Facial Artery Musculomucosal Flap Research Articles

Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes.

There has been little reported on the transoral reconstructive options following salvage transoral robotic surgery. This paper describes the facial artery musculomucosal flap as a method to introduce vascularised tissue to a previously irradiated resection bed. A facial artery musculomucosal flap was used to reconstruct the lateral pharyngeal wall in 13 patients undergoing salvage transoral robotic surgery for oropharyngeal squamous cell carcinoma. Outcomes recorded include flap and donor site complications, length of stay, and swallowing and speech outcomes. There were no immediate or late flap complications, or cases of delayed wound healing in this series. There were two facial artery musculomucosal related complications requiring surgical management: one bleed from the facial artery musculomucosal donor site and one minor surgical revision. Healing of the flap onto the resection bed was successful in all cases. The facial artery musculomucosal flap provides a suitable transoral local flap option for selected patients undergoing salvage transoral robotic surgery for oropharyngeal malignancies.

Facial artery musculomucosal (FAMM) flap

This study presents a thorough overview of the relevant anatomy of this flap, reviews its most common indications, and introduces a step-by-step approach to a successful harvest of the FAMM flap. Knowledge of the surgical anatomy and landmarks of the FAMM flap allows a successful harvest. The superiorly and inferiorly based FAMM flaps are versatile and associated with low morbidity. The indications are numerous in Head & Neck surgery. The most common indications are defects of the floor of mouth, palate, and alveolar ridge. The advantages of this pedicled intraoral flap considerably outweigh its disadvantages. Respect of the steps described herein should allow a successful harvest of the FAMM flap despite potential pitfalls. Refinement of the indications and recent modifications in the technique to lower the revision surgery rates should allow a broader use of this flap.

Reconstruction of a subtotal upper lip defect with a facial artery musculomucosal flap, kite flap, and radial forearm free flap: a case report

BackgroundFor reconstructive surgeons, massive midface defects, including large, full-thickness wounds on the upper lip, can be very challenging. Although there are many methods for reconstruction of upper lip defects, it is difficult to obtain satisfactory restoration of oral functions and good cosmetic results.Case presentationThis case report presents a man with massive midface defects, including upper lip, left nose, and cheek defects. Over the previous 2 years, the patient had three reconstructions with sequential free flaps for the resection of recurrent tumors, the first of which was in March of 2016; this resulted in the patient having massive midface defects, including an upper lip defect, a defect on the left side of the nose, and one on the left cheek. The defects were reconstructed using a radial forearm free flap (RFFF), a facial artery musculomucosal (FAMM) flap, and a kite flap. In June 2016, he underwent a second reconstruction, this time of the left nose defect, using a left anterolateral thigh (ALT) flap. In March of 2017, the patient underwent a third reconstruction with the use of a free ALT on the left intraoral cheek and the defects on the neck. All flaps survived. No complications were encountered postoperatively. The patient regained good oral sphincter function with no reports of drooling. Although the patient underwent three surgeries, the reconstruction results were acceptable.ConclusionsFor massive midface defects, including large, full-thickness wounds on the upper lip, the combination of a FAMM flap, kite flap, and RFFF promotes the reconstruction of the complex midface structure and improves the resulting functionality.

Research progress of pedicled flaps for defect repair and reconstruction after head and neck tumor resection

To summarize the current status of pedicled flaps for defect repair and reconstruction after head and neck tumor resection, and to present its application prospects. Related literature was reviewed, and the role evolution of pedicled flaps in the reconstruction of head and neck defects were discussed. The advance, anatomical basis, indications, advantages, disadvantages, and modification of several frequently used pedicled flaps were summarized. The evolution of pedicled flaps application showed a resurgence trend in recent years. Some new pedicled flaps, e.g., submental artery island flap, supraclavicular artery island flap, submandibular gland flap, and facial artery musculomucosal flap, can acquire equivalent or even superior outcome to free flaps in certain cases. Technological modification of some traditional pedicled flaps, e.g., nasolabial flap, pectoralis major myocutaneous flap, latissimus dorsi musculocutaneous flap, temporalis myofascial flap, and temporoparietal fascial flap, can further broaden their indications. These traditional flaps still occupy an irreplaceable role, especially in patients with poor condition and institution with immature microsurgical techniques. The pedicled flaps still plays an important role in head and neck reconstruction after tumor resection. In certain cases, they demonstrate some advantages over free flaps, e.g., more convenient harvest, more rapid recovery, less expenditure, and better functional and aesthetic effect.

