Radial Forearm Free Flap Research Articles

Ultradelayed Arterial Thrombosis: Critical Flap Ischemia After Phalloplasty.

Delayed arterial thrombus causing loss of a cutaneous free flap at or beyond 6 months is a rare phenomenon. The purpose of this report is to describe 2 cases of arterial compromise requiring medical and surgical intervention at or beyond 6 months after radial forearm free flap (RFFF) phalloplasty and to define the phenomenon of ultradelayed arterial thrombosis. Patient 1 is a 44-year-old transmale who presented with pulselessness, pallor, and hypersensitivity of his neophallus 10 years status post-RFFF phalloplasty using a saphenous vein interposition graft (SVIG) between the superficial femoral artery (SFA) and radial artery (RA). Patient 2 is a 35-year-old transmale who presented with similar complaints 6 months status post-RFFF phalloplasty with the same vascular connections as above. Patient 1 was found to have an arterial thrombus distal to the SFA-SVIG anastomosis requiring catheter-directed thrombolysis with tissue plasminogen activator, resulting in partial loss limited to the distal three fourths of the shaft. Patient 2 was also found to have an arterial thrombus distal to the SFA-SVIG anastomosis requiring catheter-directed thrombolysis with tissue plasminogen activator and common femoral artery CFA-RA bypass, resulting in partial loss limited to the neoglans. Ultradelayed arterial thrombosis is a rare phenomenon requiring urgent intervention. The exact causes of this phenomenon, whether mechanical or physiological or both, have yet to be fully elucidated but it is hypothesized that the original anastomosis may continue to serve as the critical blood supply to its flap as far as 10 years after surgery.

Total Phallic Reconstruction in the Genetic Male

BackgroundTotal phallic reconstruction (TPR) is a reconstructive challenge. ObjectiveTo report both surgical outcomes and patient-reported outcomes (PROs) of genetic male patients undergoing TPR utilising a radial artery forearm free flap (RAFFF). Design, setting, and participantsA retrospective tertiary referral centre analysis of a series of genetic male patients with penile insufficiency (PI) either due to congenital micropenis, or from traumatic or surgical amputation was conducted. Surgical procedureRAFFF phalloplasty was conducted as a multistaged procedure: (1) TPR, (2) glans sculpting with second-stage urethroplasty when indicated, and (3) penile prosthesis implantation. MeasurementsA descriptive analysis of the patient's baseline features, surgical outcomes, and PROs was conducted. Results and limitationsA total of 108 patients were enrolled. The median age was 32.5 yr (interquartile range [IQR] 24–46) and median follow-up was 78.5 mo (IQR 30–129). A primary anastomotic urethroplasty was performed in 90 patients (83.4%) and a staged procedure in the remainder. Four patients experienced an acute arterial thrombosis, leading to complete loss of the phallus in two. Immediate surgical exploration saved the flap in two cases of venous thrombosis. Urethral complication occurred in 49.1% of patients. The multivariate logistic regression analysis showed an association (p=0.04) between the staged urethral reconstruction and the incidence of urethral complications. The limitations of our study are its retrospective nature and the lack of control. ConclusionsDespite the high incidence of postoperative complications and the possible need for revisions, TPR in the genetic male with PI using a RAFFF yields satisfactory aesthetic and functional results. Patient summaryin this report, we looked at the outcomes from TPR in a large population of male patients with penile inadequacy either due to congenital micropenis, or from traumatic or surgical amputation. Our results support the idea that penile reconstruction with a forearm free flap leads to satisfactory outcomes.

Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration.

