Island Flap For Reconstruction Research Articles

Comparative Analysis of Radial Forearm Free Flap and Submental Island Flap in Reconstruction of Post-glossectomy Defects of Oral Squamous Cell Carcinoma and Quality of Life Assessment

Comparative Analysis of Radial Forearm Free Flap and Submental Island Flap in Reconstruction of Post-glossectomy Defects of Oral Squamous Cell Carcinoma and Quality of Life Assessment

A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction

BackgroundThis retrospective study aims to compare the oncological and functional outcomes of the submental island flap versus the radial forearm free flap used for oral cavity cancer reconstruction after minimizing differences in baseline characteristics.MethodsPropensity scores for each oral cavity cancer patient who underwent surgical resection and immediate reconstruction with a submental island flap or a radial forearm free flap with a flap size ≤ 60 cm2 between October 2008 and December 2021 were generated based on the likelihood of being selected given their baseline characteristics. Patients were matched using a 1:1 nearest-neighbor approach.ResultsThe final matched-pair analysis included 51 patients in each group. The 5-year overall survival, disease-specific survival, and locoregional control rates were 70.1% and 64.8% (p = 0.612), 77.3% and 83.7% (p = 0.857), and 76.1% and 73.3% (p = 0.664), respectively, for the submental island flap group and the radial forearm free flap group. Speech and swallowing functions were comparable between groups. However, there were significantly lower rates of complication associated with both donor and recipient sites in the submental island flap group, and also the duration of hospital stays and hospital costs were significantly lower in these patients. A subgroup analysis of patients in which the reconstruction was carried out using the submental island flap procedure revealed that in selected cases, the presence of clinically and pathologically positive level I lymph nodes did not affect survival or locoregional control rates.ConclusionsAlthough this study was not randomized, the matched-pair analysis of surgically treated oral cavity cancer patients showed that submental island flap reconstruction is as effective as radial forearm free flap reconstruction with regard to oncological and functional outcomes with lower complication rates, hospital stay, and hospital costs. This flap can be safely and effectively performed in selected cases with a clinical level I lymph node smaller than 1.5 cm and no signs of extranodal extension.

Submental island flap versus supraclavicular island flap in oral tongue cancer reconstruction: Perioperative and functional outcomes

BackgroundThe primary treatment for oral tongue cancer in both early and advanced stages involves surgical resection, which often affects tongue function. When microvascular free flaps are unsuitable for tongue reconstruction following cancer ablation, locoregional pedicled flaps become viable alternatives, for example, submental and supraclavicular island flaps. This study compares perioperative and functional outcomes between submental and supraclavicular flaps in tongue cancer reconstruction. MethodsThis retrospective cohort study analyzed the outcomes of 46 patients who underwent tongue resection and reconstruction with a submental or supraclavicular island flap between January 2015 and December 2022. We evaluated patient demographics, flap outcomes, postoperative complications, and speech and swallowing outcomes. ResultsThe study included 24 submental and 22 supraclavicular island flap reconstructions. While demographic data were similar between the two groups, the submental island flap group had significantly shorter operative times than the supraclavicular group (291 and 347 min, respectively, p = 0.018), reduced hospital stays (14.8 and 18.6 days, respectively, p = 0.016), fewer major recipient site complications necessitating interventions under general anesthesia (1 and 6 patients, respectively, p = 0.043), and less recipient wound dehiscence (1 and 8 patients, respectively, p = 0.009). Speech and swallowing outcomes were comparable in the two groups. ConclusionThe submental island flap appears to be a more favorable option for tongue reconstruction than the supraclavicular island flap, offering advantages in operative time, length of hospital stays, and lower rates of major complications and wound dehiscence.

