Minimal Donor Site Morbidity Research Articles

Diagnosis and Management of oro-antral fistula: Case series and review.

Introduction and importanceThe oro-antral communication (OAC) is a pathological opening between the maxillary sinus and the oral cavity. When it does not close spontaneously or if it is not treated, it remains permeable and epithelializes to develop into an oro-antral fistula (OAF) and can cause maxillary sinusitis.Cases presentationThe authors present through 5 clinical cases the different steps of the surgical protocols opting for the buccal fat pad flap and the advanced buccal flap to treat OAF/OAC.Clinical discussionSurgical closure of the OAC within 48 h is recommended to avoid complications. Several alternative techniques have been described over the years for the management of the OAC and OAF, with their advantages and limitations. The most commonly used surgical flaps are of two types: the advanced buccal flap and the buccal fat pad (BFP) flap.ConclusionThe adequate availability of the advanced buccal flap and the buccal fat pad (BFP) flap in the majority of patients, the easy handling, the minimal donor site morbidity as well as the excellent blood supply make them perfect flaps for the closure of OAF/OAC. However, follow-up remains a key point and very important to avoid complications. The present case series was limited by the small number of patients and the authors recommend a study with larger groups.

Anterolateral Thigh Free Flap Donor-Site Morbidity: A Retrospective Cohort Study.

The ability to achieve a good functional outcome, quality of life, and patient satisfaction related to the donor site of free flaps is an important factor in flap selection. One of the main advantages of an anterolateral thigh (ALT) free flap is its minimal donor-site morbidity. We conducted a study to analyze healing of ALT flap donor sites based on the type of closure. A total of 65 patients were included in the study. We divided the participants into two cohorts (i.e., primary closure [n = 51] and skin grafting [n = 14]). There were no statistically significant differences between the two cohorts relative to age, gender, or risk factors for wound healing (e.g., tobacco use, obesity, diabetes mellitus, and cardiovascular disease). We found there was a statistically significant difference (p < .05) between the mean donor-site wound healing time in the primary closure group (n = 51; 22.41 days [±9.94]) compared with the skin grafting group (n = 14; 54.57 days [±21.59]). To reduce wound healing time, improve cosmetic results, and increase functional outcomes in patients undergoing ALT free flap, we recommend using primary closure for the donor sites and avoiding skin grafting whenever possible.

Sideburn Reconstruction Using a Pre-Expanded Island Scalp Flap Based on the Parietal Branch of Superficial Temporal Vessels.

Sideburns are crucial for head and face esthetics. Absence of sideburns is associated with physical and psychological consequences. Many methods have been described for sideburn reconstruction; however, characteristics of the ideal method include optimal vascularization, ideal hair density, natural hair growth, and facial symmetry with minimum donor-site morbidity. In this study, the authors describe a novel method of sideburn reconstruction using a pre-expanded island scalp flap based on the parietal branch of the superficial temporal artery. Between February 2012 and December 2020, 9 patients underwent sideburn reconstruction surgery that involved 2 stages. During the first stage, an appropriately sized tissue expander was inserted underneath the scalp. After sufficient inflation of the expander, at the second stage, an island scalp flap based on the parietal branch of the superficial temporal vessels was elevated to reconstruct the sideburns. The mean size of the defects was 8 × 4.4 cm (range, 6 × 3-12 × 5 cm), whereas the average flap dimension was 10.22 × 5.67 cm (range, 8 × 4-13 × 8 cm). All flaps survived completely without any perfusion-related complications. Patients were followed up after surgery, ranging from 4 to 34 months (mean, 15.67 months). All patients and/or their parents were satisfied with the final appearance in terms of hair density, hair growth direction, and facial symmetry. Although a 2-stage procedure, this novel technique allows the reconstruction of a new sideburn with natural growth and orientation of the hair and minimal morbidity for patients.