Superiorly based facial artery musculomucosal flap: A versatile pedicled flap.

The superiorly based facial artery musculomucosal (FAMM) flap is pedicled on the angular artery. This flap offers a well-vascularized mucosal surface allowing closure of medium size defects, most frequently within the oral cavity and intranasal region. We describe a superiorly based harvest of the FAMM flap, which may be used for closure of multiple head and neck surgical defects. An operative technique video is provided, which can be viewed online. Our results demonstrate a fast and relatively straightforward harvest technique of the FAMM flap. This intraoral flap is a useful reconstructive tool, which also has the advantage to leave no visible external scars. The superiorly pedicled FAMM flap is a versatile and effective technique that may be integrated in the algorithm for reconstruction of head and neck defects.

Outcomes of facial artery musculomucosal flap for closure of small and medium sized fistula after clefts

Aim of the workThe aim of the present study is to evaluate the use of FAMM for closure of small and medium sized fistula regarding reliability, success rates and associated complications and to present a 2 years follow up for patients reconstructed by FAMM flap technique. Patients and methodsThis prospective study was carried out during the period from June 2014 to June 2016 on 24 children; 10(41.66%) boys and 14 (58.33%) girls, attending the outpatient clinic of pediatric surgery department, Al-Azhar University hospitals. Their ages ranged from 2 to 9 years with a mean 4 ± 2 years. All patients were complaining from palatal fistula after palatoplasty due to cleft palate. Written consents were taken from all patients of the children. All patients were subjected to FAMM flap technique. Data regarding surgical technique, success rate and complications were recorded with a 2 years follow up for those patients. ResultsThe fistulas were between 2 and 5 mm in size (small and medium sized). 9(37.5%) were having small fistula (<2 mm) and 15 (62.5%) were having medium sized fistula (5–10 mm). The anterior palatal fistula [14 (58.33%) patients] were reconstructed by superiorly based buccinator flap while fistula at the junction of the soft and hard palate [10 (41.66%) patients] were reconstructed by inferiorly based flap. Satisfactory closure of the fistula was achieved in all patients except in one patient (4.16%). 3 flaps (12.5%) developed venous congestion and resolved spontaneously without any active intervention. One flap (4.16%) developed suture line dehiscence. Flap revision was necessary. Differences in flap patterns, fistula location and size of palatal defect has no significant effect on flap survival. ConclusionFAMM flap is appropriate for reconstruction of small and medium sized fistula because of its reliability and versatility. The flap presents few complications and ensures adequate functional results after palatal fistula repair because of its nearly the same tissue like the palatal tissue.

Effect of facial artery musculo-mucosal flap in reconstructing defects of tongue and mouth floor

To explore the effect of facial artery musculo-mucosal (FAMM) flap to reconstruct tongue and floor of mouth defects. Between January 2011 and January 2016, 24 cases of tongue and floor of mouth defects were repaired with FAMM flap after tumor resection. There were 16 males and 8 females, aged from 38 to 70 years with an average of 55 years. The disease duration was from 1 week to 6 months with an average of 4 months. The defect located at the floor of mouth in 4 cases, at the tongue in 15 cases, and both tongue and floor of mouth in 5 cases. There were 2 cases of carcinoma at the floor of mouth, 2 cases of adenoid cystic carcinoma at the floor of mouth, 14 cases of carcinoma at the tongue, 1 case of adenoid cystic carcinoma at the tongue, and 5 cases of carcinoma at the tongue and floor of mouth. The size of defect ranged from 4 cm×3 cm to 8 cm×7 cm. Three ipsilateral and 21 contralateral FAMM flaps were harvested (5 cases were repaired with FAMM flap and submental muscle island flap due to the large defect area). The size of FAMM flap ranged from 5 cm×4 cm to 5 cm×5 cm, the size of submental muscle island flap ranged from 4 cm×3 cm to 5 cm×4 cm. All flaps survived after operation, without local necrosis. Wound dehiscence at donor site occurred in 5 cases, and healed after cleaning; primary healing was obtained in the other 19 cases. All the patients were followed up 8 months to 5 years with an average of 2 years and 4 months. No obvious facial deformity or fistula of the floor of mouth occurred after operation. Injury of the submandibular branch of the facial nerve was observed in 16 patients, who returned to normal at 3 months. All 24 patients had limitation of mouth opening after operation, which disappeared after 12 months. The functions of speech, chewing, and swallowing were normal. FAMM flap has many advantages of simple operation, good repair, high flap survival rate, and less injury at donor site for repairing tongue and floor of mouth defects.