Neurovascular Heterodigital Island Flap for Digital Pulp Defect Reconstruction: 58 Case Series

Aim: Our study aims to report the neurovascular heterodigital island flap reconstruction for finger pulp defects. Patients and Methods: This study included 58 patients presenting to our clinic with pulp defects between 2014 and 2022. The average age of the patients was 26 years (20 - 56 years). Injuries were Allen type 2 for 18 patients, type 3 for 33 patients, and type 4 for 7 patients. Pulp defects were caused by crush injury (n:42) and sharps injury (n:16). Results: None of the flaps administered to the participating patients developed any total loss. Three patients developed partial loss in the distal flap. Six patients were found to have superficial tissue infection. Two patients were found to have hyperpigmentation and hyperesthesia. While one patient with Allen type 3 pulp defect was detected to have 10 degrees of flexion contracture in the distal interphalangeal (DIP) joint and 5 degrees of flexion contracture in the proximal interphalangeal joint, three patients were found to have 5 degrees of flexion contracture only in the DIP joint. The mean static two-point discrimination of the pulp-administered flap was 5.2 mm (3-8 mm) and on the contralateral side was 3 mm. The mean Semmes-Weinstein monofilament test was 3.18 g (2.96 – 4.7 g) in the pulp administered flap and 2.92 g in the contralateral side. Conclusions: Reconstruction of pulp defects with neurovascular heterodigital island flap is a reliable treatment option with satisfactory functional and sensory outcomes.

Long-term outcomes of homodigital neurovascular island flap reconstruction of fingertip injuries in children.

We evaluated the long-term functional and cosmetic results of homodigital neurovascular island flap (NIF) used to reconstruct extensive pulp defects with bone exposure in children. Twenty-three children (mean age 4.8 years, range 1–10 years) with fingertip injuries were reconstructed with a pedicled homodigital NIF and evaluated in terms of sensation quality, cold intolerance, scar formation, nail deformity, range of motion and overall finger length at a mean follow up of 7.8 years (range 2–13). Eleven patients reported cold sensitivity in the operated fingertip, and 15 presented with hook nail deformities at the final follow-up. The total active motion of the injured finger was significantly lower than that of the uninjured side (p < 0.001). NIFs is a safe, reliable reconstructive treatment for fingertip loss in children, but commonly encountered issues in the long term include an extension lag of the interphalangeal joints, hook nail deformities and cold intolerance. Level of evidence: IV

Minimising donor-site morbidity following limbs' injuries with keystone perforator island flap reconstruction.

Plastic surgeons strive to choose better techniques to reconstruct the defects of the limbs, minimising the wound healing problems, improving the aesthetic and functional outcome with less complications. This study refers to the use of keystone perforator island flap (KPIF) in limbs' reconstruction, their harvesting technique to minimise donor-site morbidity, maximise the functional and cosmetic outcome, and will point on the most important indications and advantages. Between January 2014 and June 2020, a number of 28 cases were treated in our department, with simple or complex defects of the limbs. The database included patients' demographics, comorbidities, aetiology, characteristics of the flap, surgical factors, follow-up period and flap outcomes. We performed 28 KPIFs, 14 of type I, 12 of type IIA, 1 of type III, and 1 of type IV, with an average size of 69 cm2 (ranged from 1.25 cm2 to 318 cm2 ). Trauma was the major cause of the defects. One flap exhibited approximately 4% partial superficial necrosis. All donor sites healed without any adverse events. All patients were satisfied with the functional and aesthetic results. The KPIFs provide a simple and effective method of wound closure by using tissues of similar texture, thickness and colour. Preserving the main artery and the underlying muscle, this flap reduces the donor site morbidity. The use of KPIFs seems to be one of the most suitable choices whenever possible.

