Osteomuscular Flap Research Articles

Free microvascular transfer of the acromiotrapezius osteomuscular flap in rats

The acromiotrapezius-scapular spine osteomuscular flap is a new osteomuscular research model for use in microvascular free tissue transfer in rats. We performed anatomical studies to collect data on muscle weight, dimension, vessel calibre and bone size in 20 flaps. This flap has a triangular shape with an average size of 38 x 39 x 32 mm and an average weight of 1.25 g; the scapular spine of 20 mm in average length can be harvested with the flap. The pedicle can be taken in continuity with the cervical trunk (average diameter of artery and vein were 0.5 mm and 0.6mm, respectively, with an average pedicle length of 12 mm). The flap was harvested and transferred to the groin area of the same rat and anastomosed to the superficial epigastric vessels. Fifteen transplantations were performed and the 7-day flap survival was 93.3%. The acromiotrapezius flap is believed to be a new and reliable osteomuscular model in the rat.

Reconstruction of chronic laryngotracheal stenosis using a compound sternocleidomastoid-sternum flap

We reported the reconstruction of chronic laryngotracheal stenosis using a compound flap of sternum and sternocleidomastoid muscle. The sternum was cut into a slice and elevated with its attached sternocleidomastoid muscle as an osteomuscular flap, which was applied for the reconstruction of laryngotracheal complex. The use of free mucosal graft is needed for resurfacing the endotracheal wall. This method is useful particularly when the defect of trachea is large.

Immediate reconstruction of the central segment of the mandible using the masseter osteomuscular flap: Pereira MD, Marques AF, Brenda E, et al. Plast Reconstr Surg. 99:1749, 1997

Immediate reconstruction of the central segment of the mandible using the masseter osteomuscular flap: Pereira MD, Marques AF, Brenda E, et al. Plast Reconstr Surg. 99:1749, 1997

The fibula-flexor hallucis longus osteomuscular flap.

Limb salvage after loss of bone and soft tissue may require many operations to obtain soft-tissue cover and bony continuity. We describe a fibula-flexor hallucis longus osteomuscular flap which can provide both soft tissue and bone in a single stage. The flap is based on the peroneal vessels and is covered by a split-thickness skin graft. We report the results in five patients with an average bone defect of 8.3 cm and soft-tissue and skin loss. All regained a normal gait on the donor side; four had clinical and radiological union with excellent soft-tissue cover, but one required later amputation due to diffuse coagulopathy. The flap provides free vascularised bone with muscle cover. It has a dependable, long pedicle with minimal morbidity at the donor site, and allows monitoring of the vascularity of the fibular graft.

THE FIBULA-FLEXOR HALLUCIS LONGUS OSTEOMUSCULAR FLAP

Limb salvage after loss of bone and soft tissue may require many operations to obtain soft-tissue cover and bony continuity. We describe a fibula-flexor hallucis longus osteomuscular flap which can provide both soft tissue and bone in a single stage. The flap is based on the peroneal vessels and is covered by a split-thickness skin graft. We report the results in five patients with an average bone defect of 8.3 cm and soft-tissue and skin loss. All regained a normal gait on the donor side; four had clinical and radiological union with excellent soft-tissue cover, but one required later amputation due to diffuse coagulopathy. The flap provides free vascularised bone with muscle cover. It has a dependable, long pedicle with minimal morbidity at the donor site, and allows monitoring of the vascularity of the fibular graft.

Horizontovertical laryngectomy for supraglottic carcinoma

Recent decades have seen the expansion of indications for partial laryngectomy. This study focused on the application of horizontovertical laryngectomy for T2 and selected T3 and T4 supraglottic carcinomas. An osteomuscular flap was designed to reconstruct the laryngeal defect to preserve all the essential laryngeal functions. Seventy-six patients treated between November 1979 and October 1990 were reviewed retrospectively. All but two were followed up for at least 5 years. There were 11 cases of T2, 57 cases of T3, and 8 cases of T4 tumors. The survival rates of 7 cases of stage II, 56 cases of stage III, and 13 cases of stage IV carcinoma were 100%, 84.3%, and 74.3%, respectively. The functional recovery was satisfactory; 78.4% of 74 patients underwent decannulation, and all but one patient resumed a normal diet. This study showed that conservation surgery is reliable for selected supraglottic cancers, even for those lesions that extend beyond the confines of the supraglottis. (Otolaryngol Head Neck Surg 1997;117:280-6.)

