Reliable Flap Research Articles

An Optimal Scalp Rotation Flap Design: Mathematical and Bio-Mechanical Analysis

The design and implementation of successful rotational flaps of the scalp remains a complex process. There are several described techniques, all of which are based on a two-dimension surface, absent consideration of the convexity and thereby three-dimensional nature of the scalp. This has contributed to flaps that are either too small or unnecessarily large in a bid to compensate.Mathematical analysis using trigonometric and algebraic formulae were used to derive the relationship between the defect, triangulation, the contour of the scalp, the radius of the arc of rotation for the flap and scalp skin tension. Polyurethane models were used to test the applicability of the resultant formula, and a consecutive clinical case series is presented.Rotation flap dimensions were calculated using an apex angle of 30 degrees depicted as a two-dimensional construct. The contour of the defect was then measured as the depth of depression with radius of the rotation flap calculated based on the changes in flap surface area across the defect. Finite Element Analysis was utilised to measure redistribution of tension along the flap reconstructing the defect, and the efficacy of the approach confirmed in the consecutive clinical series. The current study provides a reliable flap design based on mathematical analysis, with evidence-based application to the clinical setting.

Reliability of Chest Wall Perforator Flaps for Breast Reshaping following Massive Weight Loss

Abstract Background Breast deformity following massive weight loss poses a unique challenge inadequately managed by traditional methods. Patients also have considerable lateral and posterior upper trunk tissue surplus. Multiple studies have used chest wall flaps for auto-augmentation with mastopexy to tackle this problem. However, the outcome measures did not include any objective tools to assess the reliability of these flaps. Hence, in this study sono-mammography and breast anthropometric measurements are used for evaluation of the added volume and long-term sustainability of chest wall perforator flaps. Methodology Twenty massive weight loss patients with Pittsburgh Rating Scale score 2-3 underwent mastopexy with autologous augmentation through perforator flaps encompassing lateral chest wall skin. Outcome measures were breast volume, and the presence of fat necrosis on mammography, and direct breast anthropometry. Conclusion All patients showed a consistent increase in volume postoperatively and no fat necrosis in postoperative mammography, reflecting flap reliability over one year of follow-up. All postoperative anthropometric measurements showed improvement in the breast deformities addressed. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Martius Labial Fat Pad Use in the Treatment of Complications Associated With Prior Surgery for Urinary Incontinence or Pelvic Organ Prolapse

ObjectiveTo evaluate the outcomes of Martius Labial Fat Pad (MLFP) in the treatment of complications related to surgery for urinary incontinence (UI) and/or pelvic organ prolapse (POP) and to assess the influence of mesh presence. MethodsFollowing institutional review board approval (n° STU 2023 1280), a review of all women who underwent a MLFP procedure at our tertiary center after UI and/or POP repair was performed by an independent investigator. The primary outcome was the rate of post-operative complications classified according to the Clavien-Dindo classification. Secondary outcomes were based on indications and functional results. A subgroup analysis was performed according to the type of prior repair: mesh or native tissue repair. ResultsFrom 2006-2022, 26 patients underwent a MLFP procedure, with a median follow-up duration of 30 (12-67.5) months. Bladder outlet obstruction and fistulae were the two most frequent indications. Post-operative complications occurred in 15 patients (58%): grade I in 6 (43%), grade 2 in 3 (21%), grade 3b in 4 (29%) and grade 4b in 1 (7%). Four of the grade ≥ 3 complications occurred in the mesh group. Median operative time was longer in the mesh group: 200 minutes (177.5-229.5) versus 146 minutes (128-190) (p=0.03) and the success rate was lower: 61% versus 85% (p=0.06). Overall, surgery was successful in 19 patients (73.8%). ConclusionMFLP is a reliable flap in specialized indications after UI and/or POP repair procedures with a higher risk of major complications and a lower success rate in women previously operated with mesh.

McGregor Flap for coverage hand defect: Report case

The McGregor flap, a pedicled inguinal flap, is highly effective in addressing hand and forearm soft tissue defects. Despite its two-stage surgical requirement, it remains a preferred option in hand surgery due to its reliability. This study aims to evaluate its advantages and disadvantages through a case study of a 62-year-old woman with upper limb injuries from a road accident. The surgical technique involves careful dissection of the flap, preserving key structures like the superficial circumflex iliac artery. Postoperative management includes mobilization exercises. The flap's reliability, minimal donor site sequelae, and low complication rates make it a valuable option, especially for surgeons less experienced in microsurgery.

