Treatment Option For Reconstruction Research Articles

Lokalni nazolabijalni režanj u rekonstrukciji defekata dna usne šupljine

After an extensive tumor resection, a defect of the floor of the mouth is a significant reconstructive challenge. The main goal is to preserve the mobility of the tongue, which allows the restauration of mastication, deglutition, and articulation. Today, a standard method for reconstruction of floor of the mouth defects is free microvascular flaps, especially radial forearm free flap. Despite that, a potential problem is the high perioperative risk and high complication rate associated with the patient’s age and comorbidities. Current literature suggests that a local nasolabial flap is a reliable treatment option for reconstruction of this type of defect, with a low complication rate and excellent functional and aesthetic results. The aim of this case presentation is to show the use of a local nasolabial flap for reconstruction of the floor of the mouth and to determine the criteria for this type of reconstruction. We present a patient who underwent resection of a floor of the mouth tumor. Due to the patient’s age, medical condition, and comorbidities, the defect was reconstructed with a local nasolabial flap. There were no postoperative complications. Articulation, mastication, and deglutition were satisfactorily rehabilitated. Follow-up showed no signs of recurrent disease twelve months postoperatively. To conclude, a local nasolabial flap is still an important reconstructive choice for oral cavity defects, especially for elderly patients with multiple comorbidities who have a higher risk of perioperative complications.

Spontaneous Osteogenic Potential of Periosteum after Segmental Mandibulectomy in Patients with Medication-Related Osteonecrosis of the Jaw (MRONJ): A Retrospective Study of 14 Cases

Medication-related osteonecrosis of the jaw (MRONJ) has chiefly involved patients receiving medications for the treatment of bone-related malignancies. The surgical methods are now cautiously recommended as the treatment option for MRONJ. The purpose of this retrospective study was to report new bone formation and examine possible factors influencing spontaneous bony bridge formation by using an R-plate for reconstruction without any graft material after segmental mandibulectomy in patients with MRONJ. A cohort of 54 patients who underwent mandibulectomy between 2017 and 2022 by a single operator were included. Of them, 14 MRONJ patients (12 females and 2 males) were selected based on the inclusion criteria. Data on new bone formation, bony bridge formation, R-plate fracture, patient age, and type and duration of medication were collected. The mean age of the patients was 74.8 ± 9.3 years. All patients showed new bone formation, and 71.4% showed bony bridge formation within a year after surgery. The older the patient, the lower was the tendency for bony bridge formation in the defect (p = 0.035). Statistical analysis was performed using Fisher’s exact test. Preservation of the periosteum might be one of the most important contributing factors to new bone formation, serving as an optimal treatment option for reconstruction after segmental mandibulectomy in patients with MRONJ.

Outcome of Knee Reconstruction using Saphenous Artery-Based Fasciocutaneous Flap: A retrospective study

Background and Aim: The soft tissue defects around the knee are common and represents a challenge for surgeons due to its complexity and desired outcome. Many reconstructive treatment options are available and flaps are recommended. The current study aimed to evaluate the outcome of using saphenous artery (SA)-based flaps for the management of soft tissue defects around the knee.
 Methodology: Files of 34 patients treated by SA-based flaps were reviewed for outcome and complications. Collected data included patient demographics, etiology, size, site and side of the defect and outcome (flap survival and complications) at the end of the 6th postoperative month.
 Results: There were 26 males and 8 females. Their age ranged from 18 to 45 years; the mean age was 33.18±6.58 years. The commonest etiology was posttraumatic (64.7%) then post-burn contracture (20.6%). The majority of defects were on the right side (82.4%). The maximum length of the defect ranged between 14 and 20 cm (mean ± SD were 16.56±1.62) while the maximum width ranged between 6 and 10 cm (mean ±SD were 8.59±1.05). The flap survival rate was 97.1%. The overall complications rate was 14.7%, distal flap necrosis reported for 5.9%, wound dehiscence for 2.9% and seroma for 5.9%. All treated conservatively, except that of distal flap necrosis which need reintervention.
 Conclusion: The saphenous artery-based fasciocutaneous flap is an effective, feasible and safe option for the management of soft tissue defects around the knee.