Islanded facial artery musculomucosal flap for tongue reconstruction

Reconstruction of the tongue can be achieved by means of various local, regional, and microvascular free flaps. Local flaps commonly used for tongue reconstruction include the nasolabial flap, submental flap, infrahyoid flap, and pedicled facial artery musculomucosal (FAMM) flap. The purpose of this article is to propose a technical modification to the FAMM flap for the reconstruction of small to medium-sized tongue defects post tumour excision: islanding the flap and tunnelling it from the lingual aspect of the mandible in a single-stage procedure. Islanding of the FAMM flap was found to be an extremely useful modification, giving excellent range of movement for the flap and eliminating the need for revision in a second stage procedure.

Facial mimetic, cosmetic, and functional standardized assessment of the facial artery musculomucosal (FAMM) flap.

To objectively assess donor site morbidity after harvesting the facial artery musculomucosal flap. Use of the FAMM-flap in oral cavity reconstruction remains sporadic. This case series describes our newly developed standardized assessment of this flap in a floor of mouth (FOM) reconstructive setting. Standardized postoperative assessment of the FAMM flap for donor site wound complications, functional, facial mimetic and oncologic outcomes. There were no wound complications. Oral competence remained intact, tongue mobility was good to excellent, average word articulation score was 98%, and mimetic function excellent in all patients. Three patients experienced ipsilateral upper lip anesthesia, and five patients were noted to have slight dysfunction of the orbicularis oris resulting in a loss of lip height at rest. The FAMM flap is a reliable option for reconstruction of ablative defects of the FOM, and should be considered a workhorse flap for oral cavity defects. Unlike the submental island flap, a complete level I dissection may be concurrently performed without compromising the vascular supply to the FAMM flap.

The facial artery musculomucosal flap in the reconstruction of the cocaine-induced hard palate fistula

The versatility of the facial artery musculomucosal (FAMM) flap has been employed in the reconstruction of a number of defects in the head and neck region. Closure of the cocaine-induced palatal fistula is complex, in particular because of the poor quality local tissue. To date, the FAMM flap has yet to be reported in this situation. We describe our experience with one such case, detailing our rationale for choosing the FAMM flap, intra-operative technique, and recommendations for other surgeons with similar cases. Level of Evidence: Level V, therapeutic study.

The New Transverse–Facial Artery Musculomucosal Flap for Intraoral Reconstructions

The New Transverse–Facial Artery Musculomucosal Flap for Intraoral Reconstructions

Donor site morbidity in buccinator-based myomucosal flaps: A retrospective study

BackgroundBuccinator-based myomucosal flaps can be used as a lining in oral cavity, pharyngeal, esophageal, and nasal reconstructions. Donor site morbidity is an important factor in selecting a flap, therefore, it was decided that donor site morbidity of this type of flap should be evaluated. MethodIn a retrospective study, patients for whom this flap had been used for oral, nasal, or pharyngeal reconstruction in 2008–2012 were recalled. Donor site morbidity including reduction in maximal interincisal opening (MIO), obliteration of the mandibular vestibule, injury to the Stensen duct, and vertical fibrous band in buccal mucosa were evaluated. ResultsTwenty-two buccinator-based myomucosal flaps (20 patients) had been used for oral, nasal, or oropharyngeal reconstruction. The most common flap used was the Facial Artery Musculomucosal (FAMM) flap (50%), and the commonest cause for flap use was the presence of a cleft lip/palate sequel in patients (45%). Four patients had developed complications (minimal reduction in MIO) related to the donor site. ConclusionDonor site morbidity associated with buccinator-based myomucosal flaps is low. However, minimal reduction of mouth opening occurred in 20% of the patients.

