Pedicled Flap Reconstruction Research Articles

Long-term functional outcomes and quality of life after partial glossectomy for T2 squamous cell carcinomas

IntroductionPartial glossectomy and reconstruction strategy for malignant tongue tumors influences speech and swallowing. ObjectiveThe aim of this retrospective study was to evaluate long-term functional outcomes after partial glossectomy for pT2 mobile tongue carcinomas with a maximum dimension between 2 and 3cm. Different reconstruction strategies (with or without pedicled flap) were compared. MethodsTwenty-two patients with at least 12 months followup were included. Clinician-based and self-reported instruments were used to analyze tongue motility, speech intelligibility and articulation, swallowing, and quality of life. ResultsPatients with a higher tongue motility had better articulation and lower dysphagia. Avoiding pedicled flap reconstruction seemed to guarantee lower impairment of speech and swallowing. Worse functional outcomes induced a lower quality of life. ConclusionPartial glossectomy results in tongue motility impairment and consequently alterations of oral functions. Since the type of reconstruction impacts long-term outcomes, it should be adequately planned before surgery.

Changing trend in the management of head neck cancers during the COVID-19 pandemic.

BackgroundIn the present study, we have shared our experience in managing head neck cancers, especially the oral malignancies, during the crisis of COVID 19.Materials and methodsPatients with oral cancers underwent pedicle/local flaps and free flaps reconstruction based on the availability of intensive care unit and comorbidities of the patients. The clinical outcomes were compared at the end of one week, one month, and three months after the primary surgery.ResultsPedicle/local flaps were used in 25 cases and radial/fibular free flaps were used in 8 cases for the reconstruction of soft tissue defects. Patients with pedicle flap reconstruction had better clinical outcomes, including lesser ICU stay as compared to free flaps.ConclusionPedicle flap can be a valid alternative to the free flap for the soft tissue reconstruction in advanced oral malignancies during the COVID pandemic period in the Indian subcontinent, especially with limited infrastructure of the hospitals.

Hospital volume is associated with cost and outcomes variation in 2,942 pelvic reconstructions

Complex pelvic reconstruction is challenging for plastic and reconstructive surgeons following surgical resection of the lower gastrointestinal or genitourinary tract. Complication rates and hospital costs are variable and may be linked to the hospital case volume of pelvic reconstructions performed. A comprehensive examination of these factors has yet to be performed. Data were retrieved for patients undergoing pedicled flap reconstruction after pelvic resections in the American National Inpatient Sample database between 2010 and 2014. Patients were then separated into three groups based on hospital case volume for pelvic reconstruction. Multivariate logistic regression and gamma regression with log-link function were used to analyze associations between hospital case volume, surgical outcomes, and cost. In total, 2,942 patients underwent pelvic flap reconstruction with surgical complications occurring in 1,466 patients (49.8%). Total median cost was $38,469.40. Pelvic reconstructions performed at high-volume hospitals were significantly associated with fewer surgical complications (low: 51.4%, medium: 52.8%, high: 34.8%; p<0.001) and increased costs (low: $35,645.14, medium: $38,714.92, high: $44,967.29; p<0.001). After regression adjustment, high hospital volume was the strongest independently associated factor for decreased surgical complications (Exp[β], 0.454; 95% Confidence Interval, 0.346-0.596; p<0.001) and increased hospital cost (Exp[β], 1.351; 95% Confidence Interval, 1.285-1.421; p<0.001). Patients undergoing pelvic flap reconstruction after oncologic resections experience high complication rates. High case volume hospitals were independently associated with significantly fewer surgical complications but increased hospital costs. Reconstructive surgeons may approach these challenging patients with greater awareness of these associations to improve outcomes and address cost drivers.

Postoperative delirium in patients undergoing tumor resection with reconstructive surgery for oral cancer.