The reliability and versatility of Facial Artery Perforator-Based Nasolabial Flaps in the Reconstruction of Lip Defects

The reliability and versatility of Facial Artery Perforator-Based Nasolabial Flaps in the Reconstruction of Lip Defects

High Above Knee Amputations for Femoral Osteosarcomas Treated with Free Microsurgical Tibial Reconstruction in the Pediatric Population.

Improvements in the management of pediatric sarcoma including imaging, neo- and adjuvant therapy, and surgical technique has enhanced long-term survival of patients. Pediatric patients diagnosed with a femoral osteosarcoma undergoing oncologic resection who are ineligible for limb preservation reconstruction or rotationplasty are offered an above knee amputation (AKA). Limb amputations in the skeletally immature patient poses particular problems specific to endosteal bone overgrowth and spiking. Approximately half of these patients undergo revision of their amputation site. Furthermore, a high AKA often requires a hip-based prosthesis, which can be uncomfortable leading to poorer outcomes and higher energy expenditures.We have completed four 'spare parts' microvascular free tibial transfers for pediatric patients diagnosed with femoral osteosarcoma who were treated with an AKA. Two of these patients are currently ambulatory with their prosthetic and have not required long-term revision of their amputation site. One patient demonstrated radiographic evidence of bony union four months post-operatively, but subsequently succumbed to chemotherapy-resistant metastases. The fourth patient is in the process of prosthetic fitting and rehabilitation.This is a novel technique and the first series describing both proximal and distal free microvascular tibial bone transfers as a reconstructive option for pediatric patients with femoral osteosarcomas. It is a reliable flap with possible variations in vascular anatomy. Furthermore, it offers multiple benefits including the prevention of bony spiking, AKA stump augmentation, and facilitation of appropriate prosthetic fitting improving functional outcomes and decreased energy expenditure. However, the soft tissue coverage must be well planned.

Distribution of Perigastric Station 4d Lymph Nodes in Vascularized Gastroepiploic Lymph Node Transfer: An Anatomic Study and Case Series.

Vascularized gastroepiploic lymph node transfer (VGLNT) is a well-accepted surgical treatment for restoring physiological function in chronic lymphedema. However, the inclusion of substantial lymph nodes (LNs) in the flap remains uncertain. This study aimed to identify the anatomical basis for reliable flap harvest for VGLNT. The anatomy of perigastric station 4d LNs was studied in healthy cadavers (n=15) and patients with early gastric cancer (EGC) (n=27). The omentum was divided into three segments: proximal, middle, and distal from the origin of the right gastroepiploic vessels. The flap dimension, number, location, size of LNs, and caliber of the vessels were reviewed. Eight patients underwent VGLNT for upper/lower limb lymphedema. The mean numbers of LNs in the proximal, middle, and distal segment were 2.5, 1.4, 0.5 in the cadavers, and 4.9, 2.7, 0.7 in the gastrectomy specimens, respectively. The proximal third included a significantly greater number of LNs than the distal third in the cadaveric (p=0.024) and ECG (p=0.016) specimens. A total of 95% of the LNs were located within proximal two-thirds of the flap from the vessel origin both in the cadavers (21.0×5.0cm) and in the gastrectomy specimens (20×3.5cm). In VGLNT, the transferred flap was 25.5±6.9×4.1 + 0.7cm in dimension, containing a mean number of 6.5±1.9 LNs. At postoperative 6months, the volumetric difference was significantly reduced by 22.8±9.2% (p<0.001). This study provides a distinct distribution pattern of station 4d LNs. Inclusion of the proximal two-thirds of the flap, which carries majority of the LNs, is recommended for VGLNT.

Application of tensor fascia lata perforator flap in head and neck reconstruction

The aim of this study was to describe the authors’ experience in head and neck reconstruction with the tensor fascia lata perforator flap (TFLPF). Between April 2009 and August 2020, 16 patients underwent head and neck reconstruction with a TFLPF. The flaps were designed in a vertical or transverse fashion based on perforators traveling along the medial or lateral aspect of the posterior edge of the tensor fascia lata muscle. Clinical details and postoperative results were recorded and analyzed. The size of the flap ranged from 7 × 5 cm2 to 25 × 9 cm2. The perforators were mostly septocutaneous (11 patients), allowing a simple and straightforward dissection of the perforator and TFLPF in most patients. There were either one or two perforators in all cases. The overall flap survival rate was 100%. All of the flaps healed uneventfully with no delayed wound healing or donor site dysfunction. Follow-up ranged from 18 to 120 months, during which all patients experienced satisfactory functional and aesthetic results, without serious complications at either the recipient or donor site. The TFLPF is a pliable and reliable flap that could be a first choice in selected head and neck reconstruction cases.