Scapular Free Flap Reconstruction of Segmental Resections Involving the Maxillofacial Complex

Malignant and benign neoplasms of the maxillofacial complex that require segmental resections pose complex reconstructive challenges. Reconstructive treatment options are varied, but microvascular free flaps are favored, especially when the defect involves hard and soft tissues. The scapula free flap is a versatile microvascular free flap, but is less commonly utilized because of limited bone quantity and difficulty utilizing an in-tandem, two-team approach during surgery. An additional challenge exists when attempting to place endosteal implants into the scapula free flap for dental rehabilitation, due to limited quantity of bone.

Ten-year experience with cryopreserved vascular allografts in the Croatian Cardiovascular Tissue Bank.

The Croatian Cardiovascular Tissue Bank (CTB) was established in June 2011. Activities managed by CTB are processing of heart valves and blood vessels, as well as quality control, storage, medical release and distribution of allografts. The aim of this report is to present CTB's vascular tissue activities and retrospectively evaluate the outcomes of their use in the University Hospital Centre Zagreb. Between June 2011 and July 2021, 90 vascular allografts (VAs) from 55 donors after brain death were referred to CTB. Only 54% of VAs met the tissue quality requirements while 46% of tissues were discarded. The most frequent reasons for discard were unacceptable morphology and initial microbiological contamination. Altogether 42 VAs were released for transplantation and 37 of them were used in 27 surgical procedures. The most common indication for surgery was prosthetic graft or stent infection. According to the anatomic position of vascular reconstruction, patients were divided in the aortic and peripheral reconstruction group. A total of 23 patients were treated. In the aortic reconstruction group 58% of patients did not experience any graft-related complications. In the group of patients who underwent peripheral reconstruction significant incidence of reinfection was observed highlighting it as a major graft-related complication. Despite the small patient groups and limited duration of follow-up, presented clinical outcomes provide valuable information on the efficacy of vascular allografts. Additional clinical results collected on a larger patient groups and comparison to other reconstructive treatment options are necessary.

Immediate Mandibular Reconstruction Using a Cellular Bone Allograft Following Tumor Resection in a Pediatric Patient

Reconstruction of large segmental mandibular defects presents a challenge for oral and maxillofacial surgeons, particularly in the skeletally immature pediatric patient. Autogenous bone graft is historically preferred; however, harvest of autograft requires a second surgical site, risking donor-site complications as well as the potential for long-term complications in the growing child. Here, we present the first known report of a pediatric patient who underwent immediate mandibular reconstruction of a 6.5-cm long segmental defect using a cellular bone allograft (VF-CBA) combined with custom-fabricated guides and plates following tumor resection. The use of VF-CBA, along with the custom guides and plates, eliminated the need for autograft harvest in a child, enabled an entirely intraoral approach, avoiding the creation of a cutaneous scar, and reduced the total operative time, resulting in a fast recovery and improved patient satisfaction. By 7 months postoperative, the patient’s mandible was fully healed with solid osseous consolidation. These results support VF-CBA combined with custom intraoral guides and plates as an effective treatment option for reconstruction of large segmental mandibular defects in a pediatric patient.

Comparison of Converse Ω Anastomosis and Extracorporeal Anastomosis After Laparoscopic Distal Gastrectomy for Gastric Cancer.