Micro-vascular reconstruction of complex post traumatic ankle and foot defects with free anterolateral thigh flap: single centre experience

Background: Ankle and foot reconstruction is challenging for plastic surgeon due to paucity of local soft tissue and poor blood supply. Anterolateral thigh (ALT) free flap become popular reconstructive option where microsurgical expertise available.Methods: Retrospective study of 26 patients of complex post traumatic ankle and foot defect underwent free anterolateral thigh free flap reconstruction during 2 years duration.Results: ALT free flap provides satisfactory reconstructive option with only 8% flap loss in our study and minimal donor site morbidity. Flap thinning required in 19% patients on long term for adequate shoe fitting.Conclusions: ALT free flap provide like with like tissue replacement for foot and ankle reconstruction with supple skin cover for subsequent surgeries if required.

Osteoplastic Thumb Reconstruction in the Immediate Setting: A Case Series.

Background:Traumatic thumb amputation can have devastating effects on residual hand function. When replantation is not possible, thumb reconstruction is often performed in a delayed manner and may require multiple stages. Furthermore, reconstruction techniques often require microsurgical skills and equipment, which are not readily available at all institutions. This case series illustrates our technique for immediate osteoplastic thumb reconstruction following traumatic amputation.Methods:This is a case series involving all patients who sustained unreplantable thumb amputations and underwent immediate osteoplastic thumb reconstruction with bone autograft and pedicled groin flap by the senior author from September 2016 through August 2018.Results:Five patients underwent immediate osteoplastic thumb reconstruction during the study period. Total operative time for the initial osteoplastic reconstruction averaged 158 minutes (range 96–290 minutes). In addition to flap division surgery, patients underwent an average of 1.2 revision procedures (range 0–2), primarily for debulking and hardware removal. Patients achieved an average gain in length of 3.3 cm compared with the maximum anticipated length with revision amputation at the time of injury, and had stable clinical outcomes for a minimum of 12 months.Conclusions:Osteoplastic thumb reconstruction is a useful technique for thumb reconstruction for select patients following traumatic thumb amputation. Advantages of this approach include shorter overall operative times and hospital length of stay, minimal donor site morbidity, and a straightforward, reproducible technique.

Waveform-arranged multiple skin paddles: A novel design to reconstruct complex soft tissue defects of the extremities with a modified multi-lobed perforator flap

BackgroundMulti-lobed perforator flap was one of popular approaches for one-stage reconstruction of complex soft tissue defects because of its minimal donor-site morbidity. However, the area of skin island that can be harvested on the donor site is limited on the angiosome distribution, Moreover, large defects require more than the conventional skin island provided by a traditional multi-lobed perforator flap. For further extended skin paddles, this study presented a novel design of waveform-arranged skin paddles to elevated a modified multi-lobed perforator flap for the reconstruction of complex soft tissue defects in the extremities. MethodsFrom March of 2015 to March of 2020, fifteen patients underwent complex soft tissue defects reconstruction with waveform-arranged multi-lobed perforator flaps. According the size, shape and localization of the defects, two strategies were performed to design this modified multi-lobed flap. ResultsA total of fifteen waveform-arranged multi-lobed perforator flaps were successfully harvested to reconstruct complex soft tissue defects of the extremities. Among of them, Waveform–arranged dual skin paddles perforator flap were performed in eleven cases, and the waveform–arranged tripaddle perforator flaps were used in four cases. All the flaps survived and no flap related complication was observed postoperatively. The donor sites were closed directly in all cases. The mean follow-up time was 15.6 months. Most of the cases showed satisfactory contour. ConclusionThe waveform design of multi-lobed perforator flap was an alternative approach for reconstruction of complex soft tissue defects; it can maximize the harvested skin area of the donor site to provide extended skin island.

Reconstruction of the Palmar Defect of the Hand with a Sensory Medial Plantar Artery Flap.