Efficacy of Bi-lobed Second Dorsal Metacarpal Artery Flap in Pediatric Electric Hand Burns

Background: Bi-lobed second dorsal metacarpal artery (SDMA) flap is a viable option for the reconstruction over electrical burns of hand in the pediatric patients. The purpose of this study is to evaluate of the success rate and donor site range of motion after SDMA flap. Methods: A prospective observational cohort study was undertaken in all patients who underwent reconstruction with SDMA flap at institution from March 2016 to March 2018. Data was collected regarding flap success rate and active motion arcs of metacarpophalangeal joint (MCPJ) and proximal interphalangeal joints (PIPJ) of donor area. Results: Among 32 patients, survival rate of flap is 96.87 percent (n=31) with only partial loss of 3.12 percent (n=1). At mean follow up of 12 months, donor finger movements at MCPJ and PIPJ were almost similar to that on opposite side. Conclusion: Second dorsal metacarpal artery flap is useful and reliable flap in complex reconstruction of burn hands in pediatric group in terms of survival and range of motion. Key words: Second dorsal metacarpal artery flap, Metacarpophalangeal joint, Hand burn, Pediatric

Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest.

The purpose of this study was to evaluate the role of body mass index (BMI) in predicting postoperative complications following myocutaneous free flap transfer. In addition, we sought to identify certain body composition variables that may be used to stratify patients into low- versus high-risk for gracilis myocutaneous free flap with skin paddle failure. Using the National Surgical Quality Improvement Program database, we collected data for all patients who underwent myocutaneous free flap transfer from 2015 to 2021. Demographic data, medical history, surgical characteristics, and postoperative outcomes, including complications, reoperations, and readmissions, were collected. Body mass index was correlated with outcome measures to determine its role in predicting myocutaneous free flap reliability. Subsequently, we retrospectively obtained measurements of perigracilis anatomy in patients who underwent computed tomography angiography bilateral lower extremity scans with intravenous contrast at our institution. We compared body composition data with mathematical equations calculating the potential area along the skin of the thigh within which the gracilis perforator may be found. Across the United States, 1549 patients underwent myocutaneous free flap transfer over the 7-year study period. Being in obesity class III (BMI ≥40 kg/m2) was associated with a 4-times greater risk of flap complications necessitating a return to the operating room compared with being within the normal BMI range. In our computed tomography angiography analysis, average perigracilis adipose thickness was 18.3 ± 8.0 mm. Adipose thickness had a strong, positive exponential relationship with the area of skin within which the perforator may be found. In our study, higher BMI was associated with decreased myocutaneous free flap reliability. Specifically, inner thigh adipose thickness can be used to estimate the area along the skin within which the gracilis perforator may be found. This variable, along with BMI, can be used to identify patients who are considered high-risk for flap failure and who may benefit from additional postoperative monitoring, such as the use of a color flow Doppler probe and more frequent and prolonged skin paddle monitoring.

The Islanded Nasolabial Flap: A Versatile and Reliable Flap for Reconstruction in Cancers of the Oral Cavity

