Radial Flap Research Articles

LARYNGOPHARYNGEAL RECONSTRUCTION IN A PREGNANT WOMAN: A CLINICAL CASE

Relevance: Cancer in pregnancy is a very serious clinical condition that seriously affects women and their families, as well as the medical staff who provide care. Diagnostic and therapeutic solutions must balance the appropriate treatment with the risk to the fetus. In developed countries, cancer in pregnant women has become more common over the past 30 years due to an increase in the number of older women giving birth. Melanoma, lymphoma, leukemia, and cancers of the breast, cervix, ovaries, gastrointestinal tract, and genitourinary system are the most common malignant neoplasms in pregnant women. Head and neck cancers are rare in pregnancy. A total of 3 cases of locally advanced laryngopharyngeal cancer were recorded in patients aged 23 to 28 years in 2017-2023 at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. This article describes a case of advanced squamous cell carcinoma of the laryngeal region in a young pregnant woman and also discusses the diagnosis and treatment of head and neck cancer in pregnant women. The study aimed to describe a clinical case of squamous cell carcinoma of the larynx in a pregnant patient. Methods: The description of a clinical case presents data from laboratory, instrumental, and physical research methods of a pregnant patient with hypopharynx squamous cell carcinoma, who was examined, treated, and followed up at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. The patient was diagnosed with IVA laryngopharyngeal cancer T4aN2cM0. Grade III dysphagia. Laryngeal stenosis. Grade II cachexia” and received three courses of neoadjuvant polychemotherapy. Then, she underwent surgical intervention in the volume of laryngopharyngectomy and reconstructive surgery using a free radial flap and was administered adjuvant external beam radiation therapy. Results: The article presents the results of laryngopharyngectomy for locally advanced squamous cell carcinoma of the hypopharynx. The postoperative period was without complications, the patient was discharged 14 days after surgery in satisfactory condition and continued adjuvant radiation therapy. Conclusions: The reviewed clinical case demonstrates the importance of an integrated approach to treating laryngopharyngeal cancer, including effective reconstruction of postoperative defects using free fasciocutaneous flaps.

Development of a porcine training model for microvascular fasciocutaneous free flap reconstruction

BackgroundIn reconstructive surgery, improvements are needed in the effective teaching of free flap surgery. There is a need for easily accessible and widely available training without high financial costs or ethical concerns while still providing a realistic experience. Our aim was to develop an appropriate training model for microvascular flaps.MethodsWe identified pig head halves as most appropriate regarding availability, cost, and realism. These accrue largely by the food industry, so no animals need to be sacrificed, making it more ethical from an animal welfare perspective. We evaluated the suitability as flap donor site and analyzed the vascular anatomy of 51 specimens.ResultsAnatomical evaluation revealed a reliable and constant vascular anatomy, allowing the design of a flap model that can effectively illustrate the entire process of microvascular flap surgery. The process was divided into 6 key steps. The flap can be harvested after marking the vascular pedicle 5.3 cm from the lateral corner of the mouth. Skin island design and subsequent tissue dissection follow until a fasciocutaneous flap is raised, similar to a radial flap. Upon completion of flap harvesting, it can be freely transferred for defect reconstruction. Microvascular anastomosis can be performed on recipient vessels in the cervical region, and the difficulty can be individually adjusted.ConclusionsThe developed training model is a reasonable compromise in terms of surgical realism, availability, didactic value, and cost/time effectiveness. We believe it is a powerful and effective tool with high potential for improving surgical education and training.

Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction

Primary and secondary reconstruction of the thumb is a common reconstructive challenge for the hand and plastic surgeons. Currently, The kite flap or the First dorsal metacarpal artery flap remains the regular choice and is believed to be the best for distal thumb defects, but it’s the first time we have utilized a reverse homodigital dorsal radial flap for the thumb with an expected outcome. A 37 - year - old male patient suffered partially, obliquely, and radially necrotic thumb tip in the second week following conservation stitching of the wound due to a motorcycle accident. The necrotic tissues were desbrided and the residual defect was covered simultaneously by reverse homodigital dorsoradial flap. The Interphalange (IP) and Metacarpalphange (MCP) joints were flexible, and the active rang of motion (ROM) of the affected thumb was not limited at 3 months post - op. The reverse homodigital dorsoradial flap has become a useful and valuable material for thumb reconstruction. The flap provides acceptable aesthetic results with primary closure of the donor site and returns the essential functionality to the affected thumb.