Many attempts have been made to identify the risk factors for postoperative delirium, but this has proved difficult due to its complex morbidity. Furthermore, there is little information on postoperative delirium in patients undergoing tumor resection and reconstructive surgery for oral cancer. The aim of the current study was to investigate the incidence of and risk factors for postoperative delirium in patients undergoing resection and reconstructive surgery for oral cancer. The present study included 104 patients with pedicle or free flap reconstruction. Postoperative delirium developed in 22 (21.2%) of these patients. The mean time to onset of postoperative delirium was 2.5±1.0 days and the duration of delirium was 1.9±1.2 days. Univariate analysis demonstrated that the occurrence of postoperative delirium was significantly correlated with operating time (P=0.033), duration of anesthesia (P=0.039), amount of blood loss (P=0.027), method of reconstruction (P=0.008), type of flap used (P=0.009) and time until postoperative ambulation (P=0.0008). Low postoperative red blood cell count (P=0.004), hemoglobin (P=0.004) and hematocrit (P=0.004) were significantly associated with delirium, but preoperative blood test results were not. The multiple logistic regression analysis of these risk factors revealed that the only significant correlation that remained was between postoperative delirium and the time to ambulation after surgery (P=0.005). Since 2009, the Department of Oral and Maxillofacial Surgery, Kumamoto University Hospital has promoted ambulation after the first two postoperative days for patients with oral cancer undergoing tumor resection with reconstruction, and the occurrence of postoperative delirium has decreased from 29.2 to 14.0%. The results of the current study suggest that early postoperative ambulation in patients who undergo reconstructive surgery for oral cancer is effective for preventing postoperative delirium.

Early postoperative outcomes in implant, pedicled, and free flap reconstruction for breast cancer: an analysis of 23,834 patients from the ACS-NSQIP datasets.

Many patients seek breast reconstruction following mastectomy. Debate exists regarding the best reconstructive option. The authors evaluate outcomes comparing implant, free flap, and pedicled flap reconstruction. Patients undergoing implant, pedicled flap, and free flap reconstruction were identified in the 2011-2016 NSQIP database. Demographics were analyzed and covariates were balanced using overlap propensity score. Logistic regression was used for binary outcomes and Gamma GLM for length of stay (LOS). Of 23,834 patients, 87.7% underwent implant, 8.1% free flap, and 4.2% pedicled flap reconstruction. The implant group had the lowest mean operative time (206min, SD 85.6). Implant patients had less pneumonia (OR 0.09, CI 0.02-0.36, p < 0.01), return to operating room (OR 0.62, CI 0.50-0.75, p < 0.01), venous thromboembolism (VTE) (OR 0.33, CI 0.14-0.79, p = 0.01), postoperative bleeding (OR 0.10, CI 0.06-0.15, p < 0.01), and urinary tract infections (UTI) (OR 0.21, CI 0.07-0.58, p < 0.01) than free flap patients. Pedicled flap patients had less postoperative bleeding (OR 0.69, CI 0.49-0.96, p = 0.03) than free flap patients. Pedicled flap patients had more superficial surgical site infections (p = 0.03), pneumonia (p = 0.02), postoperative bleeding (p < 0.01), VTE (p = 0.04), sepsis (p = 0.05), and unplanned reintubation (p = 0.01) than implant patients. Implant patients had the lowest LOS (1.6days, p < 0.01). Implant reconstruction has less short-term postoperative complications than free flaps and pedicled flap reconstructions. The overall complication rate among all reconstructive modalities remains acceptably low and patients should be informed of all surgical options.

P61 An Unusual Case of Intermittent Cardiac Tamponade

A 64-year-old man presented to his GP complaining of intermittent shortness of breath on exertion, particularly when constipated. His background included coronary artery bypass surgery 20 years ago using bilateral internal thoracic arteries and the left radial artery; this was complicated by deep sternal wound infection that required sternal debridement and bilateral pectoral flaps advancement. A recurrent infection some time later was treated with a second debridement and partial sternectomy followed by pedicled omental flap reconstruction.

Congestive Heart Failure Predicts Major Complications and Increased Length of Stay in Lower Extremity Pedicled Flap Reconstruction.