A diversion loop provides an alternative pathway for food intake from the bucco-gingival sulcus into the thoracic esophagus. Therefore, the bolus does not pass via pharynx where choking may occur in case of severe dysphagia. The data about outcomes and complications of the diversionary procedure are short and they refer to small cohort with brief follow-up. This retrospective study analyzed data of 48 patients, mean aged 34.3 years (range, 22-58 years), undergoing the creation of a diversion loop in two stages. Patients complained of aspiration, choking, and dysphagia. Swallowing disorders were caused by corrosive injury, radiation damage, or neurologic injury, and were investigated through laryngoscopy and esophagography. A diversion loop was created in 45 cases with free jejunal flap and in 3 cases with radial forearm flap. Complications, functional outcomes, and revision rate were reviewed. The mean follow-up was 26.3 months. We reported one failure (2%) and one partial necrosis of the free flaps. The most frequent complication was hematoma (8%). One case of esophagocutaneous fistula (2%) and two cases of stricture (4%) were also observed. Forty-two patients (87%) took all of the daily diet from their mouths through the diversionary conduit. A poor functional outcome was significantly associated with pre-operative radiotherapy (p < .0001). The diversion loop offers an alternative route for alimentation. Patients are freed from their choking obsession; moreover, they are rehabilitated into society without the drawbacks of permanent jejunostomy feeding. The technique was upgraded with caudal marginal mandibulectomy to improve the outcomes. Patients undergoing a diversionary procedure due to radiation damage should be carefully informed about the expected functional results.

The Use of Dermal Substitutes for Donor Site Closure After Radial Forearm Free Flap Harvesting.

The aim of our study was to analyze the aesthetic and functional outcome in the radial forearm free flap donor site using a simple split thickness skin grafting (STSG) closure compared with the use of dermal scaffold supporting the STSG closure. The study analyzed 18 patients, divided in 2 groups based on the donor site closure modality. In STSG group, a simple STSG was used to cover the defect. In the DS + STSG group, the defect was covered by the use of dermal substitute (MatriDerm) supporting the STSG. Groups were compared on the following outcome variable: scar status; hand function; circumferences at most proximal and most distal point of the graft. All patients were followed up 1, 6, and 12 months post-operative. Nine patients from STSG group showed a difference in circumference between the operated and contralateral limbs respectively of 2.9 mm proximal and 1.2 mm distal; in the 9 patients of DS + STGS group the difference was respectively of 1.2 mm proximal and 1.3 mm distal. Welch unequal variances t-test demonstrated statistical significance of the values with P < 0.004 (P < 0.5). The average VSS was 1.82 ± 0.2 for STSG group and 1.75 ± 0.2 for DS + STGS group. The DASH score was 21.8% in STSG group and 19.4% in DS + STGS group. Our study shows that patients treated with Matriderm + STSG obtained a better result both in esthetic and functional outcomes.

An Algorithm for the Prevention and Treatment of Pain Complications of the Radial Forearm Free Flap Donor Site.

The radial forearm free flap (RFFF) is a staple of microsurgical reconstruction. Significant attention has been paid to donor-site morbidity, particularly vascular and aesthetic consequences. Relatively few authors have discussed peripheral nerve morbidity such as persistent hypoesthesia, hyperesthesia, or allodynia in the hand and wrist or neuroma formation in the wrist and forearm. Here, we present a diagnostic and therapeutic algorithm for painful neurologic complications of the RFFF donor site. The peripheral nerves that can be involved with the RFFF are reviewed with respect to the manner in which they may be involved in postoperative pain manifestations. A method for prevention and for treatment of each of these possibilities is also presented. Nerves from the forearm that can be harvested with the RFFF will have the most likelihood for injury and these include the lateral antebrachial cutaneous nerve, the radial sensory nerve, and the medial antebrachial cutaneous nerve. A nerve that may be injured at the distal juncture of the skin graft to the forearm is the palmar cutaneous branch of the median nerve. The "prevention" portion of the algorithm suggests that each nerve divided to become a recipient nerve should have its proximal end implanted into a muscle to prevent painful neuroma. The "treatment" portion of the algorithm suggests that if a neuroma does form, it should be resected, not neurolysed, and the proximal portion should be implanted into an adjacent muscle. The diagnostic role of nerve block is emphasized. Neurological complications following RFFF can be prevented by an appropriate algorithm as described by devoting attention to the proximal end of recipient nerves. Neurological complications, once present, can be difficult to diagnose accurately. Nerve blocks are critical in this regard and are employed in the treatment algorithm presented.

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).