Versatility of the perforator radial artery flap in the reconstruction of the upper limbs and comparison of the outcomes with the “classic” radial flap, a retrospective study

IntroductionRadial forearm flap, first described in the early eighties in China, is a well-known and handy flap to cover soft tissue defects of the distal upper limb. It has, though, some inconveniences, such as the sacrifice of the radial artery and non-neglectable esthetic sequelae in the donor site. In the following years, a similar flap based on the perforators of the radial artery has been described as achieving similar results, allowing to spare a main vessel. The authors reviewed retrospectively the patients that underwent surgery with one of those two flaps in their center to compare outcomes. Materials and methodsPatients operated between January 2016 and January 2022 have been reviewed. Ten had a classic radial artery flap, and ten had a radial artery perforator flap. Twelve weeks after surgery, Vancouver Scar Scale was used to assess the results at the donor site and over the flap. Reintervention and failure rate within one year and patient satisfaction -using a visual analog scale ranging from 0 to ten-at 12 months were also assessed. ResultsAll classic radial artery flap group patients had “successful” surgery, and none needed secondary surgery. On the other side, three patients required a second surgery in the perforator flap group, and nine out of ten ended up with “successful” flaps. Mean Vancouver Scar Scale results regarding the flap are comparable, whereas those at the donor site are significantly better in the patients with the perforator flap. Patients’ satisfaction results are similar in both groups. ConclusionThe radial artery perforator flap is an important flap to be held in mind by all surgeons approaching reconstruction of the elbow, the forearm, and the hand, and should be preferred, when possible, to the classic radial forearm flap.

Cervical esophagus reconstruction by adapted microsurgical radial forearm autologous graft

The treatment of localized oncological process requires a reconstructive intervention in the vast majority of cases. Thus, the problem of reconstructive plastic material is acute. There is no standard material for reconstruction, due to the variability of defects in length, composition and localization of the tumor process. Both cover tissues and fragments of the gastrointestinal tract can be used as the autologous graft.
 The presented clinical case describes the esophageal reconstruction with the radial forearm flap. The radial flap is easy to cut out, survives well, and its use excludes the presence of complications from the donor area, in comparison with the techniques of using fragments of the gastrointestinal tract.
 The ability to perform simultaneous tumor removal and reconstruction allows for full restoration of vital functions eating, breathing, speech, achievement of good aesthetic and functional results, including long-term ones, and a satisfactory quality of life.

Radial Flap in Reconstructions of the Hand - Case Series Study

Abstract Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2×3.1cm to 9×13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.

Left Radial Flap in the Treatment of Tracheo-Gastric Fistula

Left Radial Flap in the Treatment of Tracheo-Gastric Fistula

Clinical observation of cervical esophageal cancer

Esophageal cancer is one of the hardest to treat malignant cancers. Patient prognosis remains unsatisfactory despite considerable progress in surgical, radiation, and drug treatments. Surgery remains the main form of treatment for this pathology as it is the only radical treatment method. The objective is to evaluate short-term treatment results for cancer of the cervical esophagus and laryngopharynx after large-scale resection with reconstruction and plastic surgery stage. A clinical case of locally advanced squamous cell carcinoma of the mucosa of the cervical esophagus is presented. Use of free radial fasciocutaneous flap for reconstruction of the cervical esophagus with preservation of the pharynx is described. Problems of diagnosis and surgical treatment of this pathology from the point of view of our clinic’s experience are considered. We show that radial forearm flap can be used for reconstruction of the pharynx and cervical esophagus during circular resections.

Utility of radial flaps for defect repair after surgical excision of head and neck tumors

Introduction. Surgery at the first stage has always been the gold-standard treatment for locally advanced head cancer of almost all locations. Such patients often have significant postoperative defects that cause serious functional and aesthetic disorders. This requires simultaneous defect repair. The technique of defect repair should be chosen carefully with the consideration of its benefits and potential consequences.Objective – to evaluate the efficacy of revascularized radial flaps for defect repair after combination extensive surgical excisions of head and neck tumors.Materials and methods. This study included 67 patients with head and neck cancers of different locations who had undergone surgical tumor excision followed by defect repair using a radial flap.Results. All patients had their defects repaired using radial autologous grafts. Since this study included primarily patients with oral and oropharyngeal tumors (53 patients), we also analyzed the survival in this cohort. patients were followed-up for 2 to 7 years. fourteen patients (26.4 %) developed progressive disease during this time, including 8 individuals with recurrent primary tumor and 6 individuals with regional metastases. The mean time to nasoesophageal probe removal and restored swallowing was 12.2 days; mean length of hospital stay was 13.5 days.Conclusion. Thus, radial flap is a reliable and multifunctional material that can be used to repair complex and combination defects in patients with head and neck tumors. In some cases, it is the method of choice, since it helps to achieve satisfactory quality of life. Repair of tongue defects with radial flaps ensures good functional results.