On the Indian subcontinent, oral cancer represents a significant health burden. Local flaps offer a viable alternative to free flaps in specific reconstructive scenarios where free flaps may not be feasible. The islanded nasolabial flap, based on the facial artery, proves to be a robust and versatile option for single-stage reconstructions of oral cavity defects. In this study, we share our experience employing the islanded nasolabial flap at a high-volume cancer center in Central India for reconstructing buccal mucosa and tongue defects. This prospective observational study focused on approximately 76 patients diagnosed with squamous cell carcinoma of the oral cavity (specifically, the anterior 2/3rd of the tongue and buccal mucosa) at our cancer hospital between August 2021 and January 2023. Initially, 76 patients were included; however, four patients were subsequently excluded due to inadvertent facial vein injury during neck dissection caused by level IB node invasion. Consequently, 72 patients underwent islanded nasolabial flap reconstruction and were monitored for postoperative complications and functional outcomes. Our study's patients fell within the age range of 24 to 81 years, with the majority between 40 and 50 years old. Most of our patients had carcinoma affecting the anterior two-thirds of the tongue (61.11%), followed by carcinoma of the buccal mucosa (38.88%). Surgical site infection occurred in four patients (5.55%) at the donor site, and one patient (1.38%) experienced flap necrosis after tongue carcinoma surgery. However, the majority of our patients (93.05%) experienced no postoperative complications. Speech intelligibility was good for all patients (100%) with buccal mucosa cancer. A significant portion of patients (78.57%) could tolerate a normal diet, while 21.42% required a soft diet. Among patients with tongue carcinoma, 56.81% had good speech intelligibility, and 43.18% had acceptable speech intelligibility. Regarding swallowing capacity assessment, 65.90% of patients tolerated a normal diet, and 34.09% could manage a soft diet. None of our patients had poor speech intelligibility, and none depended on a liquid diet or tube feeding. This study underscores the versatility of the islanded nasolabial flap in oral cancer resection reconstruction. The islanded nasolabial flap proves to be a straightforward, effective, and reliable technique with a low incidence of complications and exceptional functional outcomes, establishing it as a valuable reconstructive option for small-to-medium-sized oral defects. This is particularly noteworthy for high-volume centers and regions with limited resources.

A PROSPECTIVE COHORT STUDY OF REVERSE PERONEAL ARTERY FLAP FOR LARGE SOFT TISSUE DEFECTS OF THE FOOT IN GMKMCH, SALEM : A RELIABLE COVERAGE

Background: Islanded Reverse Peroneal Artery Flap (RPAF) can be designed as a large regional flap from the popliteal crease. It can be used in single stage. It is based on the anastomosis around ankle joint from posterior and anterior tibial arteries based on the reverse flow to the peroneal artery. It can be used in peripheral centers where microsurgical options not feasible. Methods: Twenty patients with large plantar and dorsal defects of the foot operated for Reverse Peroneal Artery Flap for soft tissue reconstruction over a period of 2 years. All patients were operated in a single stage. Mean age of the patients was 38 years. Results: Of the 20 flaps , all patients showed complete survival without even marginal necrosis. Two patients developed donor site problems settled with conservative management. Conclusion: Reverse peroneal artery flap is a very reliable flap in soft tissue reconstruction of the large defects of the dorsal and plantar aspects of the foot upto base of the toes. Reverse peroneal artery flap needs meticulous dissection of the peroneal artery from the fibula.

Bipaddle Pectoralis Major Myocutaneous Flap (PMMC) for Complex Composite Oral Cavity Defects: An Experience of a Tertiary Cancer Centre.

Although microvascular free flaps are considered the first choice in head and neck cancer defect reconstruction, their use is limited in developing regions by availability of resources and the expertise .The Bipaddle pectoralis major myocutaneous flap (PMMC flap) is a commonly used flap in head and neck cancer reconstruction, but in literature flap is associated with high incidence of drawbacks including donor site morbidity and added bulk of the flap reducing cosmetics and function. The purpose of the study is to evaluate the Bipaddle PMMC flap reliability, operative technique and outcome in reconstructive head and neck cancer surgery in the era of microvascular free flaps. Its a prospective study in which the records of 50 patients treated with Bippadle PMMC flap reconstruction between January 2022 to July 2022 were systematically collected and reviewed. Data of recipient site, serum albumin, history of adjuvant, recurrence, defect dimension, type of donor site closure, length of hospital stay, postoperative complications and outcomes were analysed. There were 45 males and 5 females with a mean age of 41 years (31-60). Bipaddle PMMC flap reconstruction was done in all patients of advanced squamous cell carcinoma of oral cavity. There were two males with complete necrosis of flap salvaged with latissimus dorsi flap and forehead flap. Minor infections were noted in two female and one male patient, managed conservatively and recovered well with acceptable final outcome. The Bipaddle PMMC flap is reliable for large defects in head and neck reconstructive surgery, particularly when a bulky flap is required to reconstruct composite defects where the lesion is involving the skin. Placing the flap horizontally with inclusion of nipple and areola in most of the patients increased the reach and size of available flap.