Evaluating the free radial forearm flap versus the pedicled pectoralis major myocutaneous flap for oesophago-pharyngeal reconstruction: decision making, outcome and literature review

The successful reconstruction of oesophago-hypopharyngeal defects is a challenge and the choice of the best reconstructive option is still controversial. The purposes of this study were to evaluate the use of the free radial forearm flap (RFF) or the pedicled pectoralis major (PM) flap for oesophago-hypopharyngeal reconstruction and to review the literature, considering the free flap option as the state of the art. The decision making, outcome and common complications were assessed. From 2013 to 2018, 15 sequential patients with laryngeal carcinoma, 61 years and BMI 24.6, were included in this retrospective study. They underwent laryngectomy-pharyngo/esophagectomy and immediate or secondary pharyngoesophageal reconstruction. Nine patients underwent reconstruction with RFF (group A) and six with PM flap (group B). We excluded patients with history of thoracic and breast surgery and synchronous malignancy. We used the SPSS v.21 for statistical analysis. The duration of surgery for RFF was longer (731 min versus 435 min). Postoperatively, all patients received radiotherapy, whereas chemotherapy was administered in one patient. The RFF was the procedure of choice for stages III–IV and larger defects and the PM for stage II (p = 0.002). Overall complication rates, fistula, stricture and swallowing dysfunction were found higher in group B, but not significant (pCompl = 0.315, pFist = 1.000, pStrict/Swall = 0.143). Furthermore, the secondary PM reconstructions had non-statistically significant even higher fistula and swallowing dysfunction rates (p = 0.400). Both groups reported equal good results in terms of oral alimentation and speech. We found that the RFF and PM flap could provide comparable outcomes in oesophago-pharyngeal reconstruction. The RFF seems to be a superior reconstructive option for advanced disease and larger defects and is associated with better swallowing and fewer complications Level of evidence: Level III, therapeutic study.

Our Experience in Oral Commissure Reconstruction After Surgical Excision of Stage 3 and Stage 4 Oral Cavity Malignancy

The upper and lower lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. The reconstructive aims are to restore the oral lining, oral competence and function (i.e. articulation, speech and mastication). Functional and aesthetic restoration of lip and oral commissure defects can be achieved using the composite radial free forearm flap (RFFF) with Palmaris longus tendon. To present the technique, we have used our experience with this form of reconstruction in 30 consecutive patients with lip and oral commissure defects who were surgically treated between 2012 and 2018. Reconstruction of the lip defect was done with RFFF with Palmaris longus tendon. The ends of the Palmaris longus tendon were passed intraorally and anchored to the remnant orbicularis oris muscle of the upper lip to provide adequate tension so that oral competency could be achieved and sagging of the commissure could be prevented, and in cases, where adequate orbicularis oris was not present, the tendon was sutured to the zygomatic prominence. The patients were followed for 1 year. In our study of 30 cases of stage 3 and stage 4 oral cavity squamous cell carcinoma, we did RFFF with Palmaris longus and found that the graft uptake was excellent, i.e. 93.33%. Flap failure occurred in only 2 out of the total 30 cases. Re-exploration of the flap was done, and venous congestion was the cause of flap failure. Re-anastomosis of the vessels was done, but still the flap could not be salvaged. Donor site healed satisfactorily without any complications except for scarring. All patients had excellent oral competence during rest, speaking and eating. Good sphincteric function was obtained in early post-operative days. Drooling or air leakage was seen only in 6 out of 30 cases after 1 year of follow-up. The patients’ articulation was near-normal. The aesthetic results were accepted by 24 patients. All patients were able to resume regular diet. No complications were observed such as dehiscence, fistula formation or abscess formation. The mouth opening was also adequate (2–3 finger width) in 24 out of 30 patients of oral commissure reconstruction. The RFFF with Palmaris longus has excellent viability. It is a secure and reliable reconstructive option which produced satisfactory aesthetic and functional results.

Fascio-cutaneous-free flaps as primary reconstruction in salvage total laryngectomy.

