Rekonstruksi Pasca Ablasi Tumor Kepala dan Leher dengan Teknik Chimeric Flap

Keganasan pada kepala dan leher yang meliputi laring, kavitas oral dan orofaring, menempati urutan ke-enam jenis keganasan yang paling sering terjadi di dunia, di mana ?90% berasal dari sel skuamosa. Rekonstruksi pasca ablasi tumor menjadi hal yang menantang karena defek yang dihasilkan pasca ablasi tumor pada kepala-leher seringkali melibatkan struktur jaringan yang kompleks pada lokasi yang tidak berdekatan. Saat ini, chimeric flap menjadi pilihan dalam rekonstruksi defek pasca ablasi tumor karena flap ini mampu menyediakan variasi jaringan untuk defek multipel namun dengan satu tahap operasi. Beberapa pilihan chimeric flap yang dapat digunakan dalam rekonstruksi defek kepala dan leher adalah flap anterolateral thigh (ALT), flap sistem pembuluh darah subskapula, flap sistem pembuluh darah peroneal, flap temporoparietal, dan flap sistem pembuluh darah thoracoacromial.

Pedicled Chimeric Perforator Flap Based on Inferior Gluteal Vessel Axis for the Reconstruction of Stage-Four Primary Ischial Pressure Sores—A New Design

Background “Subfascial void reconstruction” in ischial pressure sores (IPSs) goes a long way in the amelioration of the common complications like persistent drainage, infection, wound dehiscence, and late recurrence. No locoregional flaps suffice this requirement. So we have designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) Pacman-style fasciocutaneous flap on a perforator and (2) gluteus maximus muscle (inferior portion) on another independent perforator. Aim and Methods After confirming the feasibility of novel design of chimeric pedicled IGVA perforator flap with cadaver study, we embarked on the clinical study with this chimeric flap. In this prospective cohort study, the study and the control existed in the same patient so that the biological factors affecting the wound healing would be the same. Results Twenty-one patients were included whose mean age was 39 years. Late recurrence occurred in one patient (4.8%) of chimeric flap while the control group (who had undergone conventional reconstruction) had recurrence in 11 patients (52.4%). On assessment with overall institutional score, grade A was observed in 18 patients of the chimeric IGVA flap group (p < 0.045), and in only 3 patients of the control group. Conclusions This anatomically construed flap, a new addendum in the armamentarium of reconstruction of IPSs, with its potential to congruently fill the ischiogluteal subfascial void may provide a lasting solution for preventing recurrences.