Converse Ω anastomosis is a recently developed technique of delta-shaped anastomosis for intracorporeal gastroduodenostomy to simplify the anastomotic procedures and reduce their potential risks. This study aimed to evaluate the safety and effectiveness of converse Ω anastomosis, comparing it with conventional extracorporeal Billroth-I anastomosis after laparoscopic distal gastrectomy (LDG) for gastric cancer. Among 169 gastric cancer patients who underwent LDG with Billroth-I anastomosis anastomosis between April 2013 and March 2018, we selected 100 patients by propensity score matching (50 in the converse Ω anastomosis group and 50 in the extracorporeal anastomosis group). Patients' characteristics, intraoperative outcomes, postoperative complications, and survival time were compared between the 2 groups. Median anastomosis time was significantly longer in the converse Ω group than in the extracorporeal group (40.0 vs. 30.5 min, P=0.005). However, the total procedure time did not differ significantly between the groups. Intraoperative blood loss volume was significantly lower in the converse Ω group than in the extracorporeal anastomosis group (40 vs. 120 mL, P<0.001). There were no significant differences in the number of dissected lymph nodes, postoperative morbidity, mortality, or length of hospital stay. The postoperative body mass index and the prognostic nutritional index did not differ between the groups 1 year after surgery. There were no significant differences in overall survival and relapse-free survival between the 2 groups. Converse Ω anastomosis is feasible and safe. This novel technique can be adopted as a treatment option for reconstruction after LDG in patients with early-stage gastric cancer. Therefore, the risks and benefits of converse Ω anastomosis after LDG should be confirmed in larger cohorts.

The role of the reconstructive surgeon treating neuropathic pain after iatrogenic nerve lesions

The role of the reconstructive surgeon treating neuropathic pain after iatrogenic nerve lesions Abstract. Any surgical intervention bears the potential risk of iatrogenic nerve lesions with consecutive functional deficits and chronic neuropathic pain syndromes. These complications obviously result in patient dissatisfaction and frequently bear legal consequences. A broad experience in diagnosis and treatment of peripheral nerve lesions is needed to initiate the proper diagnostics and treatment modalities in an according time frame. The quick and appropriate response after any nerve trauma is an important criterion for success or failure of the reconstruction. Surgeons from other specialities, who do not deal with nerve lesions in their daily routine, need a distinct overview about diagnostics and treatment, to initiate the adequate therapy shortly after the injury. This review provides an overview of peripheral nerve lesions, the underlying pathomechanisms, the diagnosis and reconstructive treatment options. Even with highest accuracy and experience, nerve lesions are part of any surgical practice. However, we are convinced that with adequate and prompt action of the primary surgeon a good patient-doctor relationship may be maintained, often more favourable results may be achieved after reconstruction and legal trials avoided.

Defect coverage after severe soft tissue infections: when and how?

Severe infections frequently cause large soft tissue defects which require early defect coverage by plastic surgeons. Anumber of reconstructive treatment options are available, ranging from local flaps to microvascular free flap reconstructions. In this respect it is important that the selection of the optimal reconstructive technique is made based on individual patient characteristics and in a timely manner. Weeks of inpatient treatment with vacuum dressings often delay defect coverage and should be avoided as they burden both the patient and the healthcare system. Therefore, it is in the best interest of patients to receive early treatment by plastic surgeons. This manuscript presents the essential reconstructive treatment approaches based on highly informative case reports of patients from the plastic surgical practice at auniversity hospital.

Evaluation of Total Alloplastic Temporomandibular Joint Replacement in TMJ Ankylosis.

Total joint reconstruction using autologous or alloplastic materials is one of the treatment options for the reconstruction of the affected joint in TMJ ankylosis. The clinical results of alloplastic TM joint replacement (Biomet Microfixation system) that was carried out for the treatment and reconstruction of TMJ ankylosis have been summarised. A retrospective analysis of eight cases clinically and radiographically diagnosed as TMJ ankylosis with minimal facial asymmetry presenting beyond the growth period and willing for at least 12months of follow-up who have been taken up for gap arthroplasty and reconstruction using Biomet Microfixation TMJ replacement system was carried out. Follow-up of these patients was carried out at regular intervals and assessed on the following criteria: maximal interincisal mouth opening, TM joint pain on the affected side (on VAS), lateral mandibular excursions to the unaffected side deviation on mouth opening, occlusal discrepancy and neuromotor deficit of peripheral branches of facial nerve. The mean maximal interincisal mouth opening pre-surgery and 1year post-surgery was 2 and 31.8mm, respectively. The mean lateral excursive movement to the unaffected side was found to be 5.5mm with mean deviation on mouth opening to be 4.6mm. No pain, occlusal discrepancy or neurological deficit existed at the end of 1year. Biomet Microfixation system is a viable treatment option for reconstruction of TMJ in cases of ankylosis with no major complications.