Salvage total laryngectomy (STL) is the most common treatment for recurrent laryngeal cancer after (chemo)-radiotherapy [(C)RT]. In this scenario, a higher rate of local wound complications, such as pharyngo-cutaneous fistula (PCF) and pharyngo-esophageal stenosis (PES), is generally expected. The aim of the present study is to evaluate outcomes using a standardized reconstructive protocol. Between 2009 and 2019, patients undergoing STL after (C)RT were collected at two referral hospitals with the objective of evaluating surgical outcomes using a standardized reconstructive policy based on the use of fascio-cutaneous free flaps as inlay patch grafts and a long-lasting salivary bypass stent. Fifty-five patients (mean age, 66years; male-to-female ratio, 8:1) were included in the study. Previous treatments were RT in 22 (40%) patients, CRT in 21 (38.2%), and partial laryngeal surgery followed by adjuvant (C)RT in 12 (21.8%). Reconstruction was accomplished by radial forearm and anterolateral thigh free flaps in 16 (29.1%) and 39 (70.9%) patients, respectively. Flap success rate was 98.2%. Concerning postoperative complications, we encountered 3 PCFs (5.4%) and 1 PES (1.8%). The standardized reconstructive protocol analyzed herein granted significantly lower rates of PCF and PES after STL compared with data available in the literature.

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation

IntroductionPosterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. ObjectivesTo report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. MethodsThe study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. ResultsNine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. ConclusionPrimary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

Barrel-shaped design of the forearm free flap for lower lip reconstruction: a pilot case-control study

BackgroundRadial free forearm flaps is indicated patients with total or near-total defects in their lower lip. The purpose of our study was to evaluate a simple and effective barrel-shaped design of the radial free forearm flap for lower lip reconstruction and to compare its clinical outcomes with those of a conventional rectangular shaped free forearm flap.MethodsTwenty-two patients with a lower lip carcinoma who underwent radial forearm free flap reconstructive surgery were enrolled in this study between January 1, 2012, and December 31, 2017. A barrel-shaped design of radial forearm free flap for reconstruction was used in 8 patients (case group), and a rectangular design was used in 14 patients (control group). The patients’ quality of life was evaluated preoperatively and postoperatively in all the patients using the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-HN35) questionnaire. We analyzed the differences in the EORTC QLQ-HN35 scores pre- and postoperatively between the case and control group.ResultsThe patients in the case group had better outcomes in swallowing, speech, social eating, social contact, and dry mouth than the control group at 1-year follow-up (P < 0.05).ConclusionsThe use of a barrel-shaped design free forearm flap for lower lip reconstruction is an effective procedure and can achieve better results than the use of rectangular free forearm flap.

Comparison of functional outcomes and health-related quality of life one year after treatment in patients with oral and oropharyngeal cancer treated with three different reconstruction methods.

We evaluated the functional outcomes and health-related quality of life (HRQoL) of 117 patients (who had had primary operations for oral and oropharyngeal squamous cell carcinoma) using the University of Washington Quality of Life Questionnaire version 4 (UW- QOL V4), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3 (EORTC QLQ-C30 v3) and Head and Neck version 1 (EORTC H&N35 v1). The patients were divided into groups according to the reconstruction techniques used: primary closure, submental island pedicled flap (SIPF), and radial forearm free flap (RFFF). Patients who had reconstruction with RFFF had better HRQoL as measured by swallowing, mastication, speaking, and overall score, than the primary closure group (p<0.05). There was no significant difference (p>0.05) between the RFFF and SIPF groups in overall QOL one year postoperatively. The HRQoL of the SIPF group was also better than that of the primary closure group in terms of mastication, speaking, and loss of appetite. Swallowing, mastication, and speaking are major factors that affect the HRQoL of patients one year after operation for oral and oropharyngeal cancer. Flap reconstruction can improve patients' QoL postoperatively. They can regain their ability to speak and swallow through training, and the importance of this issue must be addressed postoperatively.

The Usefulness of Medial Sural Artery Perforator Free Flap for Head and Neck Reconstruction

Background and Objectives The ideal flap for head and neck reconstruction should be pliable, have sufficiently long pedicle and minimize donor defects. Anterolateral thigh free flap (ALTFF) and radial forearm free flap (RFFF) have been the workhorse flaps for head and neck reconstruction. However, ALTFF is too bulky and RFFF leaves a conspicuous scar on the donner site. Medial sural artery perforator free flap (MSAPFF) is a possible alternative, which has the benefit of thin RFFF and low donor site morbidity of ALTFF. Here, we evaluated for the first time the usefulness of MSAPF for head and neck reconstruction in Korean patients. Subjects and Method We carried out a retrospective study of patients who underwent MSAPFF for head and neck reconstruction from October 2018 to July 2019 by retrieving their data from electronic medical records. Patient characteristics, flap characteristics, surgical outcomes, and complications of donor sites were analyzed. Results Eight patients underwent MSAPFF reconstruction after head and neck surgery. The recipient sites were the following: the floor of the mouth, palate, tongue, the base of the tongue and nasolabial fold. The average median flap size was 34.1 cm2 (range 17.5-50 cm2), length 7.1 cm (5.0-10.0 cm), width 4.7 cm (range 3.5-5.0 cm), and pedicle length 9.2 cm (range 8-10 cm). There was one flap failure because of pedicle arterial insufficiency. All donor sites were closed primarily without any complication. Conclusion Based on the findings of this study, MSAPFF may be a new workhorse flap because it has thin, pliable tissue with low donor-site morbidity for head and neck reconstruction.

