Flap Patients Research Articles

Delayed maxillary reconstruction following mucormycosis: A comprehensive analysis of surgical strategies and outcomes

Study designThis study is a prospective observational study conducted over two years from December 2020 to March 2023 at the Department of Plastic and Reconstructive Surgery. ObjectiveTo evaluate the outcomes of delayed reconstruction in patients with maxillectomy defects post-COVID-19 associated mucormycosis, focusing on safety, morbidity, and aesthetic results. MethodsFifty patients with post-COVID-19 mucormycosis and maxillectomy defects without skin involvement were included. These patients underwent radical debridement and were treated with Amphotericin B followed by Posaconazole therapy until clinical and radiological resolution of the disease. Reconstruction was performed after a minimum of six months post-maxillectomy. Flaps used for reconstruction included the radial forearm free flap (RAFF), anterolateral thigh flap (ALT), and free fibula osteomyocutaneous flap, planned using a 3D-printed model. Follow-up was conducted weekly for the first month and monthly for the next two months, with semiannual visits thereafter. ResultsOf the 50 patients, 42 % were male, and 58 % were female, with a mean age of 43 ± 8.75 years. Most patients (88 %) were diabetic. Maxillectomy defects were categorized as type IIA, IIB, IIIA, IIIB, and IV based on the Cordeiro classification. Four flaps (8 %) required re-exploration, with three salvaged. Complications included marginal flap necrosis (4 %) and oro-nasal fistula (2 %). The average hospital stay was six days, extended to ten days for re-explored cases. Flap dimensions varied with the largest being 62 cm² for the free fibula flap. ConclusionsDelayed reconstruction using free flaps in patients with post-COVID-19 mucormycosis maxillectomy defects without skin involvement is a safe approach with minimal morbidity. This method allows confirmation of disease resolution before major reconstructive surgery, resulting in excellent aesthetic and functional outcomes.

Comparative evaluation of postoperative functional and esthetic outcomes for lip reconstruction with Fujimori gate flap versus Abbe-Estlander flap in patients being operated for oral squamous cell carcinoma

Background: Lip carcinomas account for 23.6% to 30% of tumors affecting the oral cavity. Lip reconstruction aims to achieve a competent oral sphincter with a good cosmetic appearance while avoiding microstomia. There are various techniques for lip reconstruction like Fujimori gate flap, Abbe-Estlander Flap, Gillies fan flap, Nasolabial flap, Karapandzic flap, bilateral advancement flap, perialar crescentic advancement flap, Bernard-Burow flap, and free flap. Aims and Objectives: To compare the Fujimori gate flap and Abbe-Estlander flap in terms of functional and esthetic outcomes when used for reconstruction of the lip. Materials and Method: Ten patients diagnosed with oral squamous cell carcinoma requiring resection and reconstruction of lip were included in the study. Functionally, maximal interincisal opening, lip competence, speech intelligibility and esthetically, scar, symmetry of lip during mouth opening, and symmetry of lip at rest were evaluated at the end of 1 week and 1 month. Results: On evaluation of functional and esthetic parameters, the Fujimori gate flap provides superior results in terms of mouth opening, speech intelligibility, and symmetry of lip at rest. However, results were comparable in both groups in terms of lip competence, scar, and symmetry of lip during mouth opening. Conclusion: The results of this study suggest that the Fujimori gate flap provides superior results with respect to function and esthetics when used for the reconstruction of lower lip defects with minimal or less complications.