Combined Anterolateral Thigh and Tensor Fasciae Latae Flaps: An Option for Reconstruction of Large Head and Neck Defects

The advent of microvascular free tissue transfer has provided the reconstructive surgeon with an enormous array of treatment options for reconstruction of large head and neck defects. However, when indicated by defect size, the need for more than 1 flap not only increases surgical complexity but also patient morbidity. The combination of the anterolateral thigh (ALT) flap and the tensor fascia latae (TFL) flap can be used to reconstruct such complex head and neck defects, thereby minimizing any additional morbidity that would be imposed by an additional flap harvest site. The present study reports on the use of the combined ALT-TFL flap to reconstruct large and complex head and neck defects. A retrospective chart review was conducted of all microvascular head and neck reconstructions performed by the Maxillofacial Tumor and Reconstructive Surgery Service at the University of Miami/Jackson Health System (Miami, FL) from 2013 through 2016. Inclusion criteria for the study were head and neck defects at least 20m × 10cm and reconstruction with soft tissue flaps using perforating vasculature to the TFL and ALT vascular territories. Other study data included disease history, location of defect, flap size, recipient vessels, harvest time, ischemia time, surgical complications, and overall flap survival. Seven patients met the inclusion criteria. Five patients were treated for the diagnosis of stage III osteoradionecrosis and 2 patients underwent reconstruction in conjunction with ablative surgery for head and neck carcinoma. All 7 patients underwent successful head and neck reconstructions using the ALT-TFL flap. There was no partial or total flap failure. One patient had a wound healing complication at the donor site that did not require surgical intervention. Reconstruction of a large head and neck soft tissue defect with a combined ALT-TFL flap is a reliable method with minimal donor site morbidity and no major postoperative complications. This combined flap should be considered when the defect size extends beyond the bounds allowed by the ALT flap alone.

Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common.

Primary bone or soft tissue tumors of the femur sometimes present with severe and extensive bone destruction, leaving few limb-salvage options other than total femur replacement. However, there are few data available regarding total femur replacement and, in particular, regarding implant failures. We asked: (1) What are the revision-free and overall implant survival rates of conventional total femur replacements in patients treated for sarcoma of the femur or soft tissues? (2) What are the revision-free and overall implant survival rates of expandable total femur replacements in skeletally immature patients? (3) Using the comprehensive International Society of Limb Salvage failure-mode classification, what types of complications occur with conventional and expandable total femur replacements? Our retrospective, single-center cohort study was based on data prospectively collected for 50 patients who received a total femur replacement after tumor resection for indications other than carcinoma or metastatic disease. Of the 50 patients, six (12%) were lost to followup before 6months. Ten of the remaining 44 patients received expandable implants. The mean followup was 57months (range, 1-280months) and 172months (range, 43-289months) for patients who underwent conventional and expandable total femur replacements, respectively. For implant survival, competing risk analyses were used. At 5years, revision-free implant survival of conventional total femur replacements was 48% (95% CI, 0.37-0.73), and overall implant survival was 97% (95% CI, 0.004-0.20). Five-year revision-free implant survival of expandable total femur replacements was 30% (95% CI, 0.47-1.00) and overall implant survival was 100%. With conventional total femur replacements soft tissue failures occurred in 13 of 34 patients, structural failures in three, infection in six, and local tumor progression in one. No patient had aseptic loosening with conventional total femur replacements, but hip disarticulation occurred in two patients owing to extensive wound-healing problems and infection. With expandable total femur replacements soft tissue failure, aseptic loosening, and infection occurred in one patient each of 10, and structural failures in three of 10 (two periprosthetic fractures, one loosening of an enhanced tendon anchor). No hip disarticulations were performed. Additionally expandable total femur replacement-related failures included hip instability in eight of 10 patients, contractures attributable to massive scar tissue in six, and defect of the implant's expansion mechanism in four patients. Although the indications for total femoral resection are rare, we think that total femur replacement is a reasonable treatment option for reconstruction of massive femoral bone defects after tumor resection in adults and skeletally immature patients, and results in limb salvage in most patients. Level IV, therapeutic study.

