Cases Of Flap Necrosis Research Articles

Moving from the O-Z flap to the O-S flap for scalp reconstruction: A new geometrical model

The O-Z flap is the most commonly used local flap technique to repair round and oval scalp defects in clinical practice. Preoperative flap marking is one of the major technical issues of this reconstructive method and it is essential to achieve an optimal outcome. Nevertheless, the absence of a unified arc design scheme could significantly limit the use of this useful and reliable technique, and flap drawing is sometimes based more on the surgeon's experience than on a real geometrical model. Our aim was to describe an intuitive and standardizable method for O-Z flap marking, that we called "O-S flap," based on a simple and easily replicable geometrical pattern. We reported our experience in this case series of eight patients with skin tumors of the scalp who underwent scalp reconstruction with the "O-S flap" technique at our university hospital. Most patients had defects located on the vertex or parieto-occipital regions of the scalp. The area of the defects ranged from 7 to 78.5 cm2. There were no cases of flap necrosis, wound infection, or positive margins, and no patients required revision surgery. We believe that our technical refinement represents a safe, easy, and reproducible method for O-Z flap marking. It follows a simple geometrical model which could be customized according to different clinical needs.

The Utility of a "Second-Look" Debridement Following Endonasal Skull Base Surgery in the Pediatric Population.

Background Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second-look procedure may require general anesthesia; however, there is currently little evidence assessing the benefit of this practice. Methods This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second-look debridement under general anesthesia following ESBS. Intraoperative findings, interventions performed, and perioperative complications were reviewed. Multivariate regression analysis was performed to identify associations between intraoperative findings and clinical factors. Results We reviewed 69 cases of second-look debridements (age mean 8.6 ± 4.2 years, range: 2-18 years), occurring a mean of 18.3 ± 10.3 days following ESBS. All abnormal findings were noted in patients age ≤12 years. Synechiae were noted in 8.7% of cases, bacterial rhinosinusitis in 2.9%, and failed reconstruction with cerebrospinal fluid leak in 4.5% (two cases of flap malposition and one case of flap necrosis). All failed reconstructions were noted following expanded endonasal cases for craniopharyngioma, and in each case, a revision reconstruction was performed during the second-look surgery. Synechiae were not significantly associated with younger age, revision cases, or cases with reconstructive flaps. There were no perioperative complications. Conclusion Second-look debridement under general anesthesia may be useful in the identification and intervention of sinonasal pathology following endoscopic skull base surgery, particularly in children ≤12 years old or those with pedicled flap reconstructions. Larger controlled studies are warranted to validate this practice and refine indications and timing of this second procedure.

Shape-modified radial forearm flap: does it still have a role in upper extremity reconstruction?

ObjectivesTo carry out a radial forearm flap, the radial artery is usually harvested, incurring severe donor site morbidity. Advances in anatomical knowledge discovered constant radial artery perforating vessels, enabling the subdivision of the flap into smaller components suitable for a wide range of differently shaped recipient sites, with marked reduction of downsides. Material and methodsEight pedicled or free shape-modified radial forearm flaps were used to reconstruct upper extremity defects between 2014 and 2018. Surgical technique and prognosis were examined. Skin texture and scar quality were assessed on the Vancouver Scar Scale while function and symptoms on the Disabilities of the Arm, Shoulder and Hand score. ResultsAt a mean follow-up of 39 months, no cases of flap necrosis, impaired hand circulation or cold intolerance were found. ConclusionThe shape-modified radial forearm flap is not a new technique, but is poorly known by hand surgeons; in contrast, our experience showed it to be reliable, with acceptable functional and esthetic outcomes in selected cases.