Axilla Reconstruction Post Burn Contracture: Thoracodorsal Artery Flap Versus Local Flap and Skin Grafts

Background: Burns are a prevalent worldwide morbidity that frequently results in contractures that impede function and appearance, especially in the axilla, which has a major impact on upper limb mobility. Aim: To compare the functional results of local flaps with skin transplants versus Thoracodorsal artery flaps for axilla repair following burn contracture. Methods: A prospective comparative study was conducted. In the Department of Plastic and Reconstructive Surgery, thirty patients were split into two groups for a prospective comparative study. Group B underwent local flaps utilizing skin grafts, whereas Group A underwent thoracodorsal artery flaps. An analysis was conducted on pre- and post-operative shoulder joint abduction, complications, and demographic factors. Result: The two groups' post-operative shoulder abduction did not significantly differ, according to the results; however, younger patients and those with concomitant conditions including diabetes and hypertension were more likely to benefit from thoracodorsal artery flaps because of increased vascularization. The study discovered that middle-aged individuals typically had local flaps, but younger patients frequently had thoracodorsal artery flaps. Though not statistically significant, the gender distribution revealed a trend with more males obtaining local flaps and more females receiving thoracodorsal artery flaps. Thoracic dorsal artery flaps were substantially more common in patients with diabetes and hypertension. Practical Implication: The higher prevalence of thoracodorsal artery flaps in patients with diabetes and hypertension underscores importance of choosing flaps that provide better vascular support for patients with compromised vascular health. Conclusion: The findings highlight the significance of considering patient-specific criteria when choosing a flap, as thoracodorsal artery flaps provide better vascular support and are advantageous for patients with compromised vascular health. These results emphasize the need for customized surgical planning to improve results in post-burn contracture axilla repair. To enhance patient care and further improve surgical protocols, future research should concentrate on long-term results.

Review of Current Techniques of Cleft Palate Repair Concerning Palatal Innervation: A Preliminary Assumption.

To highlight the possible surgical steps that could affect the neural supply of soft palate and velopharyngeal sphincter during Furlow palatoplasty and posteriorly-based myo-mucosal buccal flaps in patients with persistent velopharyngeal insufficiency after primary cleft palate repair. Institution-based retrospective study. Academic Medical Center. Non-syndromic patients with persistent hypernasality (after primary cleft palate repair) who had Furlow palatoplasty or posteriorly-based buccal myo-mucosal flaps and were followed up for at least 60 months after the secondary surgery. All patients were examined using a fiberoptic endoscopy, the movement of components of the velopharyngeal sphincter: soft palate, and lateral pharyngeal walls were traced on the monitor and given a score from 0-4. The pattern of VPS closure was reported whether coronal, circular, or sagittal for each case. Patients' characteristics, auditory perceptual assessment, the severity of hypernasality, intraoperative lengthening of the palate, and operative complications were recorded. At postoperative (at least 60 months) evaluation of the patients statistically non-significant differences were reported when comparing the pre-versus post-operative auditory perceptual assessment following both procedures (P value ≥0.05). A greater tendency towards improvement was noticed with BF but was non-significant. The nerve supply of the palate could be jeopardized by many techniques of primary or secondary repair of the cleft palate leaving behind a deceiving intact but weak poor-functioning palate. All efforts should be made to provide more neural-preservation techniques in primary/secondary repair of the cleft palate. Further wide-scale research is essential to have final clear conclusions.

VRAM Versus ALT Flap Reconstruction for Large Head and Neck Defects: Does Weight Influence Complication Rate?

Background: Obesity remains a high-level risk factor for various cancers. Yet, some research has shown that higher BMIs may improve survival outcomes, particularly for head and neck squamous cell carcinoma (HNSCC). While this is a clear deviation from the norm, it raises the question of what other effects obesity may have on head and neck cancer patients, including surgical outcomes. Choosing the most appropriate flap for patients can be difficult for even experienced surgeons. Head and neck reconstructive surgeries are no exception to this rule and can be especially challenging. To produce the most favorable outcomes, a physician must be able to combine all flap attributes including donor and recipient site location, flap thickness, as well as each patient's individual risk factors such as prior radiation. Purpose: The purpose of this study was to compare the outcomes of vertical rectus femoris myocutaneous (VRAM) and anterolateral thigh (ALT) flaps in overweight and obese individuals with varying head and neck cancers leaving large-sized defects to the outcomes in normal and underweight patients. Methods: A retrospective chart review was conducted of VRAM and ALT flaps performed over a period of 12 months at our university hospital for large head and neck reconstruction. Results: Of the 17 ALT patients, 80% (4/5) of the underweight patients, 57% (4/7) of the normal weight patients, 50% (1/2) of the overweight patients, and 33% (1/3) of the obese patients experienced complications. Of the 15 VRAM patients, 40% (2/5) of the underweight patients, 83% (5/6) of the overweight patients, and 50% (1/2) of the obese patients experienced complications. Conclusions: In our small sample size, a smaller percentage of obese patients with head and neck cancer who underwent flap reconstruction surgery had complications when undergoing ALT flaps than VRAM flaps, which contrasts with the normal and underweight patients, who had less complications with VRAM flaps than ALT flaps.