Immediate Reconstruction of the Central Segment of the Mandible Using the Masseter Osteomuscular Flap

We describe a new technique for reconstruction of the central segment of the mandible using a masseter osteomuscular flap. The advantages of this method are that bone viability is preserved, both form and function of the mandible are maintained, it is a local flap with low donor-site morbidity, and the operative time is shortened.

Transmanubrial Osteomuscular Sparing Approach for Apical Chest Tumors

The transclavicular approach improved the treatment of apical chest tumors. However, removing the internal half of the clavicle and sectioning its muscular insertions led to serious postoperative alterations. We propose a transmanubrial approach, through a manubrial L-shaped transection and first costal cartilage resection, which allows retraction of an osteomuscular flap including but sparing the clavicle and all its muscular insertions. The elevation of the osteomuscular flap affords excellent access to the subclavicular region with safe control and resection of neurovascular outlet structures during the resection of apical chest tumors. Shoulder articulations and stability of the scapular girdle are respected, thus avoiding functional and cosmetic consequences of clavicle resection.(Ann Thorac Surg 1997;63:563–6)

Application of a modified segmental osteotomy in the maxilla

The aim of this study was to evaluate the success rate of different techniques of repairing maxillary and midfacial defects according to their extent.In this retrospective study, 47 maxillary reconstructions in 41 patients were reviewed. Evaluation took place an average of 4.5 years postoperatively. The cases were divided into three groups according to the classification of Brown et al. (Br J Oral Maxillofac Surg 40: 183–190, 2002): Group 1: maxillary defects limited to one side (Class 2a); Group 2: bimaxillary defects (Classes 2b and 2c); Group 3: maxillary/midfacial defects (Classes 3 and 4). Most reconstructions were performed with non-vascularized bone grafts in the first patient group, whilst microvascular soft tissue flaps combined with free bone grafts were used in the second group, and re-vascularized osteocutaneous flaps in the third group.Overall flap survival was 79%. Dental reconstruction was successfully completed in 31 cases (66%). Postoperative infection leading to transplant loss was the main reason for failure. This complication was specifically associated with temporal osteomuscular flaps (50%) and free iliac crest grafts (61%) and was related to the extent of the defect. In the reconstructive methods evaluated here, associated radiotherapy had a minor influence on the occurrence of complications.Non-vascularized iliac bone grafts should be used sparingly in Class 2b, even in combination with microvascular flaps. There is a very limited indication for these grafts in Classes 3 and 4. Temporal osteomuscular flaps do not seem to be suitable for maxillary reconstruction.

Long-term results at the donor site after free microvascular iliac crest transplantation (experience in 95 cases) and review of the literature

The use of anterior iliac crest as donor site for free osseous, osteomuscular and osteomyocutaneous flaps has developed during the past decade into an important reconstructive instrument both in maxillofacial and in orthopedic surgery. Frequently published follow-up studies focus on reconstructive success evaluation and modification of the operative technique. A long-term retrospective evaluation of the donor site after vascularized free anterior iliac crest transfer is presented. The study is based on 95 cases from 1985–93 including 11 cases from Switzerland (Kantonsspital Aarau). The patients were examined looking for objective complications and asked questions about their subjective symptoms at the donor site. These objective and subjective results were then correlated. Three percent developed hernias, loss of sensibility in the region of the lateral cutaneous femoral nerve occurred in 9.5%, but recovered in two-thirds. Seven percent of scars were unsatisfactory but no keloid or hypertrophic scars developed. All wounds healed primarily. Minor alteration in contour of the donor site was notable in 20–25% of the patients. Pain was a problem in an average of 7% of cases. Impairment in private life occurred in 3.5%, in professional life in 4.7%, and in daily life in 11.9% of cases; 13.5% were dissatisfied with the situation of the donor site, while 12% of the interviewees were not satisfied with the preoperative information. Nonetheless, 98.8% of the patients were willing, if necessary, to undergo the same operation again.