Submental Island Flap for Reconstruction of Oral Cancer Post Resection Defects: Surgical Outcomes and Oncological Safety

Submental Island Flap for Reconstruction of Oral Cancer Post Resection Defects: Surgical Outcomes and Oncological Safety

Application of facial-submental artery island flap in reconstruction of oral and maxillofacial defects

Application of facial-submental artery island flap in reconstruction of oral and maxillofacial defects

Outcomes of patients with mucoepidermoid carcinoma of minor salivary gland in palate undergoing radical resection followed by submental flap reconstruction

ObjectiveTo investigate the outcomes of patients with mucoepidermoid carcinoma of the palate undergoing pedicled facial-submental artery island flap (FSIF) reconstruction following resection. Patients and methods41 patients with early stage disease and 9 patients with advanced-stage disease underwent radical excision and neck dissection. 37 IIb, 4 class IIa and 9 IIIb maxillary defects were reconstructed with FSIF, folded FSIF or folded FSIF with titanium mesh respectively. The skin paddles were 3 × 8 to 5 × 15 cm and 3 × 8 to 5 × 14 cm, respectively. 5 patients with high grade disease were treated with cobalt 60 adjuvant radiotherapy after operation. ResultsOne flap failure occurred, yielding a success rate of 98.0% in the reconstruction of palate II and III defects with FSIF or titanium mesh. The patients were seen for follow-up for 16–60 months postoperative. 76.0% patients alive with no disease (AND); 14.0% patients alive with disease (AD) and 10.0% died of disease (DD). Rates of AND, AD and DD differed significantly according to histopathologic grade and TNM stage (P < 0.001); rates of AND, AD and DD differed obviously according to necrosis of the tumors lymph node metastasis, and tumour cell anaplasia and treatment (P < 0.05). ConclusionsRadical resection with wide safety margins of normal tissues including neck dissection is the mainstay of treatment modality. The patients with high grade disease should be treated with postoperative radiotherapy. The FSIF is a reliable and safe method for repairing Brown class II maxillary defects.

Oncologic safety of submental island flap reconstruction in clinically node-negative oral cancer patients: a prospective comparative study

The purpose of this study was to evaluate the oncologic safety of submental island flap (SIF) reconstruction in clinically node-negative oral cancer patients. Forty-four clinically node-negative oral cancer patients with tumour size T1–T3 were divided into two groups. The Submental group consisted of 21 patients, who underwent submental island flap reconstruction whereas the control group consisted of 23 patients who underwent reconstruction with other locoregional or free flaps. The locoregional recurrence rate (LRR) and recurrence-free survival (RFS) in these two groups were assessed and compared. The follow-up period in the two groups ranged from six to 28 months, with a median follow-up period of 15 months and 21 months, respectively. Results showed that the LRR in the control and the submental group was 21.7% and 19%, respectively (p = 0.825). Kaplan–Meier curve showed that the difference in recurrence-free survival in the two groups was not statistically significant (p = 0.749). Multivariate and bivariate analyses did not establish any relationship between the predictive parameters and locoregional recurrence. Thus, the Submental island flap is a reliable and versatile locoregional flap for the reconstruction of post-resection defects in oral cancer. It has no predictive influence on locoregional recurrence in clinically node-negative oral cancer patients.

Use of the supraclavicular artery island flap for reconstruction of maxillofacial defects: a case report and literature review

BackgroundFree flaps are widely used in maxillofacial reconstruction; however, this approach was not feasible in the current case. It was not possible because the free flap method requires microvascular anastomosis expertise, which is difficult, time-consuming and costly.Case presentationAn 86-year-old woman suffered squamous cell carcinoma on the right side of her face, which resulted in a large soft-tissue defect. Here, we present a case of facial reconstruction from the inferior margin of the jaw to the top of the head. The size of the defect was 18.5 cm × 7.5 cm, which is rare for a patient of this age in the maxillofacial area. We used the supraclavicular artery island flap (SCAIFP) which measured 19.3 cm × 8.3 cm to repair the defect. After the operation, the flap survived without complications. Then, the patient was followed for 10 months and was satisfied with the aesthetic and functional results at the donor and recipient sites following the tumour resection. The tumour did not recur, and facial nerve function was preserved.ConclusionOur results provide a new choice for the reconstruction of large defects of the head and face, and expand the potential applications of the SCAIFP.