Gender Disparities and Ultrasonographic Evaluation of Anatomic Features of Anterolateral Thigh Flap (ALT) in Individuals with Diverse BMI: A Retrospective Clinical Study

BackgroundThe anterolateral thigh (ALT) flap plays a crucial role in reconstructive surgeries, providing versatile and reliable soft-tissue coverage. Flap thickness is a critical determinant of tissue volume and quality. Vascular factors, including the vascular diameter of the perforators and the length of the vascular pedicle, significantly influence flap viability and postrepair outcomes. To enhance preoperative assessment, this study integrated gender and body mass index (BMI) to analyze the anatomical characteristics of ALT flaps. MethodsThis study used somatic penetrating ultrasonography to examine bilateral ALT flaps in patients. This study analyzed the relationship between gender and ALT flap thickness, vascular diameter of the perforators, and vascular pedicle length. Chi-square test was used to assess variations in age and gender. Multiple t-tests compared flap thickness, vascular diameter, and pedicle length between men and women in different BMI groups. ResultsA total of 158 patients were included in this study from January 2018 to December 2022. In BMI < 24 and BMI ≥ 24.0 groups, males had lower ALT flap thickness than females (p < 0.0001 in each subgroup). Similarly, the vascular diameter of the perforators followed the same trend, with females having larger vascular diameters than males in BMI < 24 and BMI ≥ 24.0 groups. In terms of vascular pedicle length, males had longer pedicle length than females in both BMI < 24 and BMI ≥ 24.0 groups (p < 0.05 in each subgroup). ConclusionsFemales demonstrate greater ALT flap thickness and larger vascular diameter of the perforators than males, whereas males have a longer length of the vascular pedicle.

Free Flaps in Patients with Advanced Arteriosclerosis of the Tibial Vessels: Mini Vein Graft to the Peroneal Artery.

Lower extremity reconstruction with free flaps in patients with only peroneal artery runoff remains a challenge. Here, we present a novel technique for reconstruction of medial defects in the distal leg using a medial approach to the peroneal artery and a short interposition vein graft anastomosed end to side to the peroneal artery. A retrospective, single-center study was performed including all patients who underwent lower extremity reconstruction with free flaps anastomosed to the peroneal artery using a mini vein graft from November 2020 to March 2022. The primary outcome measure was limb salvage. Secondary endpoints were flap survival and postoperative complications. Seven patients received lower extremity free flap reconstruction with a mini vein graft to the peroneal artery. Flap loss rate was 0%. Limb salvage was achieved in five patients (71%). At 6-month follow-up, all patients were ambulatory. One patient died 1 month after surgery due to heart failure. Mini vein graft to the peroneal artery allows reliable and safe free flap reconstruction of distal leg defects in patients with only peroneal artery runoff.

