Results Of Free Flap Reconstruction Research Articles

Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer.

Patients with local advanced hypopharyngeal combined with esophageal cancer often require total laryngectomy and cervical esophagectomy, which result in big-sized upper aerodigestive tract defects and neck deformities. Although free flap is widely used to reconstruct aerodigestive defects, the aesthetic results especially that of neck contour have not brought to the forefront or discussed extensively. This article aims to report the preliminary aesthetic results of free flap reconstruction for local advanced hypopharyngeal cancer combined with cervical esophageal cancer defects, highlighting the thickness of subcutaneous fat of the flap. A retrospective study of 21 patients with local advanced hypopharyngeal combined with cervical esophageal cancer from July 2010 to August 2022 was conducted. After completing total laryngectomy, bilateral neck dissection, and removal of the tumor with safe margin, a free thigh flap of subcutaneous fat greater than 1 cm in thickness was used to reconstruct the hypopharyngeal and cervical esophageal defects. In addition to general demographic, oncological, and reconstructive data, preoperative and postoperative neck circumferences were recorded and compared. A subjective questionnaire survey was conducted on patients' satisfaction with postoperative neck contour. The patients were followed up from 3 to 10 years, with an average of 3 years. There were 2 cases (2/21) of free flap loss because of flap necrosis and secondary repair with a pedicled pectoralis major flap. Nineteen flaps (19/21) survived. Three cases (3/21) developed a pharyngeal fistula and one case (1/21) experienced salivary fistula, all of the fistulae healed after drainage and dressing change. There was a relatively high satisfaction rate among patients (16/21) with the postoperative neck contour. A paired sample t test showed no statistically significant difference between the preoperative and postoperative values ( t = 2.002, P > 0.05). Patients with a thicker subcutaneous fat flap (≥1.5 cm) had a more symmetrical and fuller neck contour during long-term postoperative follow-up. The application of a fat-rich subcutaneous free thigh flap to reconstruct the defect of local advanced hypopharyngeal combined with cervical esophageal cancer can achieve better neck aesthetic contour.

Results of free flap reconstruction for patients aged 80 years or older with head and neck cancer

ObjectiveFree flap reconstruction in elderly patients is one of the most challenging surgeries in the treatment of head and neck cancers. The aim of this study was to examine the oncological and functional outcomes of free flap reconstruction for elderly patients with head and neck cancer. MethodsWe retrospectively reviewed elderly patients who underwent free flap reconstruction for the treatment of head and neck cancers. All patients were 80 years or older. Clinicopathologic features, surgical procedures, oncological and functional outcomes were obtained from medical records. ResultsFree flap reconstructions were performed in 13 patients (3 female, 10 male). The mean age was 82.6 ± 3.4 years (range: 80–91). The mean follow-up period was 23.3 months (range 4–41 months). The mean disease-free survival was 49 ± 6 months (range 4–60 months). All patients had been alive more than one year after surgery. Reconstruction was performed using free jejunum in 10 patients and radial forearm flap in 3 patients. Graft necrosis occurred in 2 patients. Other two patients experienced major postoperative medical complications. ConclusionFree flap reconstruction in well-selected older adults is safe and effective. Advanced age should not preclude consideration of free flap reconstruction in those patients.

Primary surgical treatment versus salvage surgery: Results of free flap reconstruction performed in 100 patients with oropharyngeal cancer

This research sought to analyze the functional results of free flap reconstruction in two groups of patients with head and neck cancer: first group started with radiochemotherapy followed by reconstructive surgery, second group underwent initiative surgery. Materials and methodsIn a group of 100 patients, surgery was used as the primary form of treatment in 55 (55%) patients, and the remaining 45 patients (45%) had chemoradiotherapy introduced first. Statistical analysis was performed with Statistica v. 12. The chi-square test and test of proportion were used for categorical data. Student's t-test was used for continuous data. Probability of survival was calculated using the Kaplan–Meier method where the censoring variable was time to death. To compare survival between cohorts, we used the Cox's test. The level of significance was set at p < 0.05. Results and conclusionsInitial radiochemotherapy prior to surgical treatment indicated an increased risk of local tumor recurrence, flap degeneration, and other local complications.

Results of free flap reconstruction after ablative surgery in the head and neck.