Results of two-stage plasty in severe consequences of burns of the upper extremity

Aim. To study the immediate and long-term results of the use of non-free flaps in the treatment of patients with the consequences of burns of the upper limb.Material and methods. The study included 32 patients with the consequences of burns of the upper limb, who were admitted to the Republican Scientific Center of Cardiovascular Surgery in the period from 2003 to 2020. The age of the patients ranged from 4 to 32years, the average value was 19.6 ± 1.9 years.Results. There were no intraoperative complications. The average volume of blood loss during one operation was 125.6 ± 11.3 ml (determined by squeezing napkins). The average duration of the operation was 128.6 ± 15.7 minutes. There were no complications after transplantation of a non-free inguinal flap. To achieve a more acceptable aesthetic result, a non-free radial flap was used in a period of five to fifteen years after the primary operation.Conclusion. Thus, the observance of surgical staging depending on the prevalence of one or another lesion component is decided individually and the principles of reconstruction of important anatomical structures shall be strictly followed.

Fatal complications in reconstructive plastic surgery and ways of their prevention

The world experience and experience of the Institute of Microsurgery (Tomsk, Russia) in rescuing dying free flaps are summarized in the paper. The issues related to the prevention of vascular disorders, which in 85–95% of cases lead to fatal complications in the form of total necrosis of the reperfused flap, are discussed. We are talking about the immediate, early and late complications due to the compromise of blood flow along the vascular pedicle (arterial, venous, arterial-venous). Unlike irreversible disorders, temporary disturbances in blood supply in free flaps are caused by the consequences of primary ischemia and reperfusion. Their duration and reversibility depend on the tissue composition, i.e. from the anoxic resistance of the tissues constituting the flap and, of course, the structures that form the wall of the flap vessels themselves. With a short duration of primary ischemia (up to 1 hour) and compensated reperfusion syndrome, temporary vascular disorders are manifested by flap skin flushing and metabolic edema of its tissues, which disappear 10-40 minutes after reperfusion. The indications for revision of the vascular pedicle are doubts about the adequacy of blood flow in the flap due to the appearance of the first signs of anastomotic thrombosis. The highest rates of flap rescue are achieved after revision of the vascular pedicle no later than 90 minutes after the first signs of thrombosis appear. It is important that the surgeon performing these microvascular anastomoses does the revision. The development of technologies for rescuing a perishing flap has become especially relevant in the last decade. This is due to the rapid development of reconstructive microsurgery of head and neck tumors. In such patients, there is practically no alternative to free transplantation of tissue complexes for the reconstruction of the lower jaw, tongue, soft tissue defect of the lower face and neck. The main technical problem leading to fatal complications after transplantation of a radial, peroneal, anterolateral femur flap is the difficulty of finding recipient vessels suitable for revascularization in soft tissues previously exposed to radiation. The search for alternative recipient vessels during the primary reconstruction of defects, for example, in the oral cavity, is accompanied by a significant increase in the duration of primary ischemia (up to 3–4 hours) and the death of flaps. The preservation of the viability of such free flaps is possible only by their temporary extracorporeal perfusion with extracorporeal membrane oxygenation. It is possible to preserve the viability of free flaps for 2 weeks (without microvascular anastomoses) during tertiary reconstruction of head and neck defects by continuous extracorporeal perfusion of the flap until it is completely engrafted in the recipient area. There is experience of using a tubular non-free radial flap on the long vascular pedicle of the radial vascular bundle (from the wrist to the ulnar fossa) in tertiary tissue reconstruction after removal of head and neck tumors.