Early Experience of Combined Anterolateral Thigh Flap and Ilioinguinal Flap in Patients with Severe Lower Extremity Trauma

Early Experience of Combined Anterolateral Thigh Flap and Ilioinguinal Flap in Patients with Severe Lower Extremity Trauma

Forehead flap perfusion monitored by laser speckle contrast imaging: Importance of flap length and thickness

PurposeForehead flaps are commonly used in oculoplastic surgery to cover defects after tumor excision. Blood perfusion is vital for flap survival. The aim of this study was to monitor the perfusion in forehead flaps and investigate the impact of flap length and thickness. MethodsNineteen forehead flaps in patients undergoing direct brow lift were studied. Perfusion was monitored using laser speckle contrast imaging, immediately after raising flaps consisting of epidermis, dermis, and subcutaneous tissue, and after removing the subcutaneous tissue resulting in a thin flap. ResultsPerfusion decreased gradually along the length, the mean value being 44% at 5 mm and 26% at 15 mm from the base, in thick flaps. Perfusion was significantly lower in thin flaps, being 13% when measured 15 mm from the flap base (p < 0.0024). Perfusion was better preserved in thick than in thin flaps. Very low perfusion was observed 16.7 mm (16.0–17.3 mm) from the base in thick flaps, and from 10.2 mm (9.8–10.6 mm) from the base in thin flaps (p < 0.0001). ConclusionsFlap thickness is important in maintaining adequate blood perfusion and thus increasing the probability of flap survival. This may be particularly important in long flaps and in patients with impaired microcirculation.

Revisiting Elliot's Modification of Moberg's Flap and Our Improvisation.

Thumb tip injuries constitute one of the most common hand injuries. There are various reconstructive options for thumb tip injuries. We present our series of thumb tip injuries reconstructed using Elliot's modification of the Moberg flap, which provides like-for-like tissue. We also present our flap improvisation, which can be useful in the armamentarium of plastic surgeons. Background Moberg described the advancement flap for thumb defects in 1964, which was modified by O'Brien in which the proximal part of the flap is incised and advanced. Although it is a popular flap, it has the disadvantage of interphalangeal (IP) joint flexion deformity. Among the various modifications of the Moberg flap, Elliot's flap provided more tissue with minimal donor site morbidity and no usage of skin grafts or first web skin. Methods We retrospectively analyzed the patients who underwent reconstruction of thumb defects by Elliot's modified Moberg's flap. The size of the defect, etiology, and IP joint movement were analyzed. Two patients underwent our improvised flap where a daughter flap was elevated within Elliot's flap. Results Between January 2021 and September 2023, 12 patients underwent reconstruction by Elliot's flap. All flaps settled well. There was no IP joint deformity. Two patients had scar hypertrophy that was managed conservatively. Conclusion Elliot's modification of the Moberg flap is a very useful but underutilized flap for thumb tip injuries that provides like tissue with sensation and with little donor site morbidity. It can be used for thumb tip defects of up to 3 cm . It is possible to incorporate a second V-Y flap in patients for whom additional movement is required for tension-free closure.

Outcome of modified fleur-de-lis latissimus dorsi myocutaneous flap for breast reconstruction

BackgroundReconstruction of breast following mastectomy is important in terms of rehabilitating patients of breast cancer. Numerous approaches have been used in the reconstruction process. A procedure that has gained interest of the patients is reconstruction of breast using the autologous form. Main objective of this study is to determine the outcomes of modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction. MethodologyThis is a retrospective case series which was conducted at the Department of Plastic Surgery, SIMS/Services Hospital, Lahore, from January 2020 till December 2022. 184 patients age 25–60 years and Females with a history of mastectomy, who had to undergo creation of breast shape using a tissue flap from another part of the body at the site of breast following mastectomy were included. All patients were subjected to standard procedure of breast reconstruction with latissimus dorsi flap using modified fleur-de-lis technique and postoperatively weekly assessment in the first month and then monthly until 3 months was carried out and outcome of the study was analysed. ResultsThe mean age and VAS score of the patients was 49.7 ± 9.17 and 6 ± 2.21, respectively. 57.1 % patients have DCIS, benign in 38 % patients and other tumours were present in 4.9 % patients. Immediate versus delayed reconstruction was done in 63.6 % versus 36.4 % patients respectively. Good aesthetic outcome was achieved in 80.3 % patients ConclusionModified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction yielded a good aesthetic outcome in the majority of the patients.

