Cervical Flap Research Articles

ADVANTAGES OF CONSERVING SURGERY WITH EXCISION OF MUCO-MUSCULAR CERVICAL FLAP BY USING TRANSVAGINAL MORTSELLYATOR IN THE TREATMENT OF BENIGN COMBINED PATHOLOGY OF THE CERVIX AND UTERINE BODY

On the basis of a comprehensive study of the clinical and laboratory parameters of a comparative assessment of the effectiveness of operations subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator and total hysterectomy about benign combined pathology of the cervix and uterine body. Depending on the extent of surgical treatment 2 groups of women were formed, who have had total hysterectomy and subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator. As a result of further examination revealed the benefits of subtotal hysterectomy with excision of muco-muscular cervical flap: the duration of the operation, blood loss, and drop in hemoglobin levels after surgery. Preserving the anatomical relationship of the pelvic organ, saving ligament apparatus and cervical innervations save vaginal integrity, reduce the risk of complications in the form of descent and prolapse of the vaginal walls in the late postoperative period, which will undoubtedly improve the quality of life of women.

A large squamous cell carcinoma over the zygoma- a rare presentation reconstructed with mustarde advancement rotation cheek flap

Background & Objectives: The use of Mustarde advancement rotational cheek flap for moderate to advance facial defects is a simple and effective alternative among other local, regional, free flaps like rhomboid flap, bilobed flap, cervical flap and for repair of the large defect of the facial skin with microvascular free flap like rectus abdominis free flap are used for facial reconstruction. Instead of using more complex free flaps, this flap can be considered as an alternative. Method: Mustarde advancement rotational cheek was harvested by carrying superior part of incision cephalad towards temple. Result & Interpretation: Defect site showed satisfactory healing with reduced morbidity with satisfactory result. Conclusion: Mustarde advancement rotational cheek flap proved to be useful alternative for surgeons for reconstruction of large facial defects with minimal morbidity. It can definitely replace the other complex flaps in most instances. In this article, we report the use of Mustarde advancement rotational cheek flap to reconstruct the facial defect. Keywords: Mustarde Advancement Rotation Cheek Flap Ectropion, Epiphora, Tarsal Plates

Turned in fasciocutaneous island flap from face and neck based on subdermal microcirculation for reconstruction of the oral cavity following cancer surgery.

Background:The skin and soft tissues of the face and neck have a rich plexus of dermal-subdermal vessels, which creates the possibility of raising a fasciocutaneous flap based on this vascular supply. A turned in fasciocutaneous island flap (TIFCIF) from an adjacent area of the defect can provide a simple substitute to many complex reconstructive procedures.Materials and Methods:Fifteen patients underwent wide excision for oral cancer and upper neck dissection, maintaining bone framework, between August 2010 and June 2014. The reconstruction was done with a ’turned in fasciocutaneous island flap’ (TIFCIF) from the upper neck-lower face based on subdermal superficial adipofascial microvascular network instead of a specific known feeder vessel. The upper cervical flap, the donor site, when raised during the initial incision and the upper neck dissection, was cut off from the facial artery, the submental artery, the superior thyroid and the transverse cervical arteries. The microcirculation depended largely on the rich vascular plexus formed of the branches of the superficial temporal and the maxillary arteries. The donor site was primarily closed in Fourteen of the Fifteen patients. Eight patients received post-surgery irradiation.Results:All the flaps survived and healed and withstood radiation well. Two patients had flap dehiscence from suture line, of which one needed reattachment while other a minor one healed by itself and one patient had occasional drooling. There was no difficulty in eating or swallowing.Conclusions:A random patterned TIFCIF based on superficial subdermal adipofascial microcirculation, formed of a rich vascular plexus in the face and neck region can provide a simple alternative for intraoral reconstruction.

Expanded Cheek-Shaped Flap for Aesthetic Cheek Reconstruction in the Cervicoperiauricular Area.