Microsurgical reconstruction of the skull base and midface after orbitomaxillary resections for malignant tumors

Background. Orbitomaxillary resection includes exenteration of the orbital contents with resection of the inferior orbital and medial walls. The main goals are: reconstruction of soft tissue and bone structure defects, tamponade of the orbital cavity and/or its preparation for further ocular prosthetics, and reconstruction of the skull base defect. The purpose of the study to present the immediate results of orbitomaxillary resections in patients with malignant neoplasms of the skull base and midface. Material and methods. Between 2014 and 2020, 6 patients who previously underwent surgery for primary cancer (n=3) and recurrent cancer (n=3) were treated at the Head and Neck cancer department of N.N. Blokhin National medical Research center of oncology. To reconstruct defects after resection of bone structures (maxilla, frontal and nasal bones) and skin, a musculocutaneous alt-flap was used in 3 (50 %) cases and a fascial skin radial flap in 3 (50 %) cases. Results. The aesthetic result was assessed in 6 patients. In all cases, a satisfactory result was obtained. None of the patients who underwent resection of the dura mater followed by reconstruction had no symptoms of liquorrhea in the postoperative period. Conclusion. Flap selection depends on the defect size. In cases with a small defect size (up to 70 cm3), reconstruction with the radial fascial skin flap can be performed. If the defect size is more than 71 cm3, reconstruction with musculocutaneous alt flap can be the method of choice.

Technique for accelerated tests of samples for wear resistance

A review of the existing methods of accelerated abrasive wear tests is presented. The shortcomings of the technique implemented on an IM-01 installation of the VISKHOM design, as well as the Brinell-Howarth technique for laboratory studies, in which a powder abrasive is used are discussed, e.g., a problem of a uniform distribution of a free-flowing abrasive material over the surface of the contact zone, as well as problems of ensuring the stability of the supply of the abrasive material during the experiment. The goal of the study is to develop a methodology for comparative assessment of the wear resistance, excluding noted shortcomings. The tests were carried out on an M-1 installation using plate specimens 60 × 40 × 3 mm. The abrasive material used was a radial flap wheel 150 – 220 mm in diameter (width 30 mm, bore diameter 30 – 40 mm). The degree of wear was determined by a decrease in the mass of the sample by weighing on a balance with an accuracy of 0.1 mg before and after testing. The test results were considered as a relative wear resistance ε equal to the ratio of the wear resistance of the test specimen to the wear resistance of the reference one. The use of relative wear resistance makes it possible to increase the accuracy of the results obtained due to elimination of the influence of natural changes in external parameters that determine the intensity of wear during the test. The developed installation provides significant shortening of the accelerated comparative test (8 min) compared to 40 min on an IM-1, the structure and grain size of the working fluid, the constancy of the load in the contact zone and the speed of interaction between the sample and the tool being the same. Flap wheels of various grain sizes provide application of the device to a wide range of tasks without preliminary grinding of the samples and necessitate only their preliminary cleaning from slags and large particles after applying wear-resistant coatings.

Patients' Characteristics Can Predict Clinical Outcomes Following Hip Arthroscopy by Reflecting the Patterns of Labral Tears: A Retrospective Observational Study.

To evaluate the relationship between morphological differences in labral tears and clinical features of the hip joint in patients who underwent hip arthroscopy. We retrospectively analyzed data from patients who underwent arthroscopic surgery for the treatment of labral tears. Hip labral tears were morphologically classified as longitudinal peripheral tears (group L), radial fibrillated tears (group FI), radial flaps (group FL), and an unstable labrum (group U). Radiographically, the center-edge angle, acetabular roof obliquity, vertical-center-anterior angle, alpha angle, femoral head-neck offset ratio, and crossover sign were evaluated and compared among the groups. The relationship between labral morphology and these radiographic findings, as well as clinical findings, such as age, gender, preoperative range of hip motion, and the clinical outcomes using modified Harris Hip Score (mHHS) were also examined. This study included fifty patients. Groups L and FI were often observed in late middle-aged patients with relatively shallow acetabular coverage. Group FL tears were frequently observed in young males with radiographic features, such as femoroacetabular impingement (FAI), compared to the other groups. Group U comprised mostly young females with relatively shallow acetabular coverage compared to the other groups. For the postoperative mHHS, group FL showed the best score among all groups, with a significant difference between groups FL and FI (p = 0.034). Our study revealed that morphologically, different labral tears were associated with different clinical features and radiological findings. Especially, our study can provide predictive findings for hip arthroscopists that younger males with FAI show better clinical outcomes when compared to middle-aged females with shallow acetabulum, which is indicative of degenerative hip labral tears. IV case series.