Study of options and procedures in reconstruction of post mastectomy breast defects in a regional cancer centre

Background: Post mastectomy autologous breast reconstruction is challenging and involves restoring the patients lost structure and prepping the patient for adjuvant therapy and also psychosocial benefits that comes with early breast reconstruction. We analysed latissimus dorsi flap, transverse rectus abdomenis flap, deep inferior epigastric perforator flap and thoracoabdominal flap. Aim was to reconstruct post mastectomy defect using various methods, to enable the patient to receive early adjuvant therapy. Objectives were to study the various procedures used for post mastectomy defect autologous breast reconstruction. To evaluate the reliability of various flaps used. To evaluate the complications of flaps and their management. To assess the advantages and disadvantages of each flap. Methods: 42 post mastectomy defect patients reconstructed with 4 flaps over 24 months, included in the study and results analysed. Results: In 42 cases, latissimus dorsi flap was done in 11 cases, transverse rectus abdominis flap was done in 6 cases, deep inferior epigastric perforator flap was done in 3 cases and thoracoabdominal flap was done in 22 cases. Total flap loss in 1 case and partial flap loss in 6 cases was seen. Conclusions: Immediate autologous breast reconstruction is helpful in making the patient ready for upcoming adjuvant therapy along with psychosocial benefits. We have analysed 4 different types of flaps and compared their advantages and disadvantages. We found that thoracoabdominal flap is a good option of immediate coverage in low socioeconomic class patients and ones with terminal disease.

Critical Evaluation of Lateral Calcaneal Artery Fascio-Cutaneous Flap in Re-Surfacing Posterior Heel Defects: A Review of 24 Cases.

To assess feasibility and functional acceptability of lateral calcaneal artery fascio-cutaneous flap (LCAFCF) in providing cover to posterior heel defects in single stage. To provide stable and sensate cover to small and moderate posterior heel defects. This review was conducted in department of Burns & Plastic Surgery of Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana between October 2021 and September 2022 to analyse the clinical outcome of LCAFCF in 24 patients (18 males, 6 females) aged between 20 and 35years who had chronic dry wounds n = 9, failed primary reconstruction by reverse sural flap n = 1, granulated wounds n = 8, exposed achilles tendons n = 4 and scarred tissue restricting ankle joint movements n = 2 in region of posterior heel following trauma, while riding motor-cycle. Course of lateral calcaneal artery was marked with hand-held doppler. Flap size ranged from 3 to 3.5cm in width and 5.5-7.5cm length. The donor sites were split skin grafted. Sutures were removed on 22nd day of surgery. Mean follow up was 13months. All flaps survived. Two had partial loss of skin graft and two developed hyperkeratosis on grafted site. Sensations in flap, regain of movements of ankle joint, comfort of walking and driving were acceptable. LCAFCF is handy, safe and reliable flap for re-surfacing difficult wounds of posterior heel, therefore should be included in surgical armamentarium.

The contralateral-based submental artery island flap: feasibility and oncological safety in oral cancer–related defect reconstruction

ObjectivesOncologic risk is a serious concern of submental artery island flaps. Here, we introduce the contralateral-based submental artery island flap (C-SAIF) and demonstrate its feasibility and long-term oncological safety in reconstructing oral cancer–related defects.MethodsAn anatomical study was performed concentrating on the pedicle length in seven cadavers. Then, a retrospective study was carried out on C-SAIF patients operated on by a single team. The standard surgical technique of C-SAIF was conducted. Outcomes including operative time, length of hospital stay, volume of intraoperative blood loss, and scores of the Multidisciplinary Salivary Gland Society (MSGS) questionnaire were compared with a similar cohort reconstructed with anterolateral thigh free flap (ALTF). In addition, oncological outcomes were evaluated by the 5-year cumulative survival rate between C-SAIF and ALTF patients.ResultsThe pedicle length of C-SAIF was sufficient for the flap to be extended to the contralateral oral cavity. Fifty-two patients were included in the retrospective study, and nineteen of them underwent reconstruction with C-SAIF. The operative time of C-SAIF was shorter (p = 0.003), and the intraoperative blood loss was less (p = 0.004) than that of ALTF. There was no difference in MSGS scores. The results of survival analysis revealed comparable survival curves for the two groups in terms of overall survival, disease-specific survival, and disease-free survival.ConclusionC-SAIF is a feasible and reliable flap for reconstructing oral cancer–related defects. Moreover, it is an effective island flap to preserve the perforator and pedicle without compromising oncological safety.

