Sterno-omohyoid Free Flap for Dual-Vector Dynamic Facial Reanimation

2019 ◽  
Vol 129 (2) ◽  
pp. 195-200
Author(s):  
Aurora G. Vincent ◽  
Scott E. Bevans ◽  
Jon M. Robitschek ◽  
Kelly L. Groom ◽  
Marc W. Herr ◽  
...  
Keyword(s):  
Facial Palsy ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Superior Thyroid Artery ◽  
Skull Base Tumor ◽  
Dual Vector ◽  
The Face ◽  
Facial Reanimation ◽  
Fast Twitch Muscle

Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation. Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis. Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had improved objective facial symmetry. Conclusion: Herein, we demonstrate the first use of the sterno-omohyoid flap for successful facial reanimation. Overall, it is a novel flap in facial reanimation with many advantages over traditional flaps, including the potential to produce a more synchronous, dynamic smile while adding minimal bulk to the face. Future series will better elucidate the potential of the sterno-omohyoid flap.

scholarly journals Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique

2020 ◽  
Vol 9 (9) ◽  
pp. 3030
Author(s):  
Kathrin Bachleitner ◽  
Laurenz Weitgasser ◽  
Amro Amr ◽  
Thomas Schoeller
Keyword(s):  
Breast Cancer ◽  
Surgical Technique ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Operating Time ◽  
Cancer Recurrence ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Aesthetic Result ◽  
Secondary Operations

Various techniques for breast reconstruction ranging from reconstruction with implants to free tissue transfer, with the disadvantage of either carrying a foreign body or dealing with donor site morbidity, have been described. In patients who had a unilateral mastectomy and offer a contralateral mamma hypertrophy a breast reconstruction can be performed with the excess tissue from the hypertrophic side using the split breast technique. Here a local internal mammary artery perforator (IMAP) flap of the hypertrophic breast can be used for reconstruction avoiding the downsides of implants or a microsurgical reconstruction and simultaneously reducing the enlarged donor breast in order to achieve symmetry. Methods: Between April 2010 and February 2019 the split breast technique was performed in five patients after mastectomy due to breast cancer. Operating time, length of stay, complications and the need for secondary operations were analyzed and the surgical technique including flap supercharging were described in detail. Results: All five IMAP-flaps survived and an aesthetically pleasant result could be achieved using the split breast technique. An average of two secondary corrections to achieve better symmetry were necessary after each breast reconstruction. Complications included venous flap congestion, partial flap necrosis and asymmetry. No breast cancer recurrence was recorded. An overall approval of the surgical technique among patients was observed. Conclusions: The use of the contralateral breast for unilateral total breast reconstruction represents an additional highly useful technique for selected patients, is safe and reliable results can be achieved. Although this technique is carried out as a single-stage procedure, including breast reduction and reconstruction at the same time, secondary operations may be necessary to achieve superior symmetry and a satisfying aesthetic result. Survival of the IMAP-flaps can be improved by venous supercharging of the flaps onto the thoracoepigastric vein.

scholarly journals Temporoparietal Fascia Free Flap for a Large Nasal Septal Perforation

2019 ◽  
Vol 04 (01) ◽  
pp. e42-e46
Author(s):  
Nicholas G. Cuccolo ◽  
Ryan P. Cauley ◽  
Brady A. Sieber ◽  
Syed M.D. Hussain ◽  
Laurel K. Chandler ◽  
...  
Keyword(s):  
Medical Condition ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Nasal Septal Perforation ◽  
Temporoparietal Fascia ◽  
Versatile Tool ◽  
Underlying Medical Condition

AbstractReconstruction of large nasal septal perforations can be a considerable challenge for surgeons. Reconstructive modalities are often determined by the size of the defect and the quality of local tissue and vasculature. Local and regional flaps may not provide enough tissue to achieve successful closure in patients with large perforations and those with baseline compromise of the nasal mucosa and blood supply from prior intervention or underlying medical condition. Microvascular free tissue transfer is a possible approach to reconstruction in these patients. We report a case of a 30-year-old man who presented with a large, symptomatic, 4 × 3.5 cm perforation as a result of prior functional septoplasty at an outside hospital. Reconstruction of the defect was accomplished in this setting with a free temporoparietal fascia (TPF) flap anastomosed to the columellar branch of the labial artery and the angular vein. Postoperative follow-up visits showed successful closure of the perforation without complications. As illustrated by this case, TPF flap is a versatile tool for complex nasal reconstructions. With minimal donor-site morbidity and rich vascularity capable of promoting remucosalization without the need for prelamination, the TPF flap may be suited for the repair of large nasoseptal perforations.