Congestive heart failure affects 6.2 million people in the United States. Patients have a decreased cardiopulmonary reserve and often suffer from peripheral edema, important considerations in lower extremity reconstructive surgery. In this study, the authors sought to determine the impact of congestive heart failure on postoperative outcomes following lower extremity pedicled flap reconstruction using a national multi-institutional database. The authors isolated all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent lower extremity pedicled flap reconstruction from 2010 to 2016. Preoperative, intraoperative, and postoperative variables were compared between patients with and without congestive heart failure. Multivariable regressions were performed to determine the independent effect of congestive heart failure on postoperative outcomes. The authors identified 1895 patients who underwent lower extremity pedicled flap reconstruction, of whom 34 suffered from congestive heart failure. No significant difference was observed between patients with versus without congestive heart failure in postoperative wound complications (superficial wound infection, deep wound infection, and wound dehiscence), renal failure, or readmission. On multivariable analysis, congestive heart failure was independently associated with increased cardiopulmonary complications (i.e., myocardial infarction, cardiac arrest, pneumonia, reintubation, and failed ventilator weaning) (OR, 3.92; 95 percent CI, 1.53 to 9.12), septic events (OR, 4.65; 95 percent CI, 2.05 to 10.02), and length of hospital stay (β, 0.37; 95 percent CI, 0.01 to 0.72). In patients undergoing lower extremity pedicled flap reconstruction, congestive heart failure independently predicts a four-fold increase in postoperative sepsis and cardiopulmonary complications and a significantly increased length of hospital stay. The authors' findings highlight the need for heightened perioperative vigilance and medical optimization in this high-risk population. Risk, II.

Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb

Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments. A total of 14 patients with 15 reconstructions (average age = 48years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35cm2 (range: 3-150cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1-4). The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Is It Reasonable to Use Indocyanine Green Fluorescence Imaging to Determine the Border of Pedicled TRAM Flap Zone IV?

Background:The contralateral lateral section (zone IV) of a pedicled transverse rectus abdominis musculocutaneous (TRAM) flap is generally removed intraoperatively. The border of zone IV is usually identified anatomically using the Hartrampf classification. In this study, we used the indocyanine green (ICG) fluorescence method to determine the border of zone IV and find the correlation with clinical flap outcome.Methods:The study recruited breast cancer patients who underwent a pedicled TRAM flap reconstruction. The border of zone IV was identified using the intraoperative ICG fluorescence imaging. The medial border of the removed specimen was sent for a pathological examination of vascular density.Results:A total of 29 patients underwent a pedicled TRAM reconstruction. In 16 patients, the border of zone IV identified by ICG fluorescent imaging was identical to the anatomical border. The ICG imaging showed distinct perfusion patterns, which we divided into 4 categories: sequential, simultaneous, low midline scar, and delayed pattern. Overall, there were no patient with total flap loss, 1 patient had a partial flap loss and 4 patients had a fat necrosis. Neither the ICG perfusion time nor the pathological vascular density correlates with the clinical flap outcome. The delayed ICG perfusion pattern (category IV) has the highest fat necrosis rate, although it is not statistically significant.Conclusions:In this study, more than half of the patients have ICG perfusion corresponding with the Hartrampf zone, which reflected the conventional practice of zone IV pedicled TRAM flap removal. Some ICG perfusion patterns could be helpful, especially in low midline and delayed pattern.

Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa: A Study of Quality of Life.

Hidradenitis suppurativa (HS) is a chronic skin pathology characterized by the occurrence of inflamed and swollen lesions, with a devastating impact of the disease on patient's quality of life. Wide local excision (WLE) of the affected tissue is the criterion-standard treatment, but there is no general consensus on the best reconstructive technique. The aim of this article is to evaluate the quality of life before and after WLE combined with pedicled perforator flap reconstruction, in patients suffering from HS. We analyzed 26 consecutive patients suffering from Hurley stage III HS. Every patient underwent WLE, followed by reconstruction with pedicled perforator flap. Dermatology Quality of Life Index (DLQI) tests were administered to every patient preoperatively and 6 months after surgery, when the clinical condition was considered stable. Dermatology Quality of Life Index scores were compared in terms of means with Student t test. Linear regression studies were used to compare the changes in DLQI score with the surgical and clinical variables. Axillary area involvement was found in 21 of 27 patients; 6 patients had more than 1 body region involved. Thirty-two pedicled perforator flaps were performed, and 22 were thoracodorsal artery perforator flaps. Mean DLQI test score before the first operation was 21.31 ± 4.79; the average DLQI score after the last follow-up was 5 ± 2.95 (P < 0.0001). Dermatology Quality of Life Index scores were not influenced by complications including reoperation. There were also no correlations found between DLQI score delta and number of reoperation (-0.18) or days of hospital stay (-0.13). Wide local excision followed by pedicled perforator flap reconstruction allows a radical excision of HS areas with short postoperative healing periods. Dermatology Quality of Life Index scores confirmed high levels of patients' satisfaction. Disadvantages of this technique include difficult learning curve, long operating time, and a nonnegligible complications rate.