The cervical area is well acknowledged as an ideal donor site for aesthetic reconstruction of the cheek, and tissue expansion may play an important role for maximally achieving such a purpose. However, the conventional design of the expanded cervical flap generally results in unsightly morbidity of the donor site. The aim of this study is to evaluate the results of using an improvised cervical expanded flap in aesthetic reconstruction of the cheek. From July 2004 to October 2012, a total of 23 burn sequelae patients (30 cheeks) underwent cheek reconstruction with an expanded flap that originated from the cervicoperiauricular area. The procedures were initially carried out with the insertion of a round tissue expander in the cervicoperiauricular area, followed by serial inflation of the expander, and finally, transplantation of the expanded flap to the cheek in a rotation advancement fashion. The donor site closure was along the auricular sulcus. The average area of the harvested flaps was 9.7 × 8.1 cm. All the flaps completely survived, only one major complication occur-a dome exposure of the tissue expander after the expansion was completed. The flap was salvaged, and the transfer stage was done without intact. Minor complications after flap transfer include: widened scar at the donor site, a "dog-ear" needing additional minor surgery, distal part of the flap transient congestion. The patients achieved very satisfactory results functionally and aesthetically. Using the expanded cheek-shaped flap technique can provide a safe, thin, and color-matched flap in aesthetic reconstruction of the cheek with minimal donor site morbidity.

An algorithm for using expanded cervical flaps to resurface facial defects based on five different methods

BackgroundFor patients with healthy skin in the cervical region, the expanded cervical flap method is highly recommended for resurfacing facial skin defects. Many methods exist that use an expanded cervical flap. However, a gold standard for selecting the appropriate method for each patient is lacking. Here, we introduce 5 basic principles for how to use an expanded cervical flap and an algorithm for selecting the appropriate method. MethodsThe authors reviewed the medical records for all patients treated with an expanded cervical flap to restore a facial skin lesion in Shanghai's Ninth People's Hospital between 2010 and 2015. ResultsWe summarized the 5 techniques according to different types of facial deformities: (1) an advancement of the expanded cervical flap; (2) an expanded cervical flap that is rotated toward the temporal side (the rotation pivot is located in the angle of the mandible); (3) an expanded cervical flap that is rotated toward the nasal side (the rotation pivot is located in the mentum; (4) an expanded cervical flap that is rotated cephalically along the midline toward the lower third of the face (the rotation pivot is located in the bilateral angle of the mandible); and (5) a prefabricated cervical flap that is used with superficial temporal vessels. ConclusionBy using this algorithm and following five basic principles, all facial defects except for those on the nose and forehead can be resurfaced using an expanded cervical skin flap.

The Using of Cervical and Deltopectoral Flaps in the Reconstruction Surgery of Head and Neck Area

The Using of Cervical and Deltopectoral Flaps in the Reconstruction Surgery of Head and Neck Area

Clinical application of expanded flap based on the cutaneous branch of transverse cervical artery

To investigate the clinical application of expanded flap based on cutaneous branch of transverse cervical artery for reconstruction of cervical cicatricial contracture. Based on the clinical anatomy of cutaneous branch of transverse cervical artery flap, we design the corresponding subclavicular area for expansion. The incision was usually located at the anterior axillary fold, 5-8 cm in length. The expander was implanted under the deep fascial layer, without injury of the vascular pedicle. Fixation sutures were put about 1 cm apart from the incision to prevent the expander from transposition and exposure. After expansion, the cervical cicatricial contracture was excised and released. According to the defect, the expanded flap based on the cutaneous branch of transverse cervical artery was designed, with the pedicle located at the posterior margin of sternocleidomastoid and 1. 8 cm above median point of clavicle. "S" shape incision was made at the location of vascular pedicle. Subcutaneous dissection was performed 1.5 cm in width along the incision on both sides. Then the flap was harvested under the deep fascial layer and rotated to cover defect without tension. It was not necessary to dissect the vascular pedicle further. The defect at donor site was closed directly. 17 cases were treated with the island flap. The contracture of the cervical scar was corrected completely with aesthetic appearance. Expanded flap based on cutaneous branch of transverse cervical artery has reliable blood supply. It' s an ideal flap for the treatment of cervical cicatricial contracture.