scholarly journals SUPRACLAVICULAR ARTERY FLAP: A SAFE, VERSATILE AND A RELIABLE FLAP A NEW WORKHORSE IN HEAD AND NECK RECONSTRUCTION OUR CLINICAL EXPERIENCE

2021 ◽  
Vol 9 (01) ◽  
pp. 544-550
Author(s):  
Mir Mushtaq ◽  
◽  
Bashir Ahmad Bhat ◽  
Taj Din Wani ◽  
Shabir Iqbal ◽  
...  
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Graft Loss ◽  
Surgical Techniques ◽  
Free Tissue Transfer ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Wide Range

Background: Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Material and Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between November 2015 and October 2019. It involved 50 patients (40 females and 10 males), in whom supraclavicular artery flap was done to reconstruct head and neck. Follow-up period ranged from 2-27 months (average 12.3). Results: The study involved 50 patients. Mean age was 26.5 years (range 57-12 years). Thirty five patients had post-burn neck contractures, five patients had portwine stain face, three had marjolin ulcer, four patients had post traumatic and three had post bear maul defect. We harvested unilateral flaps in all of patients. In thirty five patients the flap was pedicled, three had adipofascial pedicle and twelve were islanded. The size of the reconstructed defect ranged from 23x10 to 14x6, and the size of the flap varied from 16x7cm to 25x11. Mean length was 21.7 cm. We used a partial thickness skin graft for donor site closure in 41 cases and closed primarily in 9 cases. Flap was used to resurface neck in 35 patients, face resurfacing in 10 patients, as intraoral lining in 3 patients. The following complications occurred: hematoma in 3 cases, partial distal necrosis in 2 cases, and donor site graft loss in 3 cases. Follow-up period ranged from 2-27 months Conclusion: The supraclavicular artery island flap is a thin, malleable fasciocutaneous flap that is easily and rapidly harvested, with a reliable pedicle and minimal donor site morbidity. It constitutes an alternative to local flaps, while providing equivalent functional results, and must be an integral part of the head and neck reconstructive surgeons therapeutic armamentarium.

scholarly journals Double free-flap for a bimalleolar defect of lower leg and ankle

2016 ◽  
Vol 49 (01) ◽  
pp. 95-98
Author(s):  
Naren Shetty ◽  
Narendra S. Mashalkar ◽  
Sunder Raj Ellur ◽  
Karishma Kagodu
Keyword(s):  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Lower Leg ◽  
Donor Site Morbidity ◽  
The Other ◽  
Limb Ischaemia ◽  
Distal Limb ◽  
Limb Defects ◽  
Recipient Vessel

ABSTRACTDouble free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.

Outcomes of Subfascial, Suprafascial, and Super-Thin Anterolateral Thigh Flaps: Tailoring Thickness without Added Morbidity

2017 ◽  
Vol 34 (03) ◽  
pp. 176-184 ◽  
Author(s):  
Shawn Diamond ◽  
Akhil Seth ◽  
Anmol Chattha ◽  
Mathew Iorio
Keyword(s):  
Donor Site ◽  
Univariate Analysis ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Wound Breakdown ◽  
Patient Morbidity ◽  
Anterolateral Thigh ◽  
Flap Thickness ◽  
Anterolateral Thigh Flaps ◽  
Alt Flap