Reconstruction of plantar foot defects with free super-thin anterolateral thigh flap.

In the repair of plantar foot defects, it is important that the reconstructed area is compatible with surrounding tissue while weight-bearing ability continues. In our study, we present long-term results of plantar foot reconstruction with super-thin ALT flaps in patients that required reconstruction with free tissue transfer. We evaluated 11 patients with plantar foot defects that underwent reconstruction with a super-thin ALT flap. Patients were evaluated for postoperative ulceration, ability to wear normal shoes, time to return to work/school, LEFS score and satisfaction with aesthetic results. No bone defects were observed in the patients included in our study, except for the phalanges and distal metatarsals. Defects with soft tissue loss were reconstructed. The mean flap thickness was 4.9 mm (range 3-6 mm). Follow-up period ranged from 16 to 59 months. One patient required grafting for partial flap necrosis and recovered totally. Another patient required debulking surgery. Two patients had superficial ulceration postoperatively, which responded well to conservative therapy. The mean VAS score for cosmetic satisfaction was 8 of 10 (range, 6-9). Eight patients were satisfied with the flap contour, while three others were fairly satisfied. Mean time to return to work/school after surgery was 2.5 months. The preoperative LEFS score increased from 32.03 ± 15.2 to 58.7 ± 10.6 in the postoperative period, this difference was statistically significant (P<0.01). We consider that the advantageous features of super-thin ALT flaps such as proper tightening, reduced postoperative atrophy, and better contouring features make these flaps suitable for plantar foot defects.

The Efficacy of Free Latissimus Dorsi Flap in Patients with Lower Limb Distal Extensive Injuries.

The Efficacy of Free Latissimus Dorsi Flap in Patients with Lower Limb Distal Extensive Injuries.

Evaluation of Feasibility of Medial Plantar Artery Flap With Computed Tomography Angiography in Diabetic Patients: A Pilot Radioanatomic Study.

Background A soft tissue defect resulting from a diabetic heel ulcer can be difficult to address due to limited reconstructive options and unique local area demand. The medial plantar artery flap is ideal for heel defect coverage as it provides a thick glabrous skin with good sensory feedback. The prerequisite of medial plantar artery flap surgery is a patent medial plantar artery, which is a branch of the posterior tibial artery (PTA). Nevertheless, no feasibility study of the medial plantar artery flap in diabetic patients with vascular insufficiency has been reported so far. We conducted a pilot study with the aim of investigating the patency of the medial plantar artery in diabetic patients with suspected peripheral artery disease to determine the vascular feasibility of the medial plantar artery flap in these patients. Material and methods A pilot study was performed at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia (IIUM). A total of 15 diabetic patients with suspected vascular insufficiencywho had undergone lower limb computed tomography angiography (CTA) from January 2022 to June 2023 were included in this study. All patients were identified via the electronic record system.Lower limb CTA images were retrieved from the Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) and were double-reviewed.Both the posterior tibial artery (PTA) and medial plantar artery (MPA) were assessed for their patency, and the diameter of the lumens was measured if they were patent. Bedside clinical assessments such as palpation of pulses and portable Doppler assessment were evaluated to determine whether they could serve as substitutes for computed tomography angiography (CTA) in assessing the feasibility of medial plantar artery flap using the McNemar test. Results In this study cohort, the medial plantar artery was present in 16 legs and absent in another 14 legs. The largest diameter of the medial plantar artery was 2.5mm (range 0-2.5mm). Palpation of the posterior tibial artery was not optimal for predicting the patency of the medial plantar artery, with a false positive of 21.4% and a false negative of 68.7%. Similarly, a hand-held Doppler assessment of the posterior tibial artery was also ineffective, with a false positive of 64.3% and a false negative of 18.8%. While the medial plantar artery is a continuation of the posterior tibial artery (PTA), PTA patency did not necessarily correlate with medial plantar artery patency. This was demonstrated on CTA assessment, where two legs with absent PTA still have reconstitution, resulting in patency of the medial plantar artery. Additionally, one leg with patent PTA did not have a patent medial plantar artery distally due to calcified vessels. Conclusion This is a first-of-its-kind pilot study attempting to determine the feasibility of medial plantar artery in diabetic patients with vascular insufficiency. The medial plantar artery was present in more than 50% of the investigated lower limbs, paving the way for using the medial plantar artery flap in these patients. Nevertheless, a computed tomography angiogram is essential to determine the patency of the medial plantar artery prior to the flap procedure, as palpation and hand-held Doppler were inadequate to predict the patency of the medial plantar artery in these high-risk patients.