BackgroundThere are many approaches to repair the palmar defect of the hand, but due to the complex tissue structure, versatile functions, and high restoration demands, the repair of the palmar defect of the hand has always been a difficult task. Choosing suitable flaps to repair this kind of injury is always a tough challenge for the reconstructive surgeon because of the limitation of the number of arteries in the recipient hand and high restoration demands. The sensory medial plantar artery flap is considered as the ideal choice to repair the palmar defect of the hand. Based on this technique, in the current study, we used the free sensory medial plantar artery flap to reconstruct the palmar defect of the hand and obtained satisfactory results. The purpose of this study was to review the use of the sensory medial plantar artery flap for the reconstruction of the palmar defect of the hand.MethodFrom January 2019 to December 2020, nine patients with the palmar defect of the hand underwent extremity reconstruction by a sensory medial plantar artery flap. The indications for this surgery were that the palmar defect of the hand need to be reconstructed and both anterior and posterior tibial arteries should be free-flowing. Patients who had systemic diseases such as diabetes millitus, vascular diseases, heavy smoking histories, and injuries of the donor site were ruled out for the surgery.ResultsNine patients were successfully treated by using a sensory medial plantar artery flap, with a mean age of 39.44 (range 19–58) years. Five of the patients were male and the remaining four were female. Seven of them had a machine crush, and the other two suffered thermal injury. In all cases, reconstruction was performed during the second stage of treatment. All flaps survived completely, and all of the donor sites healed well in Stage 1, except for one case of ischaemic skin necrosis due to tight sutures, which healed after suture removal.ConclusionOur experience showed that the free sensory medial plantar artery flap was an alternative for one-stage reconstruction of the soft-tissue defect in the palm of the hand. This flexible approach not only repaired the soft-tissue defect, but also offered a satisfactory recovery of the sensory of the palm with minimal donor site morbidity.

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes.

Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

Foucher’s Flap For Reconstruction of Thumb Pulp Defects: Evaluation of 14 Cases

Background: Thumb pulp is a common site for hand injuries and the sensory function gained with its reconstruction is very important for hand function. We aimed the focusing in Foucher’s flap of the first dorsal metacarpal artery for coverage of thumb pulp defects. Methods: Our study was done over a period of two years, between 2019 and 2021 and involved 14 consecutive cases of thumb pulp defects treated in our institution. The patients included 12 males and 2 female, mean age of 40,5±14,43 years. Three elective and eleven emergency cases were operated in the study. We observed the patients for a period as following first week, 1 st. Month, 3. Month, 6 and 12 month. Results: The mean used flap was 2,57x2,07 cm. All the patients had good fine touch and the mean two-point discrimination (s2-PD) was 8,9 mm, which was satisfactory. No flap loss occurred in any patient; one patient distal margin necrosis, one patient epidermolysis and one patient venous congestion were observed. Conclusion: Foucher’s flap for thumb pulp defects is successful flap tecnique for sensation reconstruction. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation. Our experience showed that Foucher’s flap is reliable option and has minimal complications.

Perforating patterns of cutaneous perforator vessels in anterolateral thigh flaps for head and neck reconstruction and clinical outcomes.

BackgroundAnterolateral thigh (ALT) flaps are versatile soft tissue flaps that have become the standard soft-tissue flaps used for head and neck reconstruction. They provide a long vascular pedicle, constant vessel diameter, abundant soft tissue coverage, and minimal donor site morbidity. The ALT flap was initially designed on the basis of a septocutaneous (SC) perforator. However, more recent research has shown that a substantial number of ALT flaps are now based on musculocutaneous (MC) perforators, and the ratio between MC and SC perforators varies among studies. In this study, we analyzed the perforating pattern of ALT flaps along with their clinical outcomes during head and neck reconstruction in the Korean population.MethodsFrom October 2016 to July 2020, 68 patients who had undergone an ALT flap procedure for head and neck reconstruction were enrolled retrospectively. The perforating pattern of the cutaneous perforator vessel (MC perforator/SC perforator/oblique branch), pedicle length, and flap size were analyzed intraoperatively. Patient demographics and flap necrosis rates were also calculated.ResultsThe highest number of cutaneous perforator vessels supplying the ALT flap were the MC perforators (87%). The proportion of MC perforators was significantly higher than that of the SC perforators and oblique branches. Flap necrosis occurred in seven cases (11.86%); sex, hypertension, diabetes mellitus, coronary artery disease, perforator course, and history of radiotherapy did not significantly affect flap necrosis.ConclusionThe ALT free flap procedure remains popular for reconstruction of the head and neck. In this study, we observed that the majority of cutaneous vessels supplying the flaps were MC perforators (87%). When using the MC perforator during flap elevation, careful dissection of the perforator is required to achieve successful ALT flaps because intramuscular dissection is difficult. Perforator pattern and history of radiotherapy did not affect flap necrosis.