EARLY SURGICAL OUTCOMES OF OPERABLE BREAST CANCER PATIENTS BASED ON MOLECULAR SUBTYPING – A SINGLE-CENTRE STUDY

Objectives: The aim of the study was to assess patients belonging to four main molecular subtypes (Luminal A, Luminal B, HER2 neu positive and Triple negative) and their treatment plans with a view to compare their early surgical complications and the final outcomes specific to the surgical procedure adopted and molecular subtype. Methods: A Cross-sectional observational study at a Tertiary care center in central UP in a two-year period with Inclusion Criteria and Exclusion Criteria. Data Collection was carried out from the patients, diagnostic confirmation to rule out any exclusion criteria was performed. Clinical staging was done using the standard TNM criteria. All the specimens were subjected to immune-histochemical evaluation for surrogate molecular subtyping to see later the early surgical outcomes. Results: Mean age ranged from 47.57±9.57 (Group III) to 50.67±8.08 (Group II) years and BMI ranged from 23.71 (Group IV) to 26.38 kg/m2 (Group II). Neoadjuvant chemotherapy use was reported in 15.6% of Luminal A group, 33.3% of Luminal B group, 40% of Her2 negative and 52.2% of Triple negative group cases. Statistically, there was a significant difference among groups with respect to use of neoadjuvant chemotherapy. Breast conservation therapy was the preferred surgical intervention in majority of cases with Luminal A (60%) and Luminal B subtype (66.7%) whereas MRM was preferred in 54.3% of Her2 negative and 65.2% of Triple negative cases. MRM was performed in 36% of Luminal A cases. Primary surgical intervention failure (BCS) was seen in 1 (4%) case with Luminal A subtype. In this patient, mastectomy was performed as the corrective measure. Surgical site infection was noted in 1 (4%) case in Luminal A group only. Seroma formation was noted in 4 (16%) of Luminal A, 8 (22.9%) of Her2 negative and 2 (8.7%) of Triple negative patients. No case of flap necrosis was noted. Follow-up duration ranged from 15 days to 36 months. Median duration of follow-up was 6 months. No mortality was noticed in any group. Conclusion: Different surgical management strategies suggested that breast conservative surgery was more feasible in Luminal A cases whereas MRM was the preferred mode of surgery in other molecular subtypes. Within the limitations of short duration of follow-up, there was no significant difference among different molecular subtypes with respect to late complications and survival. Further studies with longer duration of follow-up and larger sample size are recommended.

Notre expérience du lambeau sural à pédicule distal dans la réparation des lésions du talon et de la plante du pied

The sural flap has often been used to cover the weight-bearing and non-weight-bearing areas of the foot and ankle. This study reports our experience in the coverage of these defects in the foot in weight-bearing areas. This is a retrospective and descriptive study of 70 months. This study includes 16 patients presenting a loss of plantar substance and/or heel of the foot covered by a sural flap with a distal pedicle. The sampling technique described by Masquelet served as our reference. An increase in the length of the pedicle of at least two centimeters during the dissection made it possible to avoid any stretching or compression for the most distal lesions. The average age was 35 years with a sex ratio of three in favor of men. Traumatic lesions predominated (n=10) with an average area of lesions of 68.8cm2. The average partial and total support times were 1.8 and 3.6 months respectively. We noted one case of flap necrosis. The natural evolution of the flap took place in three progressive stages: regeneration, keratinization and squamous metaplasia. Normal bipodal support and stable gait without footwear anomaly were noted in 15 cases. The distal pedicle sural flap technique is accessible. Its reliability makes it an ideal choice for distal loss of substance to the leg and foot.

Maximizing Safety and Optimizing Outcomes of Labiaplasty: A Systematic Review and Meta-Analysis.

The considerable increase in labiaplasty requires plastic surgeons to be acquainted with the surgical techniques, their respective complications, and satisfaction rates. The authors conducted a systematic review of the available evidence on labia minoraplasty, looking at surgical techniques, clinical outcomes, and patient satisfaction. A comprehensive search across PubMed, Web of Science, SCOPUS, and CochraneCENTRAL was performed through October of 2020. A random-effects model meta-analysis was performed to assess satisfaction and complication rates. Forty-six studies including 3804 patients fulfilled the inclusion criteria. The pooled satisfaction rate after labia minoraplasty was 99 percent (95 percent CI, 97 to 99 percent). Substantial heterogeneity was present across studies ( I2 = 63.09 percent; p < 0.001). The highest pooled incidence of dehiscence was reported for laser-assisted labiaplasty (5 percent; 95 percent CI, 2 to 8 percent) and wedge resection (3 percent; 95 percent CI, 1 to 5 perecent). The highest pooled incidence of hematoma formation (8 percent; 95 percent CI, <1 to 23 percent) and postoperative bleeding (2 percent; 95 percent CI, <1 to 15 percent) was reported for W-shape resection. The highest pooled incidence of transient pain or discomfort was reported for de-epithelialization (2 percent; 95 percent CI, <1 to 23 percent) and W-shape resection (2 percent; 95 percent CI, <1 to 15 percent). Three cases of flap necrosis were reported; two occurred using wedge resection labia minoraplasty and one was not specified. The most common causes for revision surgery ( n = 169) were dehiscence and aesthetic concerns. Labia minoraplasty is a safe procedure, but serious complications requiring surgical management have been reported. Surgical experience, knowledge of female genital anatomy, and thorough technique selection in accordance with the patient characteristics are mandatory.

