous investigative approach using a wider range of objective measures and larger sample sizes to confirm these findings to inform holistic post-operative care options.

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Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap

Facial Plastic Surgery ◽

10.1055/s-0041-1726445 ◽

2021 ◽

Author(s):

Armando De Virgilio ◽

Andrea Costantino ◽

Raul Pellini ◽

Gerardo Petruzzi ◽

Giuseppe Mercante ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck ◽

Free Flap ◽

Functional Outcomes ◽

Vastus Lateralis ◽

Life Questionnaire ◽

Donor Area ◽

Tongue Reconstruction ◽

Eortc Qlq

AbstractThe aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75–69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5–33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0–72.5). The median PSS-HN score was 80.0 (IQR: 45.0–95.0), 75.0 (IQR: 62.5–100.0), 75.0 (IQR: 62.5–100.0) for “Normalcy of Diet,” “Public Eating,” and “Understandability of Speech,” respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5–74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.

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Outcomes of free flap reconstructive surgery in Head and Neck cancer patients over eighty years old

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2021.05.004 ◽

2021 ◽

Author(s):

O. Mitchell ◽

E. Kelly ◽

M. Ethunandan ◽

N. Horlock ◽

S. Sharma ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Free Flap ◽

Reconstructive Surgery

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LONG-TERM DONOR-SITE MORBIDITY IN COMPOSITE ANTEROLATERAL THIGH FREE FLAP FOR COMPLEX DEFECT OF LOWER LEG AND FOOT RECONSTRUCTION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2020.5.12 ◽

2020 ◽

pp. 85-91

Author(s):

Phuc Le Hong ◽

Son Tran Thiet ◽

Thuy Nguyen Xuan

Keyword(s):

Soft Tissue ◽

Skin Graft ◽

Free Flap ◽

Donor Site ◽

Lower Extremities ◽

Lower Leg ◽

Donor Site Morbidity ◽

Thigh Circumference ◽

Anterolateral Thigh

Background: In recent years, the composite anterolateral thigh free flap with tensor fasciae latae or vastus lateralis has been a new-applied type of flap that can provide very good reconstruction materials in complex defects of lower leg and foot. The study purpose is to evaluate the systematically complications of donor site, related factors to results of the donor area, in order to apply the result to improve the treatment, which have not been much reported in literature. Materials and Methods: Systematic donor site morbilidy evaluation in a prospective, uncontrolled clinical descriptive study of 33 composite anterolateral thigh free flaps in various forms to reconstruct anatomical structures or to resconstruct deep defects combined with covering the surfaces for complex soft tissue defects in lower extremities for 32 patients due to different causes in lower leg and foot area from 2014-2019 at Hue University of Medicine and Pharmacy. Examining and evaluating aesthetic and functional result of donor-site 3 months and 6 months up to 2 year after surgery; evaluating the correlation between the width and the type of the flaps and donor site closure methods. Result: In 33 composite flaps used, flap width to thigh circumference less than 20% in 27 cases (81.8%), more than 20% in 6 cases (18.20% ); There were 28 cases in which the donor site was directly closed, 5 cases required skin graft; All direct closed cases had flap width/ thigh circumference index below 20%; On the contrary, in cases having this index greater than 20%, the donor site required skin graft with p < 0.01. There are 11/33 (33.33%) of cases reported complications in donor site ; lateral thigh paresthesia is the most complicated complication with 8/33 cases (24.24%), followed by bad scarring 3/33 cases (9.09%). Conclusion: Long term follow up donor site morbility after composite anterior thigh free flap present 11/33 cases (33.33%): mostly complications of the donor site are thigh paresthesia with 8/33 cases (24.24%), and bad scarring 3/33 cases (9,09%), which improve time by time. Keywords: Composite anterior thigh free flap, lower extremities soft tissue defect, donor site morbidity

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