Secondary Alveolar Bone Grafting in Patients with Cleft Lip and Palate: A Step-by-Step Video Series.

Secondary alveolar bone grafting is one of the key surgical procedures performed to restore dental arch continuity and facilitate tooth eruption in patients with cleft lip and palate. Harvest of cancellous bone graft from the iliac crest has become the gold standard; however. there is no consensus regarding the ideal technique. An optimal bone harvest technique must be aimed at producing minimal donor-site morbidity and patient discomfort. The success of the bone grafting procedure depends largely on the surgical technique. To restore cleft alveolar defects, one must be able to conceptualize the different underlying aspects of the problem to perform an effective surgical repair. It is important for surgeons-in-service to adopt newer techniques that significantly enhance the overall outcome. This article describes two techniques of iliac bone harvest and the principles involved in execution of the alveolar bone grafting procedure. The accompanying four-part video series depicts the bone harvest, flap design, dissection of the recipient cleft alveolus, and bone grafting in a step-by-step manner.

P115. MAXILLO-MANDIBULAR RECONSTRUCTION WITH VASCULARIZED BONE FLAPS USING INSOURCED VIRTUAL SURGICAL PLANNING AND HOME-MADE CAD-CAM: A 5-YEAR SINGLE-CENTER EVOLUTION IN 75 PATIENTS

PURPOSE:Virtual surgical planning (VSP) and computer aided design (CAD) and manufacturing (CAM) of surgical guides and jigs turned craftmanship into precision and enables the surgeon to complement the donor bone osteotomies with the bony resection of the jaw. In recent years, immediate dental rehabilitation became an integral part of VSP. However, outsourced CAD-CAM is expensive and may be no option to many institutions worldwide. We developed an insourced facility for ‘in-house’ VSP and ‘home-made’ 3D printing. METHODS: We present a consecutive series of 150 cases (2010-2020). In 75 cases (2015 -2020) we used insourced VSP and CAD-CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest and scapular angle flaps. Relevant parameters influencing the reconstructive outcome were determined. We compared data with 75 previous reconstructions of the jaw without CAD-CAM (2010-2015). Mann-Whitney U tests and Fisher’s exact tests were used to compare continuous and binary variables between both groups. RESULTS: We went from a fibula-based protocol, towards the selection of optimal vascularized bone for immediate placement of Osseo integrated implants. Bone flap survival was 94,7 % after 4 months. The three-year patient survival is 77,6 %. There were no significant prognostic factors for bone flap failure (such as smoking, radiotherapy or previous interventions). CONCLUSION: In-house VSP and CAD-CAM have evolved into a valuable strategies in maxillo-mandibular reconstruction that promote precision and allow for occlusion-based planning with quality of life, aesthetic outcome and minimizing donorsite morbidity as essential parts of the reconstruction even in high level oral cancers.

534 Allogeneic Cellularized Living Tissue in Pediatric Deep Partial Thickness Burns Reduces Need for Donor Sites

IntroductionHealing potential of deep partial thickness burns is not easily determined early after injury. Prolonged and continued inflammation can contribute to burn wound conversion. Early excision compared to a wait and see approach to wound healing decreases inflammation, shortens length of stay, and decreases painful wound procedures. However, early excision is at the expense of removing tissue that may otherwise heal without autografting. Use of a cryopreserved, allogeneic cellularized scaffold living tissue product (CTP) in pediatric deep partial thickness wounds with dermal elements remaining after excision is an alternative approach to wound closure. CTP may allow early excision without compromising healing potential, thereby minimize donor site morbidity, infectious complications and decrease length of stay. This case series describes the expanded access experience of a CTP on pediatric patients with thermal injury.MethodsExpanded use approval of a CTP was obtained through the FDA for pediatric patients with burns at three burn centers. Patients were taken to the operating room for excision and grafting of burns at the discretion of the attending surgeon. In wounds with dermal elements present after excision, CTP was grafted to the wound bed (Table 1). Postoperative wound care and follow up was per institutional standards of care.ResultsSix pediatric patients (9 weeks – 13 years old) with mixed depth burns having dermal elements remaining after excision were treated successfully with a CTP. Donor site surface area was reduced in all patients. No serious adverse events related to the CTP were noted in any of the cases. Average time to heal wounds treated with the CTP was approximately 2-3 weeks. In wounds ultimately deemed to be full thickness, CTP was not detrimental to subsequent autograft take. See Table 1.ConclusionsThis case series demonstrates that use of a CTP in pediatric patients is donor site sparing without any serious adverse events. Furthermore, use in full thickness burns is not detrimental to subsequent autograft take. The degree of dermal elements necessary to support wound healing is unknown and requires further study. This case series supports the application for a clinical trial investigating the safety and efficacy of CTP as an adjunct to wound healing in pediatric deep partial thickness burns.