Spacer Facial Artery Musculomucosal Flap: Simultaneous Closure of Oronasal Fistulas and Palatal Lengthening.

In this series, the authors describe a modification of the facial artery musculomucosal flap for oronasal fistula repair. The spacer facial artery musculomucosal flap technique is characterized by a pedicle inset into the retromolar trigone and palate, obviating a second operative stage. This was performed in 14 patients with a 5.2-cm mean fistula size. Average follow-up was 4.3 years, with one partial flap necrosis but no recurrent oronasal fistula. There was a mean decrease of 18 percent in the distance between the velum and the posterior pharyngeal wall. The spacer facial artery musculomucosal flap provides a single-stage reconstruction of oronasal fistula while lengthening the palate through a pushback mechanism. Although further study of velopharyngeal function is needed, the spacer facial artery musculomucosal flap may be beneficial for patients with a short velum and an oronasal fistula. Therapeutic, IV.

Current and Advancing Concepts in Pedicled Flaps, Old and New, for Oral and Maxillofacial Reconstruction

The reconstruction of postablative oral and maxillofacial defects frequently presents a challenging dilemma for the surgeon. This time the challenge comes from simpler, less costly, and often less morbid locoregional pedicled cutaneous flaps that offer equal if not superior patient outcomes. Costs, operating time and availability of expertise are major issues that influence efficient health delivery. Simple and widely reproducible techniques may be used successfully where applicable to overcome these issues. Researchers have demonstrated its technical ease of performance and reproducibility amongst trainees. This literature reviews three such flaps which are facial artery musculomucosal (FAMM) flap, submental flap and supraclavicular flap to explain their growing impact on oral and maxillofacial reconstructive surgery.

Reconstruction of Oral Cavity Defects With FAMM (Facial Artery Musculomucosal) Flaps. Our Experience

Introduction and objectivesThe facial artery musculomucosal (FAMM) flap is a good option for covering small and medium-sized defects in the oral cavity because of its similar tissue characteristics and easy implementation. MethodsWe reviewed our results using this flap between 2006 and 2014. A total of 20 patients were included and 25 FAMM flaps were performed, 16 right (64%) and 9 left (36%) flaps. Five patients had simultaneous bilateral reconstructions. The indications for flap surgery were reconstruction after resection of tumours in the floor of the mouth (8 cases, 40%), tumours in other sites of the oral cavity (4 cases, 20%), mandibular osteoradionecrosis (4 cases, 20%), oroantral fistula (3 cases, 15%), and postoperative ankyloglossia (one case, 5%). ResultsReconstruction was successful in 92% of cases (n=23). Total flap necrosis occurred in one case and dehiscence with exposure of bone in another. Oral function and ingestion were satisfactory in all patients. ConclusionsThe facial artery musculomucosal flap is reliable and versatile for reconstruction of small and medium-sized intraoral defects. It allows functional reconstruction of the oral cavity with a low risk of complications.

Oncologic safety of facial artery myomucosal flaps in oral cavity reconstruction

Buccinator myomucosal flaps are routinely used for oral cavity reconstruction and are indicated mainly in patients classified as having stage N0 cancer. This purpose of this study was to investigate whether preservation of the vascular pedicle of the flap (facial artery and vein) during stadiative neck dissection alters the oncologic safety in these patients. Fifty patients underwent resection of T1 to 3, N0 squamous cell carcinoma of the tongue or floor of the mouth, stadiative neck dissection, and reconstruction with a facial artery musculomucosal (FAMM) flap were retrospectively analyzed concerning rate of occult neck metastasis and recurrences. Occult metastasis was detected in 10 patients. Mean follow-up was 41 months. The overall survival rate was 88%, and the disease-specific survival rate was 92%. Neck dissection with preservation of the facial artery and vein does not alter the rate of regional recurrences, confirming the oncologic safety of myomucosal flaps in oral cavity reconstruction. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1200-E1202, 2016.