Salvage surgery with second free flap reconstruction for recurrent oral squamous cell carcinoma

PurposeThe purpose of this study was to evaluate the results of the reconstruction using the second free flap following resection of recurrent oral squamous cell carcinoma(OSCC). Patients and methodsA total of 25 patients from 2005 to 2018 who had undergone salvage surgery and reconstruction using the second free flap for recurrent OSCC were included in this study. Medical records were reviewed to obtain demographic data, stages of the primary cancer, region of recurrent OSCC, the period until recurrence, type of the second reconstruction flaps, recipient vessels, survival rate of the flaps and 2- and 5-year survival rates. ResultsThe patients were 13 males and 12 females. The average age was 64.1 years. Of the stages of primary cancer, stage IV patients accounted for the largest number with 13 patients (52.0%). The region of recurrent OSCC was the largest in the mandible with 13 patients, followed by 5 patients in the tongue and 4 patients in the buccal mucosa and maxilla. The mean time interval between the first and second reconstruction was about 34.1 months. Latissimus dorsi free flap and radial forearm free flap used in the second reconstruction were most frequently used in 11 patients (35.5%), followed by fibular composite free flap with 6 patients (19.4%). Facial artery in the recipient arteries of the second reconstruction was most frequently used with 13 cases (43.3%), followed by superior thyroid artery with 8 cases (26.7%) and lingual artery with 7 cases (23.3%). In the second free flap reconstruction, survival rate of the flaps was 96.8%. The 2- and 5-year survival rates in the patients were 70.0% and 62.5%, respectively. ConclusionThe study showed that the second free flap reconstruction with salvage surgery in resectable recurrent OSCC is a safe and reliable method with a high success rate of the flap and improvement of the 5-year survival rate.

Phalloplasty in biological men with penile insufficiency

Phalloplasty for penile insufficiency in biological men differs from trans-men by incorporating native tissue. The study objective was to report surgical and functional outcomes of phalloplasty in biological men. Phalloplasty was performed with a radial free forearm (RFFA) or pedicled anterolateral thigh (ALT) flap. The tube-within-tube technique was used for urethroplasty. Complications <30d postoperative were categorized according to Clavien-Dindo. 30 patients, median (IQR) age of 21 (18-30)y, were included. 17 patients (57%) had penile insufficiency due to exstrophy or hypospadias surgeries, 7 patients (23%) due to sexual development disorders. In 16 patients RFFA was used. 19 patients needed urethroplasty, the rest catheterized through stoma. Median follow-up was 33 (14-80)mo. Within 30d postoperative, 1 patients (3.3%) had Clavien-Dindo II and 6 patients (20%) Clavien-Dindo III complications. On long-term, 10 patients (33%) developed fistula, 6 needing urethroplasty. 7 patients (23%) had urethral strictures, all needing surgical intervention. All patients but one (98%) had erogenous sensitivity in the neo-phallus. All urethroplasty patients reported antegrade ejaculation. 16 patients (84%) voided through the urethra. 21 patients (70%) had an erectile device implanted. RFFA and ALT result in good erogenous sensitivity but fistulas and strictures are frequent.