Internal Mammary Lymph Node Biopsy during Microsurgical Breast Reconstruction: A Prospective Study.

Accurate assessment of regional lymph node basins is critical for oncological management of breast cancer. The internal mammary lymph node (IMLN) basin directly drains the medial pole of the breast, but biopsy is not commonly performed. While the axillary sentinel lymph node sample remains the standard of care, the majority of patients who have been found to have a positive IMLN biopsy have simultaneously had negative axillary sentinel lymph nodes. This study prospectively examines routine IMLN biopsy during microsurgical breast reconstruction. An IRB-approved study of routine IMLN biopsies in 270 consecutive patients who underwent microsurgical breast reconstruction was performed from July 1, 2018, to June 1, 2021. Recorded data included unilateral or bilateral breast reconstruction, unilateral or bilateral IMLN sampling, patient demographics, disease stage, and pathologic findings of IMLN. The majority of patients, 240 of 270 patients (88.9%), had bilateral reconstruction. Overall, 5 out of 270 (1.9%) patients had positive IMLN; one of these patients had positive axillary sentinel lymph nodes. The IMLN biopsy results in two of the five patients affected the clinical course as they were upstaged and required chemoradiation. Direct visualization of the internal mammary lymph nodes during dissection of the recipient vessels for microsurgical breast reconstruction allows for convenient sampling, with minimal donor site morbidity and enhances the therapeutic management of patients in whom nodal involvement is present. As such, the authors recommend IMLN sampling.

Perforator-based Adipofascial Flaps and ADM: A Novel Combined Approach to Distal Lower Extremity Defects.

Background:Due to the wide spectrum of lower extremity defect presentation, various reconstructive techniques are available. Classic adipofascial flaps are still a second choice. The authors described a new multistage reconstructive approach with perforator-based pedicled adipofascial flap.Methods:This retrospective study analyzed data of 23 patients undergoing adipofascial flap reconstruction after distal leg trauma between June 2017 and January 2020. A reconstructive approach with an adipofascial flap followed by a skin graft was used in all patients. Patients were divided into two treatment groups, and in only one treatment group, an acellular dermal matrix was placed above the adipofascial flap during the first stage of the reconstruction. Negative pressure wound therapy was applied to both groups. Surgical technique, outcomes, and complications were discussed.Results:All patients achieved complete healing, and no flap loss was reported. Minor complications occurred in four patients; all were treated conservatively on outpatient basis. The surgical and aesthetic results were evaluated as satisfactory from both patients and professionals. However, the group treated with acellular dermal matrix showed a lower complication rate, and resulted significantly more satisfied with the overall results and in several domains of the questionnaire administered postoperatively (P < 0.05).Conclusions:The adipofascial flap is a safe and effective approach for the reconstruction of small-to-medium-sized defects of the distal lower extremity. Our two-stage reconstructive approach maximizes the pearls offered by the established technique; the dermal matrix guarantees a layered reconstruction optimizing the surgical and aesthetic outcomes of the skin graft with minimal donor site morbidity.