Background Subfascial anterolateral thigh (ALT) flap thickness can be problematic with regards to bulk, oral competence, shoe-fit, or as a potential source of recurrent wound breakdown. We have utilized distinct upper thigh fascial planes to fashion thin (suprafascial) or super-thin (periscarpal) ALT flaps to improve surface topography. We compared outcomes based on ALT flap thickness to determine any significant differences in extremity coverage and reconstruction. Methods Analysis was completed on patients who consecutively underwent ALT free tissue transfer at a single institution from May 2012 to January 2017. Patient's operative, and postoperative characteristics were evaluated. Univariate analysis determined differences among matching as well as functional outcomes. A multivariable regression identified independent risk factors associated with patient, donor site, and flap complications. Results Fifty-one patients met inclusion criteria. Of these, 16 (31.4%) underwent traditional subfascial ALT flaps, and 35 (68.6%) underwent suprafascial (N = 23) or super-thin (N = 12) flaps. Thin flap patients were more likely to use tobacco (42.9% versus 6.3%; p < 0.01), have fewer perforators (1.20 ± 0.41 versus 1.64 ± 0.63; p < 0.009), and shorter mean operative times (425.9 ± 87.8 versus 511.9 ± 79.9; p < 0.002), but nearly identical flap sizes (163 cm2 versus 168 cm2). There were no significant differences in flap complications (18% versus 22%) or donor-site complications (6.3% versus 5.7%) between the thick and thin cohorts, respectively (p > 0.05). In subgroup analysis, diabetes mellitus was an independent risk factor for donor site morbidity (odds ratio [OR] = 1.23; p = 0.027) for all groups, whereas tobacco use and obesity (body mass index [BMI] > 30) failed to significantly alter outcomes independently. Conclusions Tailoring ALT thickness can be performed safely without compromising flap outcomes or patient morbidity. Suprafascial and super-thin ALTs allowed for safe, precise solutions for tissue coverage.

scholarly journals Ear Reconstruction

2021 ◽  
pp. 731-745
Author(s):  
Paritkumar Ladani
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Congenital Deformity ◽  
Ear Reconstruction ◽  
No Donor ◽  
Rib Cartilage ◽  
Self Confidence ◽  
Emerging Trends ◽  
The Face ◽  
Reconstructive Techniques

AbstractMicrotia is a congenital deformity of the external ear, with a prevalence rate of approximately 1 in 10,000 live births worldwide. The auricle is a distinguishing feature of the face. Its deformity may have severe psycho-social implications on the affected children, affecting their self-confidence. Current reconstructive techniques for microtia mainly include the auricular prosthesis, implantation of alloplastic or an autologous rib cartilage framework. Alloplastic implant reproduces an excellent shape of the ear with no donor site morbidity, however its bio-integration is questionable and may make them prone for extrusion and infection. Sub-cutaneous implantation of autologous rib cartilage still remains the gold-stand treatment for microtia. However this technique has its surgical morbidities and skill demands, which makes it difficult to master. Translational research in the fields of tissue engineering for generation of bone and cartilage for ear reconstruction are emerging trends.

Microvascular cover in the lower limbIndications and timing, flap types, and technique

2021 ◽  
pp. 601-610
Author(s):  
Zoran M. Arnež
Keyword(s):  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Microvascular Surgery ◽  
The Body ◽  
Potential Donor ◽  
Musculocutaneous Flaps ◽  
Tissue Transfer

Providing adequate and timely soft tissue cover is essential in the treatment of injuries to the lower extremity. Microvascular free tissue transfer is a part of the algorithm of treatment. Free flaps provide the desired quantity and quality of well-vascularized tissue from numerous potential donor sites all over the body, tailored to each specific defect. Microvascular surgery allows single-stage reconstruction of composite defects and is best done early, where possible in the first 24 hours or failing this, during the first week after injury. Free tissue transfer is a complex interdisciplinary procedure and can fail in up to 5% of cases. It is not appropriate for all patients. Free muscle, or musculocutaneous, flaps are ideal for coverage of diaphyseal defects whereas free fasciocutaneous flaps are better for coverage of metaphyseal defects. Perforator free flaps experience little donor site morbidity.

scholarly journals Free Tissue Breast Reconstruction

2019 ◽  
Vol 33 (01) ◽  
pp. 059-066 ◽  
Author(s):  
Rami Dibbs ◽  
Jeff Trost ◽  
Valerie DeGregorio ◽  
Shayan Izaddoost
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Donor Site ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Fat Grafting ◽  
Microsurgical Technique ◽  
Deep Inferior Epigastric Perforator ◽  
Aesthetic Breast

AbstractFree tissue transfer serves as a modern workhorse for breast reconstruction. Advancements in microsurgical technique have allowed for the development of free flap procedures that produce an aesthetic breast while minimizing donor site morbidity. Here, the authors review the use of different free flap procedures for breast reconstruction with a focus on the preferred and most commonly used flap, the deep inferior epigastric perforator flap. Each flap has its advantages and drawbacks, and certain patient risk factors increase postoperative complications. Other techniques of breast reconstruction including pedicled flaps and adjunctive fat grafting are also briefly discussed.

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