Use of a transverse submandibular cervical flap in the repair of defects of the middle third of the face

Use of a transverse submandibular cervical flap in the repair of defects of the middle third of the face

Total cheek resurfacing with split ascending neck flap: A new approach

BackgroundBurn scars and other forms of extensive cheek deformities are a tragedy for patients and pose a great challenge to surgeons due to limited availability of well-matching donor sites. The skin of distant regions and skin transplants contrasts with the facial skin. The most suitable site for tissue in cheek reconstruction is the neck, but this resource is limited. Cervical skin expansion is often complicated by tissue necrosis. A new approach (technique) for resurfacing the scarred cheek with a split cervical flap is presented in this paper. MethodsSixteen patients with extensive (covering more than half the area) cheek deformities (10 unilateral and 6 bilateral) were operated upon; ages ranged from 6 to 32 years old. First, the split neck flap is transposed on the cheek/cheeks, restoring the lower half; after stabilization of transferred tissues, the cervical flap on the cheeks undergoes balloon extension. Second, the cheek reconstruction is finished with an expanded neck flap. ResultsAxial flap circulation prevented tissue necrosis after the first stage of reconstruction. The cervical flap on the cheek tolerated the expander well. In all cases, the cheeks were resurfaced in full with optimally matching sensate skin posing no serious post-operative complications. Cervical skin on the face preserved its natural properties without soft tissue excess and donor site morbidity; neck and cheeks preserved normal contours. ConclusionGood cosmetic outcomes make this technique preferable for adults and children, and the technique is indicated as the first step for deformed cheek resurfacing for patients with uninjured neck.

Bilateral mucoepidermoid carcinoma of parotid

Background: Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of parotid. Bilateral mucoepidermoid carcinoma is extremely rare. We report here a case of synchronous bilateral mucoepidermoid carcinoma of parotid. Case Presentation: A 65 years old female presented at the outpatient department of our surgical oncology unit with bilateral swelling in the parotid region for 1 year with sudden increase in the size of left sided swelling for 3 months. She underwent left sided radical parotidectomy with excision of left facial, hypoglossal and spinal accessory nerve en-block with the tumor and modified neck dissection followed by cervical flap coverage. On the right side, facial nerve preserving superficial parotidectomy was done. Histopathology revealed it to be high grade MEC and patient received adjuvant radiotherapy. At 1 year follow up she has no evidence of recurrence or metastasis. Conclusion: Bilateral mucoepidermoid carcinoma is a rare tumor of the parotid for which, surgery forms the mainstay of therapy, although postoperative radiation is thought to be effective. Radiation is reserved for primary treatment of malignant tumors in patient who are poor surgical candidates, or who do not want to undergo surgery.

Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases

ABSTRACT This case series highlights the advantages in the use of three regional flaps, submental flap, sternocleidomastoid flap and transverse cervical flap in maxillofacial primary defect reconstruction after ablative cancer surgery through presentation of three head and neck cancer patients in whom it was decided to do pedicled flaps rather than free flaps. Aim and objective This article is done in an attempt for encouraging for more introduction of these three flaps in head and neck reconstruction practice, and to encourage more studies be done to describe skin territory of cervical flap. Materials and methods Three patients presented to oral and maxillofacial department, diagnosed as having different kinds of cancer. All were managed according to the evidence-based guideline of head and neck cancer management, including the work up, diagnosis, TNM classification, surgical treatment, adjuvant treatment and follow-up. In all the three cases, regional flaps were used to close the primary defect. For the first patient, transverse cervical flap was used, the sternocleidomastoid flap in the second and submental flap in the third one. Results All flaps were easy to be harvested, in term of time and technique, and successful in term of viability, extension and in achieving the functional and cosmetic aim of reconstruction, with minimum donor site morbidity, all the patient are enjoying good quality of life. Conclusion and recommendations The regional flaps have their place to overcome limitation of free flaps due to the shortage in the armamentarium available in the hospital, especially in low resources regions, or limitations related to patients general condition, in addition, regional flaps are the best option available in case of failed free flap, or when free flap failure is anticipated and avoided. Highlighting the different maneuvers in harvesting and using regional pedicled flaps for further extensions widens the scope of indications and giving the reconstructive surgeon variability of options in reconstruction, obviates the need for special microvascular expertise in free flaps with comparable results and relatively less complication. How to cite this article Aloosi SN. Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases. Int J Head Neck Surg 2014;5(1):48-55.

