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.

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 Free Tissue Reconstruction of the Scalp

2019 ◽  
Vol 33 (01) ◽  
pp. 067-071 ◽  
Author(s):  
Mofiyinfolu Sokoya ◽  
Emily Misch ◽  
Aurora Vincent ◽  
Weitao Wang ◽  
Sameep Kadakia ◽  
...  
Keyword(s):  
Free Tissue Transfer ◽  
Free Flaps ◽  
Advantages And Disadvantages ◽  
Scalp Reconstruction ◽  
Tissue Transfer ◽  
Scalp Defects ◽  
Calvarial Defects ◽  
Reconstructive Option ◽  
Tissue Reconstruction

AbstractReconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer. Different free flaps for scalp reconstructed are described with a comparison of their advantages and disadvantages. Overall, free tissue transfer for scalp defects provides a reliable, durable, and cosmetically adequate reconstructive option.

scholarly journals Functional and aesthetic outcome with free fibula osteocutaneous flap in reconstruction of anterior mandibular defects in oral malignancies: our experience

2021 ◽  
Vol 7 (9) ◽  
pp. 1438
Author(s):  
Gopika Kalsotra ◽  
Disha Koul ◽  
Arti . ◽  
Parmod Kalsotra ◽  
Rupali Sharma ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Functional Outcome ◽  
Donor Site ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Post Surgery ◽  
Oral Cavity Carcinoma ◽  
Free Fibula ◽  
The Aesthetic ◽  
Osteocutaneous Flap

<p class="abstract"><strong>Background:</strong> For anterior mandibular defects, vascularized bone flap reconstructions are the best for providing a solid arch necessary to restore form and function, especially in patients receiving tumour excision surgery in head and neck region. Our aim was to study aesthetic and functional outcome of free fibula osteocutaneous flap (FFOCF) in anterior mandibular defects in case of anterior floor of the mouth malignancies with mandibular infiltration.</p><p class="abstract"><strong>Methods:</strong> The clinical data of 15 oral cavity carcinoma patients with involvement of anterior floor of mouth with mandiblular infiltration that underwent FFOCF reconstruction at our institute, government medical college, Jammu, was prospectively collected from January 2018 till January 2020. In this study, the aesthetic and functional outcome of these patients was evaluated at 6 months and 1 year post surgery.</p><p class="abstract"><strong>Results:</strong> The aesthetic result of reconstruction was excellent in most patients. Also, there was no long-term donor-site morbidity. There was no peri-operative death. Flaps survived in all patients. Functional outcomes including the ability to tolerate oral diet and speech outcome were good in all cases.</p><p class="abstract"><strong>Conclusions:</strong> The FFOCF, in reconstruction surgery of advanced oral cavity carcinoma permits more radical resection of tumour with good functional as well aesthetic outcome.</p>

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

Advancement cheiloplasty for reconstruction of floor of mouth defects

1994 ◽  
Vol 108 (6) ◽  
pp. 486-489 ◽  
Author(s):  
John S. Rubin
Keyword(s):  
Dental Implant ◽  
Free Flaps ◽  
Skin Grafts ◽  
Lower Lip ◽  
Significant Challenge ◽  
Floor Of Mouth ◽  
Oncologic Resection ◽  
Variable Success ◽  
Mobile Tongue ◽  
Marginal Mandibulectomy

AbstractIn many cases of carcinoma of the floor of mouth, oncologic resection includes marginal mandibulectomy. Reconstruction poses a significant challenge. Requirements include coverage with thin but supple tissue to allow for dental implant or denture, and recreation of a mobile tongue and sensate floor of mouth gutter. Reconstructive efforts have ranged from skin grafts to free flaps, with variable success in fulfilling the above-mentioned requirements.This paper describes the preferred technique of the author, in which external mandibular periosteum is saved and elevated with a submucosal flap of lower lip, raised to the level of the vermilion border. This flap is then advanced to ventral tongue. In this manner the entire anterior floor of mouth can be reconstructed.Cases are presented demonstrating different aspects to the technique.

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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