The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations

PurposeThe paramedian forehead flap (PMFF) is a reconstructive option for large eyelid defects and orbital exenterations. We report a series of cases where PMFF reconstruction was carried out at various institutions in Australia.MethodsThis study was a multi-centre, retrospective, non-comparative case series investigating the clinical outcomes of the PMFF for reconstructing periocular defects and orbital exenterations.ResultsThis case series describes twenty-seven patients (Female = 15, Male = 12), operated between 1991 to 2019, with a median age of 81 years (range: 45–93 years). Defect locations involved combinations of the medial canthus (16/27, 59.3%), upper eyelids (7/27, 25.9%), lower eyelid (4/27, 14.8%), both upper and lower eyelids (5/27, 18.5%), and orbital (7/27, 25.9%). There were no cases of flap necrosis. Minor post-operative complications were observed in ten patients with the most common being lagophthalmos. Median duration of follow-up was 17months (Range: 2months- 23years).ConclusionsThe PMFF is a versatile reconstructive tool for a range of periocular defects and orbital exenterations with minor post-operative complications.

The LN Flap for Nasal Defect Reconstruction: An 84-case Experience with a Novel Technique.

Background:The nose is a common site for cutaneous malignancy and post-ablative reconstruction. To our knowledge, a myocutaneous island flap based on the levator labii superioris alaeque nasi (LLSAN) and nasalis muscles, with vascularity from the lateral nasal and angular arteries, has not been described for reconstruction of the lower lateral nose.Methods:A retrospective chart review of patients who underwent LLSAN-nasalis island flap reconstruction between 2015 and 2019 was performed. The surgical technique involved marking of an inverted-V flap on the nasal sidewall. The skin lateral to the flap was then developed in the subcutaneous plane to expose the LLSAN muscle and divide its origin on the maxillary frontal process and its caudal insertions into the alar dermis. The medial incision was down to periosteum and perichondrium, and dissection beneath the flap separated it from the nasal support structure. The resultant flap had a great caudal mobility. The donor site was closed in a V-to-Y pattern.Results: In total,84 procedures were completed, mostly for alar defects (57.1%) between 100 and 400 mm2 (71.4%). The average age of patients was 74.9 years. An estimated 27 patients were lost to follow-up. At mean follow-up of 24.3 weeks, there were no cases of flap necrosis, 1 case of hematoma (1.8%), 1 case of infection (1.8%), 3 cases of persistent trapdoor deformity (5.3%), and 3 cases of alar notching (5.3%), 1 of whom required revision surgery.Conclusion:The LLSAN-nasalis myocutaneous island flap is a simple, reliable technique for resurfacing lateral lower nasal defects up to 2 × 2 cm.

Scalp reconstruction: A 10-year experience.

Background The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons.Methods This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors.Results Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p= 0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R = 0.479, p< 0.001) and depth (p< 0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis.Conclusion There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.

Simple prosthesis versus prosthesis plus titanium-coated polypropylene mesh for implant-based immediate breast reconstruction after total mastectomy for breast cancer.

Our study compares the cosmetic effects, postoperative complications, and quality of life of immediate breast reconstruction with simple prosthesis or prosthesis plus titanium-coated polypropylene mesh (TCPM) after total mastectomy for breast cancer. In total, 69 patients who underwent total mastectomy, sentinel lymph node biopsy, and immediate prosthetic breast reconstruction from January 2015 to December 2018 in our hospital were selected, and their cosmetic effects, complications, and quality of life after reconstruction were recorded immediately after surgery and 6 months after surgery. Of these 69 patients, 29 were in the simple prosthesis group and 40 in the prosthesis + TCPM group. The incidence of surgical complications was 17.2% in the simple prosthesis group (5/29; including 4 cases of capsular contracture and 1 case of infection) 15.0% in the prosthesis + TCPM group (6/40; 1 case of flap necrosis, 2 cases of poor wound healing, 2 cases of hematomas, and 1 case of inadequate blood supply to nipple). The complications were successfully managed after symptomatic treatment in both groups. No prosthesis loss was noted. The incidence of postoperative complications showed there to be no significant differences between these two groups (P=0.06, χ2=0.80). The satisfaction rate of patients on cosmetic effects was 95.0% (38/40) in the prosthesis + TCPM group, significantly higher than that in the simple prosthesis group (75.90%, 22/29) (P=0.05, χ2=3.87). The quality of life in the simple prosthesis group at 2 weeks and six months after the operation was significantly lower than that in the prosthesis + TCPM group. The incidence rate of arm pain and fatigue at 2 weeks after operation was significantly higher than that in the prosthesis + TCPM group (P=0.04, χ2=4.42). The satisfaction of family life and sexual interest 6 months after the operation was also significantly lower in the simple prosthesis group than in the prosthesis + TCPM group (P=0.03, χ2=4.95). Breast reconstruction with prosthesis combined with TCPM does not increase surgical complications and has a good cosmetic effect and high patient satisfaction. Thus, it is a safe and reconstruction method.