Posterolateral reconstruction of the knee using capsular procedures for evaluation and treatment of posterolateral instability of the knee.

Posterolateral rotatory instability of the knee causes significant morbidity if unrecognized and left untreated. With both acute and chronic injuries, restoration of the normal anatomy is crucial for a good outcome. During capsular repairs, detailed knowledge of the anatomy will help the surgeon repair the pathoanatomy. To complement the direct approach, an osteotomy of the lateral femoral condyle that includes the attachments of the fibular collateral ligament and popliteal tendon allows superior visualization of the lateral meniscus and its attachments, as well as the associated deep structures. The osteotomy also permits placement of posterior capsular sutures that allow the capsular shift to tighten the injured structures. Fine-tuning the tension of these structures may be accomplished by slightly adjusting the position of the bone block as it is reattached without significantly affecting isometry. The osteotomy is not required for all reconstructions; however, it provides excellent access to the deep structures of the posterolateral corner. The capsular shift can complement the direct repair of structures and may be done as an isolated or staged procedure or in combination with other reconstructive treatment options.

Osteogenic Matrix Cell Sheets Facilitate Osteogenesis in Irradiated Rat Bone.

Reconstruction of large bone defects after resection of malignant musculoskeletal tumors is a significant challenge in orthopedic surgery. Extracorporeal autogenous irradiated bone grafting is a treatment option for bone reconstruction. However, nonunion often occurs because the osteogenic capacity is lost by irradiation. In the present study, we established an autogenous irradiated bone graft model in the rat femur to assess whether osteogenic matrix cell sheets improve osteogenesis of the irradiated bone. Osteogenic matrix cell sheets were prepared from bone marrow-derived stromal cells and co-transplanted with irradiated bone. X-ray images at 4 weeks after transplantation showed bridging callus formation around the irradiated bone. Micro-computed tomography images at 12 weeks postoperatively showed abundant callus formation in the whole circumference of the irradiated bone. Histology showed bone union between the irradiated bone and host femur. Mechanical testing showed that the failure force at the irradiated bone site was significantly higher than in the control group. Our study indicates that osteogenic matrix cell sheet transplantation might be a powerful method to facilitate osteogenesis in irradiated bones, which may become a treatment option for reconstruction of bone defects after resection of malignant musculoskeletal tumors.

Vascularized treatment options for reconstruction of the ascending mandible with introduction of the femoral medial epicondyle free flap.

Reconstruction of the ascending portion of the mandible, including the angle, ramus, and condyle, can be a challenging surgical problem. Many treatment options are available, but no single procedure has been able to restore long-term form and function in every case. Currently, autologous nonvascularized bone grafts are the most common treatment, with the costochondral graft as the historic leader. Nonvascularized grafts can often restore vertical height and normal function but may face the challenge of long-term durability secondary to bone resorption. Emerging techniques in microvascular surgery may offer an alternative approach with the benefits of resistance to resorption and infection by maintaining a viable blood supply to the graft. Vascularized grafts may thus be used to full advantage in cases where prior surgery, scarring, disrupted vasculature, or radiation damage may compromise the long-term surgical success of a nonvascularized graft. This article reviews the literature and summarizes key points regarding nonvascularized and vascularized treatment modalities for reconstruction of the ascending mandible. In addition, we present the use of the femoral medial epicondyle free flap based on the descending genicular vascular pedicle as a novel reconstruction of the ascending portion of the mandible with minimal donor-site morbidity. Knowledge of all available options will aid the surgeon in achieving the optimal reconstruction for their patient and improve long-term outcomes.