Reconstrucción de defectos de cavidad oral con colgajos tipo FAMM (colgajo músculo-mucoso de arteria facial). Nuestra experiencia

Introduction and objectivesThe facial artery musculomucosal (FAMM) flap is a good option for covering small and medium-sized defects in the oral cavity because of its similar tissue characteristics and easy implementation. MethodsWe reviewed our results using this flap between 2006 and 2014. A total of 20 patients were included and 25 FAMM flaps were performed, 16 right (64%) and 9 left (36%) flaps. Five patients had simultaneous bilateral reconstructions. The indications for flap surgery were reconstruction after resection of tumours in the floor of the mouth (8 cases, 40%), tumours in other sites of the oral cavity (4 cases, 20%), mandibular osteoradionecrosis (4 cases, 20%), oroantral fistula (3 cases, 15%) and postoperative ankyloglossia (one case, 5%). ResultsReconstruction was successful in 92% of cases (n=23). Total flap necrosis occurred in one case and dehiscence with exposure of bone in another. Oral function and ingestion were satisfactory in all patients. ConclusionsThe facial artery musculomucosal flap is reliable and versatile for reconstruction of small and medium-sized intraoral defects. It allows functional reconstruction of the oral cavity with a low risk of complications.

Facial artery musculomucosal flap for reconstruction of partial glossectomy defects

Facial artery musculomucosal flap for reconstruction of partial glossectomy defects

Facial Artery Musculomucosal Flap for Reconstruction of Partial Glossectomy Defects

BACKGROUND: Reconstruction of partial glossectomy defects secondary to tumor excision has always been challenging because of the complexity of tongue function. Small to medium-sized glossal defects are often repaired with primary closure or with bulkier free flaps. However, these methods of reconstruction can lead to tethering and poor tongue mobility. We present use of the using the facial artery myomucosal (FAMM) flap for partial glossectomy defects. We propose the use of the FAMM flap for improved tongue function in the setting where the defect is too large for primary closure, but where free tissue transfer would provide coverage where the volume of the flap would interfere with tongue function. METHODS: We conducted a retrospective chart analysis of nineteen patients who underwent partial glossectomy with FAMM flap reconstruction. We examined tumor type and location, along with post-operative complications, functional outcomes, and need for further procedures. We then emailed all living patients with the MD Anderson Dysphagia Inventory and the University of Michigan Voice-Related Quality of Life Measure to better elucidate their overall functional outcomes with regard to speech and swallowing. RESULTS: Of the 19 patients, all flaps provided adequate coverage and there were no flap failures. Two patients had minor post-operative complications that easily resolved. All patients had intelligible speech and adequate swallowing capabilities. Almost all of the patients rated their quality of voice to be good, very good, or excellent, and they did not feel that their flap interfered with their feeding abilities. CONCLUSION: The FAMM flap provides a good alternative to primary closure and split-thickness skin grafting for patients with small and medium-sized tongue defects after glossectomy. The flap is close in proximity to the defect, is of similar tissue composition, and produces good functional outcome. The FAMM flap provides an excellent alternative to partial glossectomy defects that are less than 50% of the total surface area of the tongue.

Facial artery musculomucosal flap in head and neck reconstruction: A systematic review.

The facial artery musculomucosal (FAMM) flap has emerged as a popular option in head and neck reconstruction in the last decade. The purpose of this study was to conduct a literature review of the FAMM flap. We have conducted a search on PubMed using specific key words to identify all articles related to the FAMM flap. We reviewed the modifications of the FAMM flap, its indications, contraindications, complications, and outcomes. Thirty-eight articles published from 1992 to 2013 were included for review. A total of 441 FAMM flaps were reported in the literature and the most commonly reconstructed site was the floor of the mouth. Functional and aesthetic outcomes were judged to be excellent. The FAMM flap is a versatile reconstructive option for small and medium size defects in the head and neck. Recent studies have explored new applications for this flap, such as in skull base reconstruction.