New Approach for Post-bariatric Abdominoplasty with Extended Vertical Resection: A Prospective Cohort Study.

As the number of bariatric surgeries has increased, so has the demand for post-bariatric abdominoplasty. The aim of this study was to describe a new approach to anchor-line abdominoplasty for the treatment of post-bariatric surgery patients. This prospective, longitudinal, single-center study was conducted with 20 women, 23-47years of age, with a body mass index < 30kg/m2, who had undergone gastroplasty. The vertical amount of tissue to be excised was estimated preoperatively by the pinch test. The amount of tissue to be removed by transverse resection was determined intraoperatively. Patient satisfaction with the body contour result was assessed. Patient self-assessment showed that 85% of patients were very satisfied, 10% were satisfied, and 5% were not very satisfied with the surgical results. There were no cases of flap necrosis or surgical wound dehiscence. The described technique resulted in improved body contour, good scar quality, and a high level of patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of controllable hair density of eyebrow reconstruction with the treatment of scar baldness during the same operation stage

Objective To explore a method of eyebrow reconstruction which can control eyebrows, and to repair scar baldness in the same operation stage. Methods Operations were performed in two stages. In the first stage, an expander was placed under the scalp at the same side of the defect eyebrow through the direction of the superficial temporal artery. Other expanders were placed around the scar baldness. After the incision healed, water was injected into the expander. During the expansion, the scalp hair density was approaching the uninjured eyebrow side. Then the second stage operation was prepared: an island flap with superficial temporal artery as axial artery was harvested and the expander was extracted. The subcutaneous tunnel was made in the temporal region of the eyebrow defect side. The expanded superficial temporal artery island scalp flap was passed through the tunnel and transferred to the defect eyebrow area to repair the eyebrow. After incising the scar baldness, the left expanded scalp flaps were transferred to cover the wound. Results 12 patients underwent this method of eyebrow reconstruction with scar baldness, all island scalp flaps survived, with no case of flap necrosis. After 6-24 months of follow-up, the hair density of the reconstructed eyebrows was very close to that of the uninjured side, without excessive thickening or excessive rarefaction. The scalp scars were small and can be shaded by the hair. All patients were satisfied with the operation. Conclusions The method of controllable hair density of eyebrow reconstruction with the treatment of scar baldness has good effects on reconstructing eyebrow defect and scar baldness. It is simple, economic and suitable for further application. Key words: Eyebrows; Cicatricial alopecia; Surgical operation; Eyebrow reconstruction

Sternocleidomastoid Flap in Parotid Surgery: A Case Series.

Superficial and deep parotidectomies are known treatments for benign and malignant neoplasms of parotid glands. Due to the gland's proximity to facial nerve and other vital structures, this surgery carries the highest risk of facial nerve palsy. Another frequently overlooked complication, which can be detrimental to patient's life style is Frey's syndrome, or gustatory sweating. Other complications include flap necrosis and various contour deformities. We conducted this study on a group of 40 patients of parotid swellings to assess usage of sternocleidomastoid flap in prevention of Frey's syndrome, contour deformities, flap necrosis, salivary fistula and drain related injuries. We divided the patients in two groups based on the usage of sternomastoid flap. In Group A, the patients underwent superficial or total parotidectomies with a partial thickness, superiorly based sternomastoid flap. In Group B, no sternomastoid flap was placed. The incidence of Frey's syndrome was seen to be 3 times in Group B, while a visible contour deformity was seen in a third of patients in Group B, with Group A reporting no incidence. Also Group A, did not see any cases of flap necrosis or salivary fistula, while Group B saw 3 and 2 cases respectively. Also, among the two revision cases done in Group A, the one with previously placed sternomastoid flap (done by us 3years back) had an excellent plane preserved, while another revision case without sternomastoid flap saw a complete adherence of facial nerve to overlying skin, resulting in Grade II permanent facial palsy. Parotidectomy is a technically challenging surgery in regards to important structures in the vicinity. Even with ostensibly perfect technique, facial nerve injury can occur for unknown reasons. All in all, sternomastoid flap is an acceptable modality to fill the parotidectomy defect, improve the facial contour and reduce the incidences of Frey's syndrome and skin necrosis.