Reconstruction of the Oropharynx With Free Posterior Tibial Flap After Tonsillar Cancer Extirpation

Oropharyngeal reconstruction after tonsillar tumor resection is a great challenge for head and neck surgeons. The aim of the present study was to explore the reconstruction efficacy of the free posterior tibial flap in the primary reconstruction of oropharynx defects after tonsillar squamous cell carcinoma (SCC) ablation. From August 2009 to March 2012, 12 patients with tonsillar SCC underwent oropharynx reconstruction with a free posterior tibial flap at the Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University. Their clinical and surgical data were retrospectively collected and analyzed. Of the 12 patients, 8 were male and 4 were female (age range 41 to 66 years, mean 55.1). The average size of the free posterior tibial flap was 9.2 × 6.3 cm (range 7 × 5 to 12 × 7), the average flap thickness was 1.1 cm (range 0.9 to 1.3), and the average pedicle length was 10 cm (range 7 to 12). Despite the multistep and time-consuming procedure, all patients tolerated oropharynx reconstruction with the free posterior tibial flap. The transferred free posterior tibial flaps survived well. No donor site complications were observed during the follow-up period. All 12 patients acquired satisfactory swallowing and speech function preservation. Satisfactory reconstruction results were achieved for all 12 patients, indicating the free posterior tibial flap should be considered a potential treatment option for reconstruction of oropharynx defects. However, additional prospective studies with a larger sample size are required to validate our results.

Management of Neglected Periorbital Squamous Cell Carcinoma Requiring Orbital Exenteration

With its perineural invasion capacity, periorbital squamous cell carcinoma (SCC) may easily invade orbital structures. When SCC invades the orbital musculature or the orbit itself, orbital exenteration, one of the most disfiguring operations on the face, is required. We reviewed elderly patients with periorbitally localized SCC requiring orbital exenteration to evaluate reconstructive options and survival. A chart review of patients' records was conducted to identify all patients older than 65 years with periorbital malignancy requiring orbital exenteration from 2006 to 2011. A total of 9 patients who met the criteria were included in the study. The mean age at surgery was 77 ± 6.7 years, and the mean defect size was 74.2 cm2. All patients had a similar history of late presentation to a doctor because of hesitation to undergo surgery. The temporoparietal fascia flap, galeal flap, free gracilis flap, and free vastus lateralis musculocutaneous flap were the treatment options for reconstruction of the defects. All patients died during follow-up, and the mean survival was 15.7 months (range, 6-36 months). Only 2 of them had relapse before the death. Our small series suggest that elderly patients with periorbital SCC requiring orbital exenteration may not have enough survival to relapse because of the death from different causes without relapse or any sign of spreading cancer. Also, prolonged surgery with free flap reconstruction may increase the risk of postoperative intensive care unit requirement. Because local flaps may work very well for reconstructing the orbital exenteration defects, free flap option should be kept for selected cases.