One-stage reconstruction of extensive composite extremity defects with low donor site morbidity: A retrospective case series of combined transfer of a vascularized fibula flap and a perforator flap

BackgroundExtensive composite extremity defects remain a challenge in plastic and reconstructive surgery. To preserve the extremity, we used combined transfer composed of the vascularized fibula flap and a perforator flap from various body parts to reconstruct extensive composite extremity defects. Patients and methodsFrom January 2004 to December 2018, 14 male patients aged 9 to 55 years with extensive composite extremity defects (large soft-tissue and long bone defect) underwent reconstructive surgery in our institution. The combined transfer surgery consisted of the vascularized fibula bone flap and a perforator flap, such as anterolateral thigh flap, deep inferior epigastric perforator flap, or thoracodorsal artery perforator flap. ResultsAll fourteen patients were treated successfully using the combined transfer method. The dimensions of the different perforator flaps ranged from 13 × 6 cm2 to 26 × 11 cm2, and the size of the skin paddle of the fibular osteocutaneous flap ranged from 9 × 3 cm2 to 21 × 7 cm2. The median length of the fibular graft was 15 cm. No serious donor site complications were observed. Only one patient developed venous congestion and was salvaged. Another patient had hematoma at the recipient site and underwent debridement. Though all patients achieved bone union (median time of 8 months), two developed a stress fracture of the transferred free fibula. ConclusionWe were able to minimize donor site morbidity and avoid amputation in these patients using the combined transfer technique Our results show that the combined transfer of perforator flap and vascularized fibula flap with or without a skin paddle is a feasible reconstruction option for the treatment of the extensive composite extremity defects.

Evaluation of Using Dermis-Fat Graft in Oro-Nasal Fistula Repair

ABSTRACT Background One of the most devastating complication that follows cleft palate surgery is oro- nasal fistula. It can lead to many problems like fluid and food regurgitation, poor oral hygiene and retropharyngeal incompetence. The repair of palatal fistula had long presented a remarkable challenge to the plastic surgeon. Repair of these fistulae required the use of more than the usual two-layered closure procedures; demanding the introduction of a ‘Third layer’ of tissue to enhance smooth healing, and thereby reduce the chance of closure failure which predispose to fistulization. In this study we used an autogenous graft of ‘’ dermis and fat (dermis-fat) graft ‘’ to serve as the third protective, supportive and enhancive layer. Aim of the study: To evaluate the use of dermis-fat graft as autogenous tissue to achieve three layers closure of the palatal fistula. PATIENT AND METHOD The study included 22 patients ( 13 males, 9 females ), ranging in the ages between 2 to 40 years (13 males versus 9 females). The fistula size varies from 4 mm to 25 mm in diameter. Timing of fistula repair ranged between 6 months up to more than 4 years, Fistula assessment was done focusing on size, site, number and shape. Then assessment of surrounding tissue viability and pliability Results, operated upon, having 30 oro-nasal, We used minimal thickness of the graft ( 4-6 mm ) in 23 fistulae, and 7-8 mm thick graft in 7 ones. 24 cases was having full healing while in 2 fistulae partial wound dehiscence occurred. In another 2 fistulae there was obliteration of the buccal sulcus. While partial graft exposure in 2 other fistulae. We experienced no hematoma, or infection or airway obstruction. conclusion Using of interpositional dermis-fat graft had shown to have promising result in closure of oro-nasal fistula that followed cleft palate surgery. It provided durable, stable, and flexible coverage with minimal donor site morbidity. It can be used for fistula of less than 1.5 cm of various locations.

Superficial Circumflex Iliac Artery Perforator Flap in Advanced Head and Neck Reconstruction: From Simple to Its Chimeric Patterns and Clinical Experience with 22 Cases.

Head and neck tissue defects after ablative head and neck surgery often require complex and composite reconstructions. The superficial circumflex iliac artery perforator (SCIP) flap is an extremely versatile perforator-based flap with minimal donor-site morbidity. The authors present their experience with both simple and chimeric SCIP flap reconstructions for complex defects in various head and neck regions. Twenty-two patients undergoing ablative head and neck surgery for oncologic abnormalities were treated by means of a SCIP flap reconstruction. Patients' mean age was 62 years; 21 were men and one was a woman. Seventeen flaps were simple and five were chimeric reconstruction patterns. Indocyanine green perfusion imaging was performed in all cases. Twenty-one of 22 patients (95.5 percent) were successfully treated with good aesthetic and functional results. Two patients (9 percent) showed minor donor-site complications that were managed conservatively. The mean follow-up period was 5.3 months (range, 2 to 8 months). This case series demonstrates the reliability and versatility of the SCIP flap for head and neck reconstruction. The chimeric options combined with bone, double-skin paddle, and muscle offer a broad variety of functional reconstructive solutions for complex head and neck surgery. Intraoperative indocyanine green perfusion examinations are a valuable tool to assess and ascertain proper inset, vitality, and postanastomosis vessel patency in these complex microvascular flap reconstructions. . Therapeutic, IV.