Repair of post-laryngectomy pharyngocutaneous fistulas using a pectoralis major flap

IntroductionThe pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies assessing variables related to pharyngocutaneous fistula recurrence after removal of the larynx. Our objectives were to review the results obtained with this type of treatment when pharyngocutaneous fistula appears in laryngectomized patients, and to evaluate variables related to the results. MethodsWe retrospectively reviewed our results using either a myocutaneous or fasciomuscular pectoralis major flap to repair pharyngocutaneous fistula in 50 patients. ResultsThere were no cases of flap necrosis. Oral intake after fistula repair with a pectoralis major flap was restored in 94% of cases. Fistula recurrence occurred in 22 cases (44%), and it was associated with a lengthening of the hospital stay. Performing the flap as an emergency procedure was associated with a significantly higher risk of fistula recurrence. Hospital stay was significantly shorter when a salivary tube was placed. ConclusionsThe pectoralis major flap is a useful approach to repair pharyngocutaneous fistula. Placing salivary tubes during fistula repair significantly reduces hospital stay and complication severity in case of pharyngocutaneous fistula recurrence.

Treatment of Implant Exposure due to Skin Necroses after Skin Sparing Mastectomy: Initial Experiences Using a Not Selective Random Epigastric Flap.

Eight consecutive cases of implant exposure (or risk of exposure) due to skin necrosis in SSM patients over a period of 5years, all patients were treated using a random epigastric rotation flap, executed by the same medical team. A random epigastric flap (island or conventional rotation flap) was used to cover the skin defect. All the patients completed the procedure and all prostheses were saved; there were no cases of flap necrosis or infection. Cases of skin necrosis after SSM and immediate implant reconstruction, in which the implant is at risk of exposure, can be successfully treated with a random epigastric rotation flap.

Effect of neoadjuvant chemotherapy on women undergoing breast cancer surgery and immediate breast reconstruction with latissimus dorsi flap and silicone implants

The use of the latissimus dorsi flap in immediate breast reconstruction is a relatively simple procedure using a flap with a very reliable and consistent vascularity. Neoadjuvant chemotherapy improves local surgical conditions; however, most chemotherapeutic agents are cytotoxic and may increase the risk of postoperative complications. This study evaluated the effects of neoadjuvant chemotherapy on women with cancer who underwent immediate breast reconstruction with latissimus dorsi flap and silicone implants. Data were collected from medical records of 102 patients with cancer who had undergone immediate breast reconstruction with latissimus dorsi flap and silicone implants from August 2010 to December 2014. Thirty-three patients received neoadjuvant chemotherapy (study group) and 69 patients underwent primary surgical treatment (control group). Three (2.9%) patients in the study group had a major postoperative complication (two cases of hematoma requiring surgical drainage and a case of flap necrosis), which was the only variable showing a significant difference between groups (P = 0.032). Neoadjuvant chemotherapy followed by cancer surgery with immediate breast reconstruction with latissimus dorsi flap and silicone implants was not associated with an increased risk of postoperative surgical and clinical minor complications. It was associated with a significant increase in postoperative major complications, despite the small number of cases. However, patients who received neoadjuvant chemotherapy had a significantly more aggressive disease and advanced-stage cancer, and required a more extensive cancer surgery. Level of Evidence: Level III, risk / prognostic study.

Compatibility of StratticeTM Matrix for Breast Reconstruction with Radiation Therapy