PS-7-15 Novel Classification of Urethral Complications in Female to Male Gender Affirming Surgery

Penile reconstruction (phalloplasty) can ameliorate the psychological distress and suicide risk of transgender men. Surgery is challenging, and urethral complications occur in up to 75% of patients. The use of free flap microsurgical reconstruction with “tube-in-tube” urethra have improved outcomes but there is no accepted gold standard. Debate continues on immediate (during phalloplasty) compared to staged urethral join-up. A classification system was developed for urethral complications to improve reporting, classification and understanding of this common adverse outcome. All men undergoing phalloplasty in the United Kingdom over three consecutive years (2014 - 2016) were included. Data were extracted retrospectively from a prospective database following urethral construction by radial forearm free flap urethroplasty or radial forearm or anterolateral thigh (free or pedicled) flap phalloplasty with “tube-in-tube” urethra. Phalloplasty was staged: 1) construction of a phallus, 2) glansplasty and urethral lengthening (anastomosis of the phallic urethra to the native urethra) with or without hysterectomy, bilateral salpingo-oopherectomy and vaginectomy, 3) insertion of an erectile device and testicular prosthesis. The rate, timing and management of urethral complications were collated.

A Case of Secretory Carcinoma of the Soft Palate

Secretory carcinoma of salivary gland origin is a recently described tumor that harbors a characteristic ETV6-NTRK3 translocation that is identical to secretory carcinoma of the breast. The majority of tumors were located in the parotid gland and other major salivary glands, while the minority occurred in a minor salivary gland. We present a case of a 71-year-old female who was diagnosed with low-grade salivary gland cancer presenting in the soft palate accompanying lymph node metastasis. Peroral wide excision, selective neck dissection, reconstruction with radial forearm free flap was performed. The final pathology report indicated secretory carcinoma of the soft palate. The patient was followed-up without evidence of recurrence for one year. At present, it is difficult to accurately assess prognosis and treatment for the secretory carcinoma of the minor salivary gland origin. Continuous follow-up with various cases is needed further. Key Words: Secretory carcinoma, Salivary gland tumor, Minor salivary gland, Soft palate

Male Genital Reconstruction in the Exstrophy-Epispadias Complex

Adult males with exstrophy-epispadias complex (EEC) are commonly dissatisfied with their genitalia and desire greater sexual normality. These patients have typically had several previous genital/pelvic procedures and there are specific considerations that must be taken into account if operative intervention is being considered. Genital reconstruction in the form of phalloplasty presents an option for improving sexual function. The majority of studies have focused on the radial free forearm flap (RFFF) phalloplasty with subsequent insertion of penile prosthesis (PP). Long-term cosmetic and functional satisfaction is high. Early urethral complications are common and PP-related complications are higher than in other patient populations. Genital reconstruction is a safe procedure for EEC males with good long-term functional and cosmetic satisfaction. RFFF phalloplasty represents the most complete surgical option and should be considered in carefully selected patients.

Predicting length of stay in head and neck patients who undergo free flap reconstruction.

ObjectiveUnderstanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS.MethodsA retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS.ResultsA total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF—73.8%, anterolateral thigh flap—11.3%, and fibula free flap—14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in‐hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004).ConclusionSeveral perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution‐level protocols for postoperative care and disposition of free flap patients.Level of Evidence2b; retrospective cohort.

Microvascular nose reconstruction after extended tumor resection.

&lt;b&gt;Introduction:&lt;/b&gt; The nose is the central and probably the most important organ of the face. In view of the three-dimensional shape and variety of tissues, reconstructive surgery after tumor resection in this anatomical region requires the surgeon's knowledge of anatomy. &lt;br&gt;&lt;b&gt;Materials and Method:&lt;/b&gt; In the years 2010-2019, 48 patients were treated in the Oncological and Reconstructive Surgery Clinic for extended nasal tumors, which required the use of free microvascular flaps after resection for functional and aesthetic supply of anatomical structures of the nose. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; In 48 patients, a total of 92 free microvascular flaps were used for nasal reconstruction including: radial forearm free flap in 24 patients, radial forearm free flap with radial bone in 14 patients, auricular free flap in 16 patients, radial forearm free flap in combination with auricle free flap in 7 patients, double auricular free flap in 6 patients, radial forearm free flap in combination with double auricular free flap in 4 patients. Total necrosis of the free flap was noted in 4 cases, partial in 6 patients. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; The presented surgical techniques using microvascular free flaps constitute a recognized method of treatment and should be used in everyday surgeon practice. The results demonstrated in this article allow to obtain optimal functional and aesthetic effects.