Functional recovery of laryngeal reconstruction with the anterior cervical turnover myocutaneous flap after partial laryngectomy

Objective To evaluate the laryngeal function recovery following laryngeal defect reconstruction with anterior cervical turnover myocutaneous flap after partial laryngectomies.MethodsThe swallowing,respiration and phonation functions of 43 patients,who received vertical partial laryngectomy,extended vertical partial laryngectomy,expanded frontovertical partial laryngectomy or subtotal laryngectomy,and laryngeal reconstruction with turnover myocutaneous flap between 2008 and 2010,were retrospectively analyzed.Thirty-two patients had glottic carcinoma(15 phase Ⅱ,16 phase Ⅲ,1 phase Ⅳ) and 11 had transglottic carcinoma(5 phase Ⅱ,6 phase Ⅲ).The aspiration rate and decannulation rate were recorded.The swallowing function score,respiration function score,and voice parameters were analyzed and compared before and after operation.ResultsSix months after operation all the cases had normal swallowing and respiration functions,with no aspiration and with a decannulation rate of 100%.The swallowing function scores were similar before and after operation(U =903.1,P =0.559),and the respiratory function was significantly improved after operation(U =713.5,P =0.012).All the cases had normal voice.Six months after operation,the voice quality(such as Jitter,Shimmer and normalized noise energy \) were significantly better than that before the operation(P 0.05).The fundamental frequency(F0) of voice was significantly decreased after operation(P 0.05),and the NNE at 12 months after operation was significantly better than that at 6 months after operation(P 0.05).ConclusionAnterior cervical turnover myocutaneous flap for reconstruction of laryngeal defects following partial laryngectomies can achieve high decannulation rate and better phonation recovery,showing a satisfactory restoration of laryngeal function.

The Application of the Anterior Cervical Flap in Major Head and Neck Surgery

We present a case of a 79-year-old male patient, who was diagnosed with a primary squamous cell carcinoma of the left parotid region that was fungating through the skin and infiltrating the sternocleidomastoid muscle. Clinically and radiologically, the patient was staged as T3 N2b M0. He underwent a near-total parotidectomy with facial nerve preservation in conjunction with a modified radical neck dissection and wide excision of the involved skin to remove all the disease in a monobloc fashion. A regional cutaneous flap, the anterior cervical flap was used for reconstruction of a large surgical defect.

Reconstruction du tiers inférieur de l’auricule par lambeau de Crikelair

Amputation of the lower third of the ear includes full thickness earlobe defects. Earlobe reconstruction depends on the covering and scaffold technique used. The Crikelair cervical skin flap is one of the available techniques for reconstruction. We discuss its assets and drawbacks by comparing it with alternative procedures.

広頸筋皮弁と頸部島状皮弁の口腔再建における適応と問題点

広頸筋皮弁と頸部島状皮弁の口腔再建における適応と問題点

383. A Case of Thyroid Cancer of Infiltrating the Trachea - Treatment by Partial Tracheal Resection and Reconstruction with Cervical Skin Flaps

383. A Case of Thyroid Cancer of Infiltrating the Trachea - Treatment by Partial Tracheal Resection and Reconstruction with Cervical Skin Flaps

Reconstruction of hypopharyngeal defects with submental flap after laryngopharyngectomy

The submental flap has rekindled interest in using cervical flaps for reconstruction of head and neck defects. In this article, the authors present their experience of using this flap for hypopharyngeal defects after laryngopharyngectomy. This is a retrospective study of six patients who underwent hypopharyngeal defect reconstruction with submental flap from 2008 to 2011, operated upon by a single surgeon (JC Lee). The flap was used primarily to reconstruct defects after tumor extirpation. The maximum flap size was 12 × 7 cm and the minimum size was 9 × 4 cm (average, 10.5 × 5.3 cm). No flap failures were observed. All the donor site defects were closed primarily. Two patients developed a small pharyngocutaneous fistula that resolved spontaneously. No other complications were observed. After speech reeducation, all achieved a good-quality, understandable artificial voice. All patients were able to eat by mouth without the need for tube feeding. The submental flap is an excellent alternative in the reconstruction of hypopharyngeal defects because of its reliability, versatility, pliability, and relative ease of application. Our initial reports confirm that this kind of reconstruction is feasible and time-saving, and restored a good quality of life.