The Use of Keystone Flap for the Reconstruction of Skin Defects

Background and objectives: Skin graft and various flaps are used to cover defects; available options have different patterns of blood supply, aesthetic outcome, donor area morbidity, surrounding soft tissue availability, operative time duration, the need for microsurgical expertise and long term complications. The aim of this study is to assess reliability and versatility of keystone flap for the reconstruction of the skin defects. Methods: Reconstruction of skin defects by keystone flap were done in plastic surgery department between (January 2018- May 2020), records of patient’s age, and cause of the defect, size, flap outcome and complications are documented.to study the ability of the flap to cover the skin defect and its long term survival. Results: Nineteen patients underwent reconstruction, age was ranging from two days to seventy-five-year-old with mean age 37.5 years, twelve were males and seven were females. Size of the defect ranged from (0.5 cm x 1 cm) to (9 cm x 7 cm) with mean defect size 31.75 cm2. Seven flaps in head and neck, five in the trunk, five in lower limb and two flaps in upper limb. All flaps were successful in covering the defects, no partial or total necrosis with minor complication in two patients. Conclusions: Keystone flap is a reliable flap with excellent survival rate, versatile and can be used for skin defects in different regions of the body with low complication rate, easy technique for learning by surgeons and have short operative duration with good cosmetic outcome.

Use of Customized Thickness Anterolateral Thigh Flap in Head and Neck Reconstruction

Objective: This study demonstrates different techniques of anterolateral thigh flap (ALT) with the appropriate surgical planes according to the thickness of the defect, which have not been previously found in the literature, with our reconstruction experiences. &#x0D; Materials and Methods: A retrospective study was performed including 26 flaps in 25 patients who underwent reconstruction of head and neck defects with different surgical planes of ALT flap including subfascial, superthin, suprafascial, chimeric and composite flaps from March 2017 through December 2020. Flap planes were chosen according to the thickness of the defect, determined during surgery by using caliper. We evaluated the characteristics, flap thicknesses, complications and need of revision surgery in postoperative period. &#x0D; Results: One of the superthin flaps was totally lost; there was not any other flap loss. Three patients died in postoperative period. Although appropriate plane of the flaps was chosen, 4 of all 26 flaps needed revision surgery. One of the patients who was performed lip reconstruction with superthin ALT flap had bulky appearance needed liposuction in postoperative 6 months and 3 patients who received subfascial ALT flaps were performed debulking surgeries. &#x0D; Conclusion: ALT flap is a versatile, reliable flap which can be harvested in different planes according to the thickness of the defect in head and neck region. The ALT flap with convenient thickness provides definitive reconstruction in a single stage without revision surgeries and the most optimal aesthetic results can be obtained.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

BackgroundThe submental island flap (SIF) is a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction. Materials and methodsA total of 32 consecutive patients with carcinoma of the oral cavity were included in this study. All patients underwent resection and immediate reconstruction with SIF pedicled the submental vessels. Donor and recipient site morbidity, functional outcome, and locoregional recurrences are reported. ResultsThe study included 22 males (69%) and 10 females. The mean age was 54 years (range of 31–79 years). The most common primary tumor site was the tongue (15 patients, 47%), followed by the buccal mucosa, alveolar margin, floor of mouth, lower lip and hard palate. In 25 patients (78%) the flap survived completely. Complete flap loss occurred in one patient (3%). Six patients (19%) developed complications related to flap vascularity. 21 patients (66%) resumed normal diet, while 11 patients (34%) tolerated only soft diet. Over a median follow up was of 15 months (range of 3–62 months), 21 patients (66%) are alive and disease free, while 8 patients died, of whom 4 of locoreginal recurrences. ConclusionsSIF is reliable for reconstruction of the intraoral soft tissue defects following cancer resection. The functional and cosmetic outcomes are satisfactory and donor site morbidity is low. Careful patient selection is necessary for favorable outcome.

Occipital artery based myocutaneous flap repair for cochlear implant extrusion- How I do it

Introduction: Cochlear implant extrusion is a challenging complication to manage. It needs meticulous planning, antibiotic cover and a good vascularized tissue covering. Occipital artery based myocutaneous flap is used to cover tissue defects in neurosurgery and oncosurgery practice and the results are widely accepted. In ENT practice we can safely utilize this versatile and reliable flap to achieve good tissue cover over an extruded cochlear implant. Objective: To improve confidence and share experience to achieve better outcomes when dealing with complications after cochlear implantation. Method: Occipital artery based flap is used to cover the tissue defects as an axial flap over the exposed implant after antibiotic cover, with the Consultant microbiologist’s guidance to overcome biofilm resistance and a through wound debridement. Results: Good healing achieved with a thick scalp skin cover. Conclusion: In ENT practice we can safely utilize this versatile and reliable flap to achieve good tissue cover over an extruded cochlear implant.