Introduction: StratticeTM is a porcine acellular dermal matrix used in breast reconstruction. It acts as a hammock for breast implants and to define the infra mammary fold. Method: All patients who underwent StratticeTM based reconstruction from 2010-15 under the care of one breast surgeon were included in this study. The StratticeTM matrix was used to create the sub pectoral pouch in which the implant was placed. Patients were divided into 2 Groups based on radiation therapy to the breast either before or after surgery (Group A) and those who received no radiation at any stage (Group B). Data regarding indication for surgery, size of implant, follow up time and significant complications were collected and analyzed using Windows Excel. Statistical analysis was performed using Chi-Squared test to compare the complications between the 2 Groups. A subgroup analysis was performed based on either breast surgery with skin sparing mastectomy and immediate reconstruction (SSM and IR), delayed reconstruction (DR) or re-do reconstruction (RR). Results: There were 76 cases with average age of 52 years (33-79). There were 30 cases in Group A and 46 in Group B. In Group A, 14 patients had IR, 15 DR and 1 RR. 3 patients had previous lumpectomy and radiation treatment for breast cancer followed by SSM and IR. In Group B, 25 had IR, 20 had DR and 1 had IR. The average size of implant used was 422 gms (195-765 gms). Follow up time was 27 months (1-62). In Group A there were 2 cases of infection, 1 case of capsule contracture and 2 wound breakdowns. 5 mastectomy flaps failed to stretch due to poor skin compliance secondary to radiation to the chest wall. There was 1 case of bottoming out of the implant in this Group requiring RR. In Group B, there was 1 case of extrusion requiring RR and 1 case of flap necrosis. Group A had more complications and implant loss than Group B and this was found to be statistically significant (p<0.0007). Conclusion: StratticeTM based breast reconstruction post radiotherapy carries higher risk of complications and abandoning due to non-compliant skin. This elevated risk should be emphasized to the patients and autologous flaps should be considered in these cases.

The Use of a Mechanical Stapler in Jejunal Free Flaps in Laryngopharyngectomy Defects.

The Use of a Mechanical Stapler in Jejunal Free Flaps in Laryngopharyngectomy Defects.

Management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection

To discuss the management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection. A total of 259 cases of free flap reconstruction performed in the Cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2013 were retrospectively analyzed, including 89 cases of anterolateral thigh flaps, 48 cases of radial forearm flaps, 46 free fibula flaps, 5 cases of inferior epigastric artery perforator flaps, 5 cases of free latissimus dorsi flaps, one case of lateral arm flap, and one case of medial femoral flap. The surveillance frequency of free flaps was q1h on post-operative day (POD) 1, q2h on POD 2 and 3, and q4h after POD 3. Vascular crises were reviewed for analysis. The incidence rate of vascular crisis was 8.1% (21/259), with 15 males and 6 females. The average age was 54.8 years old (17-68), and the average time of vascular crisis was 100.8 h post-operation (3-432). There were 7 cases of free jejunum flaps and 14 dermal free flaps. Seven of these 21 cases with vascular crisis were rescued by surgery. The success rate of salvage surgery within 72 hours from the primary operation was 54.5% (6/11), significantly higher than that of salvage surgery performed later than 72 hours from primary operation (10.0%, 1/10, P=0.043). There were 14 cases of flap necrosis, two of which died of local infection. Early detection of vascular crisis can effectively improve the success rate of salvage, so as to avoid the serious consequences caused by free flap necrosis.

Resection and reconstruction of giant cervical metastatic cancer using a pectoralis major muscular flap transfer: A prospective study of 16 patients.

If not promptly or properly treated, certain cervical metastatic cancers that develop from unknown primary tumors may rapidly grow into giant tumors that can invade the blood vessels, muscle and skin. The present study examined the feasibility and efficacy of radical neck dissection combined with reconstruction using the pectoralis major myocutaneous flap for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. A total of 16 patients who met the inclusion criteria were subjected to radical neck dissection to adequately resect invaded skin, and the pectoralis major myocutaneous flap was used to repair the large skin defect created in the cervical region. Following the surgery, the patients received concurrent chemoradiotherapy. The pectoralis major myocutaneous flap survived in all 16 patients, with no cases of flap necrosis. In addition, no post-operative lymphedema, paresthesia or dysfunction of an upper extremity occurred due to the cutting of a pectoralis major muscle. In 9 cases, patients were satisfied with their post-operative shoulder movement at the donor site; in the remaining 7 cases, patients felt greater weakness in this region following surgery relative to prior to surgery. The 14 male patients were generally satisfied with the post-operative appearance of the donor region, whereas the 2 female patients were dissatisfied with the appearance of this region. Follow-up for 6-53 months after the patients were discharged following surgery and chemotherapy revealed that the recurrence of cervical tumors in 6 cases. Overall, radical neck dissection combined with the use of the pectoralis major myocutaneous flap for reconstruction is a feasible approach for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. Post-operative concurrent chemoradiotherapy should be administered to improve the local control rate and patient quality of life, allowing a satisfactory therapeutic efficacy to be achieved.