ObjectivesDue to the complex anatomy and function of the head and neck region, the reconstruction of ablative defects in this area is challenging. In addition, an increasing interest in improving the quality of life of patients and achieving good functional results has highlighted the importance of free flaps. The aim of this study was to summarize the results of free flap reconstruction and salvage of free flaps in a single institute, and to analyze differences in the results by the flap donor site, recipient site, and learning curve.MethodsThe medical records of patients who underwent free flap reconstruction from 2004-2012 were reviewed retrospectively. One hundred and fifty free flaps were used in 134 patients, who had an average age of 57.7 years. The types of flaps applied, primary defect sites, success rates, results of salvage operations for compromised flap, and the learning curve were analyzed.ResultsThe anterolateral thigh flap was preferred for the reconstruction of head and neck defects. The overall success rate was 90.7%, with 14 cases of failure. A total of 19 salvage operations (12.7%) for compromised flap were performed, and 12 flaps (63.2%) were salvaged successfully. Dependency on the facial vessels as recipient vessels was statistically different when oral and oropharyngeal defects were compared to hypopharyngeal and laryngeal defects. The learning curve for microvascular surgery showed decrease in the failure rate after 50 cases.ConclusionThe free flap technique is safe but involves a significant learning period and requires careful postoperative monitoring of the patient. Early intervention is important for the salvage of free flaps and for lowering the failure rate.

Our experience in reconstructing the burn neck contracture with free flaps: Are free flaps an optimum approach?

Introduction: The aim of the reconstructive burn surgeon is to remove all the scar tissue in the affected area and resurface the area with supple tissue, which allows proper movement of the neck and is esthetically pleasing. We present our series of 10 patients of burn neck contracture, primary and recurrent, who were treated with free flap reconstruction. Patients and Methods: A retrospective review of all the data of the patients was done and the demographic data, preoperative and postoperative examination findings, surgery offered, results and follow-up details were tabulated and analyzed. Results: All the flaps survived completely. Two flaps showed postoperative congestion on day 1 and were taken to the operating room to be reexplored. All patients showed marked improvement in the degree of neck extension, lateral flexion, and rotation which remained unchanged with successive follow-ups. Conclusion: The results of free flap reconstruction of the burn neck contracture area appear to be better than other methods in terms of functional and esthetic restoration of the normal anatomy. The postoperative morbidities for the patient are also reduced and patient comfort is enhanced. The authors feel that in centers where microsurgical expertise is available, the patients of burn neck contractures may be offered the option of complete scar excision and free flap reconstruction as a primary option instead of scar release and split skin grafting.

Free Tissue Transfers and Replantation

After studying this article, the participant should be able to: 1. Describe the indications and contraindications for free flap reconstruction. 2. Describe the indications, anatomy, harvest technique, and advantages and disadvantages of the workhorse free flaps. 3. Describe the indications and contraindications for extremity replantation. 4. Describe the techniques and management for extremity replantation. Microsurgical free flap reconstruction uses a multitude of surgical flaps available to meet the needs of the recipient site. These include cutaneous, muscle, bone, fascia, or some combination of these as available options. Furthermore, sophisticated reconstruction has been enhanced by the development of perforator flaps, enabling multicomponent reconstruction to be performed with reduced donor-site morbidity. It is mandatory that proper débridement of the defect be performed before reconstruction, and that the anastomosis is performed without tension or twisting outside of the zone of injury. There are indications for both musculocutaneous and perforator flaps, and selection is dependent on recipient-site characteristics in addition to function and aesthetics of both the recipient and donor sites. Muscle flaps provide well-vascularized pliable tissue and are used for deep space obliteration, whereas fasciocutaneous flaps are used for flatter, more superficial wounds. Microsurgical replantation of an amputated extremity offers a result that is usually superior to any other type of reconstruction. However, replantation of extremities involves more than microsurgery, as repair of bony and tendon injury must be undertaken as well. This article focuses on the indications, technique, and results of free flap reconstruction and replantation.

Free flap cover of acute burns and post-burn deformity

Free flaps are currently used in reconstructive surgery as a one-stage procedure to achieve optimal functional and aesthetic results. The results of free flap reconstruction performed on 23 patients, ten of whom had acute burns and 13 with secondary burn deformity, are presented. The latissimus dorsi, parascapular, dorsalis pedis, temporalis and posterior calf fascia where