Correction of eating disorders in patients with oral and oropharyngeal cancer after reconstructive plastic surgery

The study objective – to evaluate the feasibility of correcting eating disorders in patients undergoing surgery for oral and oropharyngeal cancers using various reconstructive techniques to restore postoperative defects.Materials and methods. Between 2012 and 2019, a total of 56 patients with stage II–IV oral and oropharyngeal cancer underwent reconstructive surgery after either hemiglossectomy or glossectomy. The patients ranged in age from 26 to 70 years. The patients were divided into two groups. Group I consisted of 36 (64.3 %) patients who underwent tongue reconstruction using rotation flaps. For reconstruction of hemiglossectomy defects, a chin flap was used, and for reconstruction of glossectomy defects, a pectoral flap was used. Group II comprised 20 (35.7 %) patients who underwent tongue reconstruction using free revascularized flaps. For the tongue reconstruction after hemiglossectomy, the radial flap, medial sural perforator flap and fasciocutaneous anterolateral thigh flap were used. For the tongue reconstruction after glossectomy, the fasciocutaneous anterolateral thigh flap was used. The acts of chewing and swallowing were restored during speech rehabilitation due to the activation and coordination of the work of the muscles of the cheeks, lips, soft palate, pharynx, and the reconstructed tongue. Eating disorders were assessed by interviewing patients. A comparative analysis of eating disorders included mobility and coordination of facial muscles and reconstructed tongue, increased sensitive in the oral cavity, the presence of aspiration and nasal regurgitation, and subjective difficulties of patients. The time before the start of rehabilitation and its duration were taken into account. Patients were interviewed before the start of the combined treatment, at the beginning and after the completion of rehabilitation.Results. After the completion of rehabilitation, all patients received food by the oral route. The best outcomes were achieved in group 2a patients, who underwent tongue reconstruction with free revascularized flaps. This group of patients had a lower percentage of the asymmetry of facial muscles and limited mobility of the tongue compared to other groups of patients.In the subgroups of patients undergoing glosssectomy, most of the studied parameters did not have statistically significant differences in values. However, it should be noted that in group 2b, the period from the date of surgical treatment to the beginning of rehabilitation was significantly longer than in group 1b.Conclusion. The use of the microvascular surgical techniques using various donor flaps creates the basis for a more complete functional recovery and expands the rehabilitation potential of patients after surgical treatment of oral and oropharyngeal cancer.

Treatment of painful median nerve neuroma using pedicled vascularized lateral antebrachial cutaneous nerve with adipofascial flap: a cadaveric study and exploration of clinical application

The most common procedure for the treatment of painful median nerve neuroma is coverage with vascularized soft tissue following external neurolysis. However, the ideal treatment should include reconnecting the proximal and distal stumps of the damaged nerve to allow the growth of regenerating axons to their proper targets for a functional recovery. We developed a useful technique employing radial artery perforator adipofascial flap including the lateral antebrachial cutaneous nerve (LABCN) to repair the median nerve by vascularized nerve grafting and to achieve coverage of the nerve with vascularized soft tissue. In an anatomical study of 10 fresh-frozen cadaver upper extremities, LABCN was constantly bifurcated into two branches at the proximal forearm (mean: 8.2 cm distal to the elbow) and two branches that run in a parallel manner toward the wrist. The mean length of the LABCN branches between the bifurcating point and the wrist was 18.2 cm, which enabled inclusion of adequate length of the LABCN branches into the radial artery perforator adipofascial flap. The diameters of the LABCN branches (mean: 1.7 mm) were considered suitable to bridge the funiculus of the median nerve defect after microsurgical internal neurolysis. In all cadaver upper extremities, the 3-cm median nerve defect at the wrist level could be repaired using the LABCN branches and covered with the radial artery perforator adipofascial flap. On the basis of this anatomical study, the median nerve neuroma was successfully treated with radial artery perforator adipofascial flap including vascularized LABCN branches.

An Extraordinary Reconstruction of a Postoperative Defect after Metatarsophalangeal Joint Arthrodesis of the Big Toe Using the "Chinese Forearm Flap".

We present an unusual technique for reconstruction of a postoperative tissue defect following hallux rigidus surgery. A complicated course after left big toe arthrodesis resulted in a soft tissue defect with bone exposure of the first ray. Amputation of the big toe was categorically rejected by the patient. There was advanced arteriosclerosis with single-vessel supply to the foot via the posterior tibial artery. To preserve the big toe, the defect was covered by a fasciocutaneous radial free flap with a 15 cm long vascular pedicle which was microanastomosed to the posterior tibial artery and its accompanying vein at the level of the medial malleolus. In certain extreme situations, the free "Chinese" radial flap can be quite effective in covering forefoot defects and allowing satisfactory and aesthetically pleasing soft tissue reconstruction.