Surgical treatment of the fractured and dislocated condylar process of the mandible

Most fractures of the mandible can be managed conservatively. This report is a retrospective evaluation of the clinical and radiological results in 17 patients with 21 dislocated fractures submitted to open reduction and fixation, employing steel wires and maxillomandibular fixation. Follow-up ranged from 7 to 55 months, (mean 29.5). Functional assessment showed good opening movements (mean 41.9 mm). There were no cases of ankylosis, pain, or paralysis of the facial nerve. Radiological assessment was normal when the lateral pterygoid muscle was maintained adherent to the fractured proximal segment. Radiological signs of bone resorption occurred when the fractured segment was detached from the lateral pterygoid muscle. In our opinion, dislocated condylar process fractures can be managed surgically and with steel wire ligatures and maxillomandibular fixation. Whenever possible, the lateral pterygoid muscle should be inserted into the fractured proximal segment, i.e. as an osteomuscular flap.

Treacher Collins Syndrome

In the past various materials have been used for the correction of the malar bone defect, such as cartilage, dermis fat, silicone, autograft, homograft, xenograft, and free bone transplantation. The disadvantages of inorganic implants are well known: dislocation, extrusion, and capsular contraction. The bony autograft has no growth potential, and children may need several complementary corrections. None of these procedures is totally satisfactory. To solve these problems malar reconstruction is performed with the help of a temporal bone flap. Two varieties of these flaps have been described: one anteriorly with a muscular pedicle vascularized by the deep temporal artery and one posteriorly with a galeal pedicle vascularized by the superficial temporal artery. The main advantage of an osteomuscular flap is the survival of bone once it has been transferred. The second advantage is related to the osteogenic potential of the cambium layer of the periosteum, which may prove to be an ongoing concern. Our series of patients includes 20 children. Correction of the eyelid coloboma was obtained by transposition and advancement of a superior palpebral flap.

Reconstruction of pseudarthrosis of the scaphoid bone utilizing an osteomuscular pronator quadratus transposition flap

Treatment of pseudoarthroses of the scaphoid bone remains a difficult surgical problem. In many cases, it is not enough simply to stabilize the bone with a free bone graft. A pronator quadratus osteomuscular transposition flap has been used since 1983 to revascularize and stabilize the traumatized scaphoid hone. The precise vascular supply of the pronator quadratus muscle has been determined by a study of 5 injected cadaver anatomic preparations, 26 clinical cases are reported using this transposition flap.

Vascularized Cranial Bone Grafts for Mandibular and Maxillary Reconstruction—The Parietal Osteofascial Flap

The authors have performed 13 cases of vascularized cranial bone grafts for reconstruction of maxillofacial defects since 1986. Two types of flaps were used: the parietal osteofascial flap pedicled to the parieto-temporal fascia based on the superficial temporal artery and the temporalis osteomuscular flap pedicled to the temporalis muscle based on the deep temporal artery. Zygomatico-orbital complex, maxilla and mandible were reconstructed and hemifacial microsomia was also treated. The results of vascularized cranial bone grafts pedicled to fascia were as good as those of grafts pedicled to muscle. There were no major complications. Two types of vascularized cranial bone grafts seem to be useful in reconstruction of maxillofacial defects with avascular recipient beds because of their good blood supply. The parietal osteofascial flap has additional advantages including easy rotation of the flap to the defect, particularly a mandibular defect, and versatile use of fascia without bulkiness for reconstruction of soft tissue defects. This flap can be designed as a full- or partial-thickness cranial bone graft with good vascularity. In this paper, our technique for mandibular and maxillary reconstruction using the parietal osteofascial flap is introduced, and the results compared with our temporalis osteomuscular flap technique are reported.

Serratus anterior muscle in composite head and neck flaps.

The serratus muscle (SAM) can be raised as an isolated muscular or osteomuscular flap on its nutrient vessels or in combination with a latissimus dorsi (LD) myocutaneous flap on the thoracodorsal pedicle for various reconstructive purposes. The aim of the present is to report on the results achieved after the use of the SAM alone (n = 7) and in combination with an LD (n = 3) after tumor resection or osteoradionecrosis (ORN) in ten patients with defects of the head and neck. One flap was lost due to venous thrombosis. The donor site morbidity was minimal. Emphasis is given on a new indication, namely ORN of the mandible. Short-term results show that the use of the SAM prevents a pathologic fracture in cases of a class IIIa osteoradionecrotic mandible. More extensive use of the SAM flap is advocated.