Early bone resorption of free microvascular reanastomized bone grafts for mandibular reconstruction – A comparison of iliac crest and fibula grafts

ObjectivesPatients with continuous bone defects of the mandible after ablative tumor surgery need bony reconstruction for proper function and aesthetics. Free microvascular reanastomized bone grafts provide a clinically proven option for such patients, yet the optimal source of donor tissue has not yet been established. The aim of this study was to evaluate and compare the bone volume stability of vascularized bone grafts, particularly in the early highly resorptive phase, from the iliac crest (DCIA) and the fibula and to assess the implantologic rehabilitations. Materials and methodsThirty-six patients with mandibular continuity defects due to tumor resection were reconstructed by the use of vascularized bone grafts; 21 patients received DCIA flaps and 15 patients received a composite free fibular flap, depending on the size and location of the defect. Bone resorption was assessed using digital panographs. Radiographs were taken immediately after bone reconstruction, 6 months postoperatively, prior to implant surgery, and at prosthetic loading. ResultsAfter a mean observation period of 6 months, vertical bone resorption was 6.79% for the patients of the iliac crest group (DCIA), 10.20% after 11 months, and 12.58% after 17 months. Fibular grafts showed a bone resorption of 5.30% after a mean observation time of 6 months, 8.26% after 11 months, and 16.95% after 17 months. Eighteen patients received 71 implants for implant-retained dental reconstructions. ConclusionsMicrovascular reanastomized bone grafts represent a reliable treatment option for reconstruction in cases of large defects of the mandible, with low graft resorption in the early healing phase. Additionally, the compared grafts provide sufficient bone volume to permit implant rehabilitation.

Versatility of Supraclavicular Artery Island Flap in Head and Neck Reconstruction of Vessel-Depleted and Difficult Necks

The advent of microvascular free tissue transfer has given reconstructive surgeons a vast repertoire of treatment options for reconstruction of head and neck defects. However, the success of free flaps in head and neck reconstruction depends on the presence and quality of the recipient vessels in the neck for microvascular anastomosis. The supraclavicular artery island flap can be used to reconstruct a variety of head and neck defects, allowing the reconstructive surgeons to circumvent some of the problems inherent in vessel-depleted necks. The present study reports the use of the supraclavicular artery flap (SCAF) in the reconstruction of vessel-depleted neck and in difficult necks. The present study was a retrospective study of patients who had undergone reconstruction with an SCAF and who also had a difficult neck or vessel-depleted neck in the head and neck surgery section from 2011 to 2012. Our inclusion criteria were patients treated at our institution with an SCAF who also had undergone multiple previous neck surgeries or patients with severely restricted donor options for soft tissue reconstruction. We excluded any patient for whom we did not have adequate follow-up or if the flap procedure was not performed by the faculty of the head and neck section. We identified 8 patients with a total of 9 SCAFs. One patient received bilateral SCAFs. Of the 8 patients, 6 were men and 2 were women. With the exception of 1 patient, all had received previous radiotherapy to the head and neck region. All the patients had undergone multiple surgical procedures. The flap survival was 100%. However, 2 patients had partial loss of the flap, and 2 had partial donor site wound dehiscence. Our overall complication rate was 38%, including dehiscence of the flap and partial loss of the flap. The SCAF is a sound option for reconstructing defects in the head and neck region in patients with previous radiotherapy and in multiple neck surgeries. The surgeon and patient should be aware of the high incidence of complications associated with this reconstructive option.

Longitudinal radioulnar dissociation.

Proximal translation of the radius is a complication of radial head fractures that occurs in association with disruption of the longitudinal soft-tissue stabilizers of the forearm. The sequelae of this process include debilitating wrist and elbow pain secondary to ulnocarpal and radiocapitellar abutment as well as loss of grip strength. When radioulnar dissociation is recognized early, treatment involves prevention of proximal radial migration by preservation of the radial head and stabilization of the distal radioulnar joint. When primary bony repair of the radial head is not feasible, prosthetic replacement of the radial head is necessary to prevent proximal radial migration. Management is complex in chronic cases in which longitudinal radioulnar dissociation is diagnosed after radial migration has occurred. Treatment goals include normalization of the radioulnar relationship and prevention of further migration. Although several reconstructive treatment options are available, no clear solutions exist, and long-term prognosis is guarded. Therefore, early recognition of longitudinal forearm instability is critically important.