VP3: Pelvic Reconstruction After Large Sacral Chordoma Resection Using Acellular Dermal Matrix and Double Pedicled Gracilis Muscle Flap Combined with Gluteal Fasciocutaneous Rotation Flap

INTRODUCTION: Sacral chordomas are rare, malignant primary bone tumors. Surgical resection with wide margins, combined or not with radiotherapy, is the only effective treatment with near 50% remission at 10 years. Surgery results in large three dimensional defects, as total or subtotal sacrectomy is often required. The treatment is challenging and requires a multidisciplinary approach. Several reconstructive approaches have been described, classically including rectus abdominis or gluteus musculocutaneus flap and omental flap. We aim at presenting an innovative method of pelvic floor reconstruction using acellular dermal matrix and double pedicled Gracilis muscle flap combined with gluteal fasciocutaneous rotation flap. MATERIALS AND METHODS: We report the case of a 70 yo patient affected by locally invasive sacral chordoma. The oncological treatment included neuronavigation-assisted subtotal sacrectomy with en bloc resection at the level of S1-S2 intervertebral disc and laparoscopic abdomino-perineal amputation with terminal colostomy. After the R0 resection was confirmed, pelvic floor was reconstructed with an acellular dermal matrix and a double-breasted pedicled muscle Gracilis flap to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with an unilateral gluteal fasciocutaneous rotation flap partially deepitelialized to fill the dead space. The donor sites were closed directly. RESULTS: No surgical complications were observed, with flaps and donor sites healing uneventfully. After 3 days in intermediate intensive care and 22 days in plastic surgery department, he was transferred to rehabilitation center. Walking was reassumed after 2 weeks, sitting after 4 weeks. Satisfying outcomes both functionally and cosmetically for both patient and surgeons were observed at 3 months follow-up. CONCLUSION: Large sacral defect can successfully be reconstructed with double pedicled muscle Gracilis flap combined with gluteal rotation flap. The association with acellular dermal matrix is recommended to avoid abdominal cavity organs herniation. The oncological, functional results at 3 months are satisfying with minimal donor site morbidity. Presentation Type

Reconstruction of chronic tibialis anterior tendon ruptures using a free anterior half of a peroneus longus tendon autograft: A technical note.

Purpose: Chronic rupture of the tibialis anterior (TA) tendon is rare. Several reconstruction techniques have been introduced. However, to the best of our knowledge, the use of a free anterior half of a peroneus longus tendon (AHPLT) autograft has not been reported for reconstruction of TA tendon rupture. This study aimed to describe the surgical technique and present the clinical outcomes of reconstruction of the chronic TA tendon ruptures using an AHPLT autograft. Methods: Between September 2013 and April 2019, five patients with chronic TA tendon rupture were surgically treated by reconstruction using an AHPLT autograft. The AHPLT could be easily harvested percutaneously with a tendon stripper from the ipsilateral lower leg around the reconstruction site. The study included four men and one woman, with a mean age of 43.8 (range: 23-65) years. Results: At a mean follow-up period of 42.8 (range; 12-70) months, the mean Foot Function Index value significantly improved from 53.6 ± 19.8 preoperatively to 25.8 ± 20.8 postoperatively (p = .04). None of the patients had morbidities (such as nerve injury, delayed tendon ruptures, or tenosynovitis) around the AHPLT donor site. Three patients were very satisfied, two patients were satisfied, and one patient was fair with the results. Conclusions: Reconstruction of chronic TA tendon ruptures using a free AHPLT autograft could be successfully performed with satisfactory clinical outcomes and minimal donor site morbidities. Future studies with a larger population size and a comparative group are warranted to confirm these findings.