Laterally Based Island Pedicle Flap Reconstruction of Distal Nasal Defects.

Laterally Based Island Pedicle Flap Reconstruction of Distal Nasal Defects.

Management of Primary Necrotizing Fasciitis of the Breast: A Systematic Review.

Necrotizing fasciitis (NF) is a life-threatening infection that involves spreading necrosis of the subcutaneous tissue and fascia that affects the extremities, abdominal wall, and perineum. Primary infection of the breast is a rare occurrence. Shah et al described the first case of primary breast NF and recommended radical "pseudotumor" excision and delayed skin closure months after resolution. Numerous other cases reported were successfully managed with different strategies. We aimed to summarize management options for primary breast NF through a systematic review of the literature. A systematic review of English literature was performed using PubMed. A total of 58 abstracts were reviewed. Data were abstracted from 25 cases that met inclusion criteria. A total of 25 cases of primary NF of the breast without an inciting event were found within the literature. Common initial operations included total mastectomy (36.0%), excisional debridement (32.0%), and partial mastectomy (12.0%). A total or radical mastectomy was completed for definitive source control in 13 (52.0%) cases. A total of 18 cases underwent reconstruction. Split-thickness skin grafts (44.4%) and delayed primary closures (33.3%) were the most common methods of reconstruction. Majority of cases with primary breast NF are managed with a total mastectomy to gain source control. Reconstruction using split-thickness skin grafts was most common. Other options included delayed primary closure, full thickness skin grafts, local tissue rearrangement, and pedicle flap reconstruction. Reconstruction should be patient dependent, but the whole arsenal of the reconstructive ladder may be used.

Risk of Free Flap Failure in Head and Neck Reconstruction: Analysis of 21,548 Cases From A Nationwide Database.

Head and neck reconstruction is complicated and is made even more challenging by free flap failure. We identified risk factors associated with free flap failure in records extracted from a nationwide database of a 23 million populations. We used International Classification of Diseases, Ninth Version, codes 140 to 149 and 161 to identify patients in Taiwan's National Health Insurance Research Database with head and neck cancer between 2000 and 2013. Patient's age, sex, neoadjuvant treatment, comorbidities, and anticoagulation use were also retrieved. Free flap reconstruction twice, or free flap and pedicle flap reconstructions during the same hospitalization were recorded as free flap failure. Logistic regression was used to identify factors that increased risk of free flap failure. A total of 21,548 patients with head and neck cancer were identified; 883 (4.1%) experienced free flap failure. Use of aspirin, clopidogrel, urokinase, prostaglandin (PGE1), low-molecular-weight heparin, and operation time were associated with free flap failure. However, some potential confounders could not be identified from the database. Several statistically significant findings were prone to influence by potential confounders. The clinically applicable result was that longer operation time and preoperative chemotherapy could increase the likelihood of free flap failure. On the other hand, several factors were proved to be irrelevant to free flap failure.

Lymphoedema rates in pedicled anterolateral thigh flaps for coverage of irradiated groin defects.

Limb salvage surgery in conjunction with adjuvant radiotherapy is the preferred treatment for soft tissue sarcoma. This study aims to determine if ipsilateral pedicled anterolateral thigh (ALT) flap reconstruction of groin defects post soft tissue sarcoma resection results in acceptable rates of lymphoedema, while also providing good soft tissue cover and minimal donor site morbidity. A retrospective chart audit was conducted with ethics approval, obtaining a case series of 16 patients operated on at a single institution by the senior surgeon. Patients who underwent ipsilateral pedicled ALT flap coverage of irradiated groin defects following soft tissue sarcoma resection were included. Comparative six-point limb circumference measurements were utilized to diagnose lymphoedema, with a difference of 10% when compared to the non-operative side being deemed significant. Lymphoedema was noted in three patients (18.8%) with an average follow-up period of 40.9 (range 8-59) months. Previously published lymphoedema rates in sarcoma limb salvage surgery of 15.5-30% are comparable to the rates obtained in this cohort. Lymphoedema rates do not appear to be higher in patients undergoing ipsilateral pedicled ALT flap reconstruction, thus making it a useful soft tissue coverage technique in this cohort.