Experience of Island Nasolabial Flap for Patients with Oral Cavity Cancer.

To find out the utility of the island nasolabial flap in patients with oral cavity malignancy. This was an observational study conducted at a super-specialty hospital in Maharashtra from October 2019 to December 2021. Patients with oral malignancy planned for island nasolabial flaps were only considered. A total of 20 patients were operated on, out of which 16 were males and 4 were females. All the patients were followed up for a minimum period of 6 months. The hospital's online reporting system is used for the data collection including the post-operative assessment. Out of the 20 patients, 10 patients were suffering from tongue carcinoma, 6 patients from buccal mucosal carcinoma, two from hard palate carcinoma and one patient each from the floor of the mouth and lip carcinoma. The mean age of the series was 52.3 years, the average duration of the surgery is 169.4min and the average hospital stay in the series was 4.35 days. The Ryle's tube was removed on an average of 4.35 days. No flap-related complications were noted during the series, and healing of the donor site was uneventful. The functional outcomes after the reconstruction are acceptable in all the cases except in the lip reconstruction patient where there was post-operative drooling. The island nasolabial flap is relatively easy to harvest and less time-consuming. The other advantages include the post-operative surgical scar falls along the nasolabial fold, long pedicle length with preservation of the facial pedicle for future microvascular use, early transfer to the oral feed from the nasogastric feed, and early de-cannulation. In our small study, we observed that the island nasolabial flap is a very useful flap for the small to moderate-sized defects of the oral cavity. We feel, one of the disadvantages of this flap is that it is not an ideal flap for lip reconstruction.

Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision.

Nipple-sparing mastectomies (NSMs) have become a common surgical approach in the management of invasive breast cancers and ductal carcinoma in situ, and as a risk-reducing approach in genetically predisposed patients. The current standard of care in the management of positive nipple margin after NSM is total excision of the nipple-areola complex. In this article, we aimed to present a case series describing a novel approach to positive nipple margins with nipple-only excision and immediate nipple reconstruction using areolar flaps in patients who underwent NSM for noninvasive tumors. We conducted a retrospective review of patients who underwent NSM and were found to have positive nipple margins and underwent subsequent nipple excision with immediate areolar flap reconstruction. We identified 6 patients who underwent NSM and were found to have nipple margins-5 for ductal carcinoma in situ and 1 for invasive ductal carcinoma. These patients underwent nipple excision with immediate reconstruction using "sickle" flaps. We concluded that if nipple excision and immediate reconstruction with areolar sickle flaps can be performed, it results in good aesthetic outcomes without compromising oncologic results.

Radiation and free flaps: what is the optimal timing?