Vascularized cranial bone grafts for mandibular and maxillary reconstruction: The parietal osteofascial flap

The authors have performed 13 cases of vascularized cranial bone grafts for reconstruction of maxillofacial defects since 1986. Two types of flaps were used: the parietal osteofascial flap pedicled to the parieto-temporal fascia based on the superficial temporal artery and the temporalis osteomuscular flap pedicled to the temporalis muscle based on the deep temporal artery. Zygomatico-orbital complex, maxilla and mandible were reconstructed and hemifacial microsomia was also treated. The results of vascularized cranial bone grafts pedicled to fascia were as good as those of grafts pedicled to muscle. There were no major complications. Two types of vascularized cranial bone grafts seem to be useful in reconstruction of maxillofacial defects with avascular recipient beds because of their good blood supply. The parietal osteofascial flap has additional advantages including easy rotation of the flap to the defect, particularly a mandibular defect, and versatile use of fascia without bulkiness for reconstruction of soft tissue defects. This flap can be designed as a full- or partial-thickness cranial bone graft with good vascularity. In this paper, our technique for mandibular and maxillary reconstruction using the parietal osteofascial flap is introduced, and the results compared with our temporalis osteomuscular flap technique are reported.

Total and Subtotal Glossectomy

Twelve patients with advanced carcinoma of the floor of the mouth and tongue were treated with total (five patients) or subtotal (seven patients) glossectomy, partial mandibulectomy, and immediate reconstruction with the microvascular composite groin flap. The osteomusculocutaneous groin flap was used in eleven patients, and the osteomuscular flap was used in one patient. The groin musculocutaneous or muscle flap was designed to resemble the shape of the tongue for dynamic food transport, improved swallowing, and acceptable speech. Eight of the 12 patients who survived more than 1 year were evaluated for speech and swallowing. Eight patients were able to speak intelligibly, six patients could tolerate a soft/pureed diet, and two patients were limited to fluids. Cinefluorographic swallow studies using semisolid contrast material showed voluntary active intraoral transport and propulsive pharyngeal emptying without aspiration in six patients with complete flap to palate contact; the remaining two patients were unable to move the intraoral contrast material effectively for swallowing because of poor palatal contact.

Osteomuscular flaps vs. Free bone grafts in craniofacial reconstruction: Experimental assessment of osseous healing

Osteomuscular flaps vs. Free bone grafts in craniofacial reconstruction: Experimental assessment of osseous healing

The pleural osteomuscular flap in oropharyngeal reconstruction.

The addition of a pleural segment to the osteomyocutaneous flap used in head and neck reconstruction can be efficacious in selected cases. The pleura underlying the rib segment has been shown to remain viable and provide good healing and oral lining. The extent of pleura that can be transferred is unknown and currently being investigated, but pleura can be safely taken to the edges of the superior and inferior ribs. The pleura offers a thin, pliable, reconstructed surface to the oral cavity that alleviates bulky flaps or difficulty with intraoral skin grafts. This adaptation is a valuable addition to the surgeon in head and neck reconstruction.

The serratus anterior scapular flap —A new osteomuscular unit

Dye and contrast studies of 32 scapular regions have demonstrated a reliable blood supply of the scapula based on a terminal branch of the serratus anterior artery. This artery, called the “angular branch” in our paper, provides the vascular supply of a new osteomuscular flap. The anatomical study also illustrated the relationship between this angular branch and the circumflex scapular and dorsal scapular arteries. The features of this flap are as follows: 1) a constant and long pedicle based on the subscapular-thoracodorsal axis; 2) the possibility of a bony shape similar to the anterior part of the mandible and the hard palate, the maximum length being 22 to 26 cm; 3) the malleable muscular component, suitable for cover of adjacent defects alone or in combination with other regional flaps. The use of the flap for partial reconstruction of the hard palate is described.