Free Versus Pedicled Anterolateral Thigh Flap for Abdominal Wall Reconstruction.

Large full thickness abdominal wall defects following malignancies can be a reconstructive challenge. The purpose of this study was to analyze long-term outcomes and complications following abdominal wall reconstruction using composite antero-lateral thigh (ALT) flaps. The study retrospectively investigated 16 consecutive patients who underwent abdominal wall reconstruction with autologous flap between May 2003 and March 2018. Volumetric flap analysis was used to assess flap atrophy over time, evaluating the role of denervation and reinnervation. The long-term outcome was assessed to compare the two groups (free vs. pedicled ALT flap reconstructions). All flaps successfully covered the defects. We found a significant increase in flap resorption in free flaps when compared to pedicled ones. Abdominal bulging was seen in 3 out of 16 (19%) patients after more than 12 months follow-up, in close correlation with mesh absence. Free flaps were shown to be equally effective as their pedicled counterparts, without significant increase in complication rate.

Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases†

The elderly population in the United States is expanding rapidly, and with advancements in modern medicine, the number of elderly patients undergoing surgery has risen in parallel. The aim of this study was to evaluate the effect of age and frailty on postoperative outcomes following pedicled flap reconstruction. The 2005–2016 ACS-NSQIP databases were queried to identify cases involving pedicled flaps based on CPT codes. Demographic data and postoperative complications were assessed using Chi-square and t-tests for analysis of categorical and continuous variables, respectively. A multivariable regression analysis was conducted to control for confounders. A total of 44,986 cases were included in our analysis. Patients in the 70–79year age group had the highest rates of all-cause (31.2%), mild systemic (25.3%) and severe systemic (7.4%) complications. Multivariable regression identified age as an independent risk factor for all-cause, severe systemic and wound complications. A score of 3+ on the 5-factor modified frailty index (mFI-5) was associated with all-cause, severe systemic and wound complications. When stratified by flap location, age was predictive of all-cause complications for breast, trunk, upper extremity and lower extremity flaps. Finally, mFI-5 score of 3+ was identified as an independent risk factor for all-cause complications in flaps of the head and neck, trunk and lower extremity. Although, increased age does contribute to risk of postoperative complications, the frailty index appears to hold much stronger predictive capacity. These findings stress the importance of optimizing preoperative comorbidities to reduce the risk of poor postoperative outcomes.

Revisiting the musculocutaneous external oblique flap as a versatile alternative in large thoracic wall defects

BackgroundThe external oblique myocutaneous flap has been previously described for reconstruction of chest-thoracic wall defects smaller than 400–500 cm2. However, it is utilized less often than workhorse flaps such as the omental, pectoralis, rectus abdominis, and latissimus dorsi myocutaneous flaps as many plastic surgeons are not aware that the flap can cover larger areas than previously documented.Case presentationWe report a 57-year-old female tobacco user who underwent a resection of a grade 3 breast angiosarcoma resulting in a high left chest wall soft tissue defect approximating 900 cm2. The patient underwent an external oblique myocutaneous pedicle flap reconstruction of the defect, most notably in anticipation of postoperative adjuvant radiation therapy. No gross flap complications and or patient impairment were noted. Thirteen months status post flap reconstruction, the patient underwent an aortic valve replacement requiring re-elevation of the same flap for exposure. The flap demonstrated excellent viability during the procedure and postoperatively.ConclusionThe pedicled external oblique myocutaneous flap should be considered when reconstructing larger high chest wall defects when other more common flaps used in chest reconstruction may not be indicated. The external oblique myocutaneous flap is an excellent tool in the armamentarium of any reconstructive surgeon; it is a straightforward and versatile flap that can be safely and reliably used in durable reconstruction of defects of the chest wall and covers defects larger than previously described in the literature.

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study.

