Consistent Value of Two-Stage Pedicle Flaps in the Age of Microsurgical Maxillofacial Reconstruction

Introduction Up to the second half of the twentieth century, pedicled flaps marked the gold standard in reconstructive surgery. Followed by the introduction of microsurgical techniques, these flaps were increasingly abandoned. We conducted a retrospective study to determine the value of two-stage pedicle flaps in modern maxillofacial reconstruction. Material & Methods A chart review from October 2017 to November 2020 was performed to identify patients who were treated by a two-stage pedicle flap in our Department of Oral and Maxillofacial Surgery. Results A total of 31 patients, 17 female and 14 males received 36 two-stage pedicle flaps. All patients were in noticeably impaired health condition with a majority of ASA-score 3. The defect location mainly contained extraoral resections (58.3%). A variety of flaps were harvested consisting of buccal flaps, Abbe flaps, forehead flaps, deltopectoral flaps, nasolabial flaps, and a tubed flap. Discussion The study outlines two indications for the use of two-stage pedicle flaps. Firstly, as a back-up strategy in heavily pre-treated wound beds and secondly in an almost contrarily indication as a first-choice reconstructive option of the facial skin in esthetic demanding cases. Conclusion The timesaving and straight forward surgical approach as well as their low postsurgical complications and strong long-time success rates secure the two-stage pedicle flap a justified niche role in times of microsurgical maxillofacial reconstruction.

Everted Pedicled Temporalis Fascial Flap to Augment Pedicled Pericranial Flap for Lax Duraplasty in Decompressive Craniotomy: A Cost-Effective Procedure

Decompressive craniotomy is a commonly performed surgery to relieve raised intracranial pressure. At the end of the procedure, it is the convention to cover the exposed brain by performing a lax duraplasty which allows for both brain expansion and provides protection to the underlying parenchyma. Various commercially available dural substitutes are used for this purpose. These have the drawback of being both expensive and nonvascularized. We propose a technique of using pericranium along with everted temporalis fascia (both being locally harvested vascularized pedicle flaps) that can suffice in a vast majority of cases for covering the brain.

A novel application of temporoparietal fasciocutaneus (TPFC) and temporoparietal (TPF) pedicle flap for auricular reconstruction

Background: Temporoparietal fasciocutaneus (TPFC) and temporoparietal (TPF) pedicle flaps play an important role among many techniques for auricular reconstruction. Because of their unique characteristics, the flaps based on the superficial temporal artery (STA) may be used for various types of reconstruction.Case series presentation: In this paper, we present several applications of the TPFC and TPF pedicle flaps in the reconstruction of defects after ear resection, including the use of the sandwich flap and preparing basis for Vistafix® system.Conclusion: Our experiences presented in this case series confirm the reconstructive potential of the flaps, also in patients in whom the Vistafix® system was used for reconstruction of the ear. In all cases described herein, the use of the pedicle flaps resulted in optimal healing and satisfactory cosmetic and functional outcomes.

Evaluation of pectoralis major myocutaneous flap at tertiary care hospital: retrospective study of 60 cases

<p class="abstract"><strong>Background:</strong> Reconstruction following advanced oral cancer is a formidable task in developing country, with poor infrastructure and heavy chunk of advanced stage (T3-T4) oral malignancy. Options available for reconstructions are regional pedicle flaps and microvascular free flaps. Pedicle flaps particularly the pectoralis major myocutaneous (PMMC) flap have an easy learning curve for most of surgeons. Pectoralis major myocutaneous flap is regarded as the workhorse for reconstruction in many head and neck surgeries.</p><p class="abstract"><strong>Methods:</strong> A study was undertaken on patients of soft tissue defects of head and neck region after resection of tumor of oral cavity (squamous cell carcinoma). Total 60 patients, who were managed in ENT department, Sir T hospital, Bhavnagar from 2016-19 were included in this study. </p><p class="abstract"><strong>Results:</strong> Gingivo-buccal complex was the most common site observed for oral malignancy and majority of patients were in TNM stage-I, II, III in this study. Apart from total flap necrosis observed in 1 patient, in rest all the patients PMMC flap very well survived with some major/minor, flap related and unrelated complications.</p><p class="abstract"><strong>Conclusions:</strong> The PMMC flap is effective in reconstruction of defect after excision of oral cavity cancers in developing country with heavy chunk of oral cavity cancer patients. In spite of several minor flap related and flap unrelated complications, PMMC flap survival rate is high and total flap necrosis rate is very low.</p>

Gaining Large Coverage With Small Island Pedicle Flaps in Tight Cosmetic Subunits: Taking Advantage of Rotation and Pincer Principles on the Nasal Ala

Background Island pedicle flaps (IPFs) are widely used in reconstructive surgery due to their versatility, tissue efficiency, and excellent clinical outcomes. While IPF rotations and ‘pincer flap’ modifications have previously been sparsely described, they are not often discussed in the literature. Objective We demonstrate the use of both rotating IPFs and pincer techniques for defects traditionally considered too large for classic IPF design on the nasal ala. Methods Forty-four patients underwent alar repair using the rotation or combined rotation with pincer modification to the standard IPF technique from August 2014 to May 2017. Our technique is described and case examples are presented with photographs. Results Forty-four patients with an average alar defect size of 1.2 cm underwent repair using rotation only or rotation with pincer modification of the classic IPF approach. Conclusions Reconstruction of large defects in small facial cosmetic subunits such as the nasal ala can be performed using principles of both rotating IPFs and the ‘pincer flap’ technique. The degree of rotation is directly related to the length of coverage. Modifications to the flap are straightforward to perform. Using these techniques, larger defects that previously would have been reconstructed using flaps that cross cosmetic boundaries can now be reconstructed within the same cosmetic unit, thus, improving aesthetic outcomes.