The debate over when to perform flaps in patients undergoing radiation remains an ongoing dilemma without definitive resolution. Classically, reconstructive surgeons recommended avoiding exposure of autologous flaps to radiotherapy due to concerns over surgical complications and poor aesthetic outcomes. However, delayed reconstruction carries its own risk profile and aesthetic limitations, given the irreversible changes to the breast envelope. Immediate reconstruction not only confers psychosocial benefits but allows for preservation of the native breast skin and footprint. In recent years, a growing body of evidence suggests that with modern radiation techniques, long-term outcomes of immediate vs. delayed autologous reconstruction may be more similar than previously thought. This review examines the advantages and disadvantages of each treatment algorithm and critically evaluates the existing literature on autologous breast reconstruction in the setting of post-mastectomy radiotherapy. Importantly, radiation regimens have varied widely over time and between institutions, introducing significant heterogeneity in published outcomes of flap contracture or fat necrosis after immediate reconstruction. While delayed autologous reconstruction remains a reasonable pathway, the benefits of immediate reconstruction should not be dismissed. Our findings ultimately corroborate the view that immediate flap reconstruction is a sound treatment option that can be safely offered to patients. The decision regarding which pathway to pursue should ultimately be patient-centric and driven by multidisciplinary consensus, rather than by prior dogma.

Pharyngeal Flap Versus Sphincter Pharyngoplasty for the Treatment of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome: Preliminary Findings From a Systematic Review.

The purpose of this study was to examine and compare surgical and speech outcomes of the posterior pharyngeal flap and sphincter pharyngoplasty following surgical management of velopharyngeal insufficiency in patients with 22q11.2 deletion syndrome (22q11.2DS). This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist and guidelines. Selected studies were chosen using a 3-step screening process. The 2 primary outcomes of interest were speech improvement and surgical complications. Preliminary findings based on included studies suggest a slightly higher rate of postoperative complications with the posterior pharyngeal flap in patients with 22q11.2DS but a lower percentage of patients needing additional surgery compared with the sphincter pharyngoplasty group. The most reported postoperative complication was obstructive sleep apnea. Results from this study provide some insight into speech and surgical outcomes following pharyngeal flap and sphincter pharyngoplasty in patients with 22q11.2DS. However, these results should be interpreted with caution due to inconsistencies in speech methodology and lack of detail regarding surgical technique in the current literature. There is a significant need for standardization of speech assessments and outcomes to help optimize surgical management of velopharyngeal insufficiency in individuals with 22q11.2DS.

Skull base reconstruction using in situ bone flap in patients with pituitary adenomas treated by endoscopic endonasal approach.

The objective of this study is to study the effect of in situ bone flap (ISBF) repositioning, a recently proposed rigid skull base reconstruction technique, on patients diagnosed with pituitary adenoma undergoing endoscopic endonasal approach (EEA). A retrospective analysis was conducted on 188 patients with pituitary adenomas who underwent EEA from February 2018 to September 2022. Patients were divided into the ISBF group and non-ISBF group, according to whether ISBF was used during skull base reconstruction. Of the 75 patients in the non-ISBF group, 6 had postoperative cerebrospinal fluid (CSF) leakage (8%), while only 1 of 113 patients in the ISBF group (0.8%) had postoperative CSF leakage, indicating that the incidence of postoperative CSF leakage in the ISBF group was significantly lower than that in the non-ISBF group (P = 0.033). In addition, we also found that the postoperative hospitalization days of patients in the ISBF group (5.34 ± 1.24) were significantly less than those in the non-ISBF group (6.83 ± 1.91, P = 0.015). ISBF repositioning is a safe, effective, and convenient rigid skull base reconstruction method for patients with pituitary adenoma treated by EEA, which can significantly reduce the rate of postoperative CSF leakage and shorten postoperative hospital stays.

Commissuroplasty using the triangular cheek flap in patients with free flap reconstruction of through and through buccal defects.

Extensive resections of advanced stage oral cavity cancers can sometimes lead to significant through and through buccal defects with compromise of the oral commissure/lips. Post free flap reconstruction, such patients often require a secondary delayed commissuroplasty to assist with improved oral function and quality of life. In current literature, limited methods exist for free flap commissuroplasty with some key limitations, particularly their negative impact on buccal sulcus or oral vestibule. Our technique of the triangular cheek flap commissuroplasty allows the surgeon to reconstruct a neo-commissure without compromising the oral vestibular depth or decreasing mouth opening. Through this pictorial essay we describe a detailed surgical technique for secondary reconstruction of the oral commissure.