The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory frontal sinusitis after failed previous endoscopic sinus surgery (ESS), but this approach has a significant restenosis rate. We evaluated the potential benefits of mucosal grafts and pedicled flaps on the opening of the newly formed frontal ostium. Fifty patients with refractory frontal sinusitis or mucoceles after ESS were randomized to undergo EMLP, either with (n = 27) or without (n = 23) mucosal grafts and pedicled flap reconstruction of the neo-ostium. The frontal neo-ostium was measured with Lindholm distending forceps, and anteroposterior (A-P) and lateral dimensions were measured intraoperatively, and then again at 6 weeks, 6 months, and 12 months postoperatively. Olfaction outcomes were assessed using the Taiwan Smell Identification Test (TWSIT) and a smell visual analog scale (VAS) score preoperatively and at 6 months postsurgery. The initial intraoperative mean lateral and A-P dimensions were 23.2 ± 2.7 mm and 14.8 ± 2.3 mm and were significantly decreased at all time-points postoperatively. The mucosal grafts and pedicled flaps had greater lateral and A-P dimensions, and a greater percentage of intraoperative frontal neo-ostium area at all time-points postoperatively (all p < 0.05). At 6 months postoperatively, TWSIT (p = 0.027), but not the smell VAS score (p = 0.063), was significantly improved compared with baseline. TWSIT and smell VAS score changes did not differ between groups (p = 0.92 and p = 0.85, respectively). The use of mucosal grafts and pedicled flaps reduces stenosis of the frontal neo-ostium postsurgery and should be considered after EMLP.

Outcomes of younger and older patients with palatal cancer undergoing pedicled facial-submental artery island flap reconstruction

The purpose of this study was to evaluate the outcomes of younger and older patients with palatal cancer undergoing reconstruction using the pedicled facial-submental artery island flap (FSAIF) following cancer ablation. Fifty-eight patients with palatal squamous cell carcinoma (SCC) were divided into two age groups: ≤60 years (n=31) and >60 years (n=27). By clinical SCC stage, 6.4%, 83.9%, and 9.7% of the younger group and 3.7%, 85.2%, and 11.1% of the older group were stage I, II, and III, respectively. The incidence of comorbid conditions was 35.5% (11/31) in those ≤60 years and 137.0% (37/27) in those >60 years. Brown class II maxillary defects (four class IIa, 44 class IIb, three class IIc, and seven class IId) were repaired using FSAIFs following cancer ablation. There were two flap failures; thus the success rate was 96.6%. Significant differences in mean age and the incidence of comorbid conditions were evident between the groups. No significant differences in TNM stage, maxillary defect classification, flap size, overall flap survival, rates of local and general complications, or survival status was evident between the groups. The FSAIF is a reliable and safe method for repairing Brown class II maxillary defects following cancer ablation, particularly in older patients.

Resultados funcionales de pacientes tratados con faringolaringectomía y reconstrucción faríngea con colgajo pediculado

Introduction : Total laryngectomy is the treatment of choice for advanced laryngeal cancer and after radiotherapy failure. In patients with pharyngeal invasion, it is associated with total or partial pharyngectomy, wich defect can be repaired with free or pedicle flaps. Aim : To present a brief series of pedicle flap reconstruction approach after pharyngolaryngectomy in laryngeal carcinoma patients and functional outcomes. Materials and Method : We looked at laryngeal cancer patient records who were treated with total laryngectomy with partial pharyngectomy and pharyngeal reconstruction with pedicle flap at “Hospital Regional de Talca” between the years 2009 and 2017, finding 6 cases, 4 of which were alive at the beginning of the study. We analized videoflourocopy swallow studies to assess mechanisms of deglutition, and presence of stenosis or fistulas. We also performed a nutritional state assessment and a quality of life questionnaire. Results : During videodeglutition study, the 4 patients showed minimal contrast swallow delay at hypopharynx and cervical esophagus. All the patients were found eutrophic in their nutritional assessment and with no significant evidence of quality of life disturbances secondary to deglutition state. Conclusions : Partial pharyngeal reconstruction using pedicle flaps in patients who underwent total laryngectomy with partial pharyngectomy allows to maintain an adequate deglutition without dysphagia, as well as a good nutritional state.