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.

Effect of submental flap reconstruction versus obturator rehabilitation after maxillectomy on quality of life: a randomized clinical trial

The surgical removal of a maxillary tumour will result in an oronasal communication, which can negatively affect the patient’s life and daily functions. Following maxillectomy, the defect can be treated with a prosthetic obturator or microvascular flap. However, the gold standard technique remains controversial. The aim of this study was to evaluate and compare quality of life (QoL) outcomes of submental island flap versus maxillary obturator reconstruction after partial maxillectomy. Sixty patients indicated for maxillectomy were allocated randomly to two equal-sized groups. Control group patients underwent reconstruction with a surgical obturator, while intervention group patients underwent submental island flap reconstruction. Patient QoL was evaluated at the 6-month follow-up using the University of Washington Quality of Life Questionnaire. Statistically significant differences in QoL were found between the two groups. Chewing (P = 0.034), swallowing (P < 0.001), speech (P = 0.009), taste (P = 0.04), mood (P = 0.01), and anxiety (P = 0.003) domains showed a statistically significant improvement in the submental group compared to the obturator group. However, the obturator group showed a greater improvement in appearance (P < 0.001). The masticatory function scores in the obturator group were significantly higher after obturator rehabilitation (P < 0.001). In conclusion, this study found that submental flap reconstruction provided better function and QoL than the obturator. This reconstruction was associated with less pain and better pronouncing of words, chewing, swallowing food, and psychosocial adjustment.

Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.

Keystone design perforator island flaps for coverage of non-oncological periarticular defects surrounded by the zone of injury

ObjectivePeriarticular defect coverage remains challenging because multi-vector tension forces affect wound tensile strength. This study presents our experience with keystone design perforator island flap (KDPIF) reconstruction of non-oncological periarticular defects surrounded by the zone of injury and describes the expanding versatility of KDPIF reconstruction for periarticular defects.MethodsFrom June 2017 to July 2019, 12 patients aged 8 to 84 years underwent KDPIF reconstruction to cover periarticular defects. All defects resulted from non-oncological causes and were surrounded by the zone of injury. We reviewed the patients’ medical records and clinical photographs to collect and analyze clinical and operative data.ResultsThe defect size ranged from 0.8 × 1.2 to 7 × 10 cm2. The flap size ranged from 1.5 × 3 to 15 × 18 cm2. All flaps survived completely. All patients showed favorable functional outcomes without significant limitation in joint range of motion during the follow-up period (range, 4–12 months). The mean observer scar assessment scale summary score and patient scar assessment scale total score were 17.667 ± 5.921 and 20.167 ± 6.478, respectively.ConclusionKDPIF reconstruction is a simple and effective surgical option for coverage of non-oncological periarticular defects surrounded by the zone of injury.

Postauricular Island Flap in Reconstruction of Auricula Tumor Defects.

The most common malignant tumor in humans is skin cancers. Skin cancers are most commonly seen in the head and neck region due to direct exposure to sunlight. Most frequently seen skin cancer in the auricula are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study is to evaluate the results of postauricular island flap after resection of tumors in the auricula.Twelve patients aged 58 to 84 years were included in the study. Eight patients had BCC, 3 had SCC, and 1 had basosquamous carcinoma (BSC). The tumor was located at the cavum concha in 7 cases, antihelix in 3 cases, triangular fossa in 1 case and scapha in 1 case. Surgical procedure was performed under local anesthesia in 7 patients and under general anesthesia in 5 patients. Postauricular island flap was used in all cases. There were no early complications. Three patients had non-apparent narrowing of the auriculomastoid angle. The patients were followed for an average of 2.6 years between 1 and 9 years. Only one patient with basosquamous carcinoma of the cavum concha had recurrence at 19 months.We believe that the postauricular island flap may be a good alternative for the reconstruction of the defect after resection of tumors in the auricle due to its proximity to the surgical site, color matching, adequate thickness, good vascularization, aesthetic acceptance by the patient and completion of the procedure in one session.