Burned Unilateral Half-Cheek Resurfacing Techniques

Postburn cheek deformities are a tragedy for patients and pose a great challenge to surgeons due to a limited number of well-matching donor sites. In cases of unilateral half-cheek deformity, the flap's skin should match the contralateral cheek and the residual skin of the deformed cheek. The skin of a distant flap does not match the facial skin and resembles a patch. The most suitable skin type is the neck's skin and residual cheek's skin transposed on the defect with special techniques. Seventy-six patients with unilateral cheek scars covering nearly half of cheek's surface (total cheek deformities are not included in this series) were personally operated. The deformities were divided into four types or forms: lower cheek, lateral, medial, and upper. The flaps and techniques were designed for each type. The cervical skin, residual cheek skin, and periauricular skin (most matching the cheek's skin) was used in form of different flaps, depending on the scar location on the cheek. The basic flap used was the cervical split flap which could include A) a thoracic adipose-cutaneous layer (cervico-thoracic flap); B) periauricular fasciocutaneous layer (cervico-periauricular and cervico-thoraco-periauricular flaps); C) residual healthy facial adipocutaneous layer (cervico-facial, cervico-facio-periauricular, and cervico-thoraco-facioperiauricular flaps). Cervical flap has axial circulation and is elevated without platysma; it is transposed on the cheek with some tension. The lower and lateral cheek deformities were eliminated most successfully with the cervico-thoraco-periauricular flap by one-stage procedure. Medial and upper cheek deformities were eliminated with the cervico-facio-thoraco-periauricular flap. The facial segment can be expanded (usually in cases of upper cheek reconstruction); in such cases, the thoracic region is not included in the flap (cervico-facio-periauricular flap). The cheeks were reconstructed in all patients without serious complications. The flap's skin matched the contralateral cheek and surrounding healthy skin; the donor site's damage was minimal; operation scars' line was maximally shortened. The use of cervical split flap in combination with thoracic, facial, and periauricular adipose-cutaneous layer opens, in author's opinion, a reliable and most successful way for postburn half-cheek resurfacing.

Delayed Pharyngoesophageal Reconstruction with Combined Local and Regional Flaps: A Case Report

We describe an unusual technique for performing delayed pharyngoesophageal reconstruction following circumferential pharyngolaryngectomy. The patient was a 52-year-old man who underwent a circumferential pharyngolaryngectomy for the treatment of hypopharyngeal carcinoma. In view of the patient's poor clinical status, we opted to perform a pharyngostomy and an esophagostomy and to postpone pharyngoesophageal reconstruction for a more appropriate occasion. After the patient's clinical condition had sufficiently improved, the repair was planned. Microsurgical flaps were contraindicated because the blood flow through the cervical vessels was unreliable. Pharyngoesophageal continuity was restored with a cervical flap vascularized by the prevertebral fascia, a pectoralis major myocutaneous flap, and a deltopectoralis flap. A reasonable degree of deglutition was achieved, and no signs of stricture were detected. Although our technique was unusual, we believed that it might provide a valid alternative when a delayed pharyngoesophageal reconstruction is required and free flaps are contraindicated for any reason.

An exploration of the surgical modality of sentinel lymph node biopsy in patients with cN0 tongue carcinoma: An animal study

Lymphatic mapping with vital dye is often exploited during a sentinel lymph node biopsy (SLNB); however, the time restraints associated with blue dye may limit its efficacy in tongue carcinoma. Using an animal study, this exploration attempted to achieve a rational surgical modality to circumvent this hindrance. Forty-eight rabbits were divided into 2 equal groups: A and B; 0.2 mL methylene blue (MB) was injected into 4 parts of the tongues of the rabbits in A just after elevating the cervical flap and into the tongues of the rabbits in B just before the elevation. The times when the lymphatic vessel and lymph node turned blue and then returned pale were recorded. Cases in group A had significantly more time left for tracing blue-stained lymphatic vessels than those in group B. Elevating the cervical flap before injecting MB can alleviate the time restraint of MB as a lymphatic tracer in SLNB with tongue carcinoma.