Microsurgical reconstruction of the hard palate after resections for malignant tumors

Background. The main aims of hard palate reconstruction include separation of the nasal and oral cavities, restoration of chewing, swallowing, speech, ensuring good aesthetic results, and preparation for dental rehabilitation. The choice of reconstruction method is determined by such factors as the nature and location of the defect, surgeon’s experience in certain reconstruction methods, cancer prognosis, and patient’s preference. The study objective is to analyze the results of microsurgical reconstruction of hard palate defects using different types of flaps. Materials and methods. Forty-one (41) patients underwent microsurgical reconstruction of defects of the hard palate, soft palate, and alveolar process between 2014 and 2020. Defects of the anterior portion of the hard palate (grade I, IIc, IId according to the classification of J.S. Brown; grade IB, II, III according to the classification of D.J. Okay) were formed in 13 cases; all of them involved the alveolar margin of the maxilla to some extent. To repair these defects, we used flaps containing revascularized bone (n = 10; scapular tip flaps in 8 patients and fibular flaps in 2 patients) and fasciocutaneous or musculocutaneous flaps (n = 3; radial fasciocutaneous flaps in 2 patients and musculocutaneous flap from the anterior surface of the thigh in 1 patient). Defects of the posterior portion of the hard palate (grade Ib according to the classification of J.S. Brown; grade Ib according to the classification of D.J. Okay) were formed in 18 patients. To repair these defects, we used radial fasciocutaneous flaps (n = 17) and fibular autologous graft containing skin, muscles, and bone (n = 1). Soft palate resection was performed in 10 patients; all surgeries were combination, since the lateral oropharyngeal wall was included in the block of removed tissues. None of the patients had the opposite side affected. These defects were repaired using radial fasciocutaneous flaps.Results. Six patients (15 %) developed total flap necrosis due to venous thrombosis on days 2, 3, and 6 postoperatively; two patients developed flap necrosis due to arterial thrombosis 2 days postoperatively. Good speech quality was achieved in 33 patients (80 %), while 6 patients (15 %) had satisfactory speech; rhinolalia was observed in 2 patients (5 %). All patients with defects of the posterior hard palate and of the soft palate had excellent aesthetic results. Among participants with defects of the anterior hard palate and alveolar process, 10 patients had excellent aesthetic results, while 5 individuals had good results. Three patients had unsatisfactory results due to scarring in the middle portion of the face.Conclusion. Patients with subtotal defects of the hard palate and defects of its anterior portion (grade I, IIb, IIc according to the classification of J.S. Brown; grade II, III according to the classification of D.J. Okay) require repair of the alveolar margin of the maxilla; flaps containing revascularized bone are preferable in this case. The method of choice is defect repair using musculoskeletal scapular tip flap. In patients with short defects, defects located posteriorly, minimal or no defect of the alveolar margin of the maxilla (grade Ia, IB according to the classification of J.S. Brown; grade Ia, Ib according to the classification of D.J. Okay; grade V according to the classification of M.A. Aramany), soft palate defects, radial fasciocutaneous flaps should be used.

Reliability of propeller flaps in post-traumatic reconstruction of wrist and hand defects.

This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients' satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5cm to 4.5 × 10.5cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients' factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients' satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for small- and medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended.

Oral cancer reconstructive surgery using the free radial forearm flap (review)

This review covers the issues related to the application of radial free forearm flaps for the reconstruction of defects after surgeries for oral squamous cell carcinoma. The advantages of this method include optimal match of the flap to the tissues of the oral cavity, good adaptation to defect edges, and possibility to replace defects of almost any size and locations. Flap survival rate reaches 92.0–98.4 %. The method demonstrated good functional and aesthetic results when used for the repair of extensive defects of the tongue, oral floor, cheeks, as well as total defects of the lips, hard and soft palates. The main disadvantages of the method include aesthetic defects of the donor site and possible forearm dysfunction, but most patients are quite comfortable with these inconveniences. The death rate is 0.09 %; the incidence of complications is 15–24 %. The main cause of graft failure in this case is venous thrombosis. Advanced age is not currently considered as a contraindication for this method. Further studies evaluating free radial flaps are highly relevant, particularly those comparing this method with other ones and determining strict indications for it (such as size and location of the defect, tumor characteristics, and previous treatment).