Comparison of Clinical Results and Quality-of-Life in Tongue Cancer Patients Undergoing Submental Island Flap and Radial Forearm Free Flap Reconstruction

Our goal was to compare the clinical results and quality-of-life (QoL) in tongue cancer patients undergoing submental island pedicled (SIP) flap and radial forearm free (RFF) flap reconstruction. Patients undergoing SIP or RFF flap reconstruction for primary tongue squamous cell carcinoma were prospectively enrolled and were asked to complete the University of Washington Quality-of-Life (UW-QOL) questionnaire, version 4, at 12months after the operation. The study's main interest was QoL as well as locoregional recurrence control. A total of 190 patients were enrolled for analysis, and the SIP and RFF groups showed significant differences in patient age, American Society of Anesthesiologists classification, and hospital cost. In the survival analysis, locoregional recurrence occurred in 35 patients in the SIP group and 48 patients in the RFF group; the difference was not significant (P=.440). In the QoL analysis, compared with patients in the SIP group, those in the RFF group had higher scores in the domains of activity and recreation. No significant differences were found with respect to the other domains. The SIP flap and RFF flap have comparable survival control in tongue squamous cell carcinoma patients. The RFF flap might lead to better QoL, but the SIP flap imposes fewer limitations on patients' health status and is associated with lower hospital cost.

Tunneled island flap for reconstruction of eyebrow defect

Tunneled island flap for reconstruction of eyebrow defect

Submental island flap reconstruction of large and complex oral commissure defects

Background Oral commissure squamous cell carcinoma frequently presents at advanced stage and surgical treatment will eventually result in large and complex lip, buccal, and facial skin defects. Reconstruction of such defects is a challenge. The authors hereby present the experience with the reconstruction of large and complex postexcisional defects of the oral commissure with submental island flap. Patients and methods Eighteen patients with stage IVA squamous cell carcinoma of the oral commissure were enrolled. For all patients wide surgical excision of the primary tumor with supraomohyoid neck dissection followed by immediate reconstruction of the resultant defect with submental island flap was done. During the follow-up period, surgical and oncologic outcomes were reported; and functional and aesthetic outcomes were evaluated using the Functional Lip Glasgow Scale score. Results Male predominates and the mean operative time was about 197 min. Surgical complications were unremarkable. Functional Lip Glasgow Scale score ranged from 18 to 25. Recurrence occurred in three cases. Conclusion Submental flap is a feasible reproducible reconstructive technique for oral commissure tumors surgery with satisfactory functional and aesthetic outcomes.

Survival and functional outcomes of patients who underwent facial-submental artery island flap reconstruction after oral cavity or HPV-negative oropharyngeal squamous cell carcinoma ablation

The purpose of this study was to evaluate the outcomes of survival and functional outcome of patients with Oral cavity squamous cell carcinoma (OCSCC) and HPV-negative oropharyngeal squamous cell carcinoma (HPV-negative OPSCC) using FSAIF reconstruction of the defects. The 275 patients were divided into OCSCC and HPV-negative OPSCC group were treated with surgery and oral cavity and oropharynx reconstruction with the FSAIF. The skin paddles in the OCSCC and OPSCC groups were 3×9 to 5×14cm and 3×8 to 5×15cm, respectively. The original primary tumor site was the oral cavity in 203 patients and the oropharynx in 72. No significant differences TNM or clinical stage, skin paddle of the flap, rate of flap failure, or local complications were observed between the OCSCC and HPV-negative OPSCC groups. Ten flap failures occurred, yielding a success rate of 96.4%. There are not differences of survival and speech function of patients with OCSCC and HPV--negative OPSCC using FSAIFs reconstruction of the defects following cancer ablation, but there are differences of the swallowing function. This flap is suitable for reconstructing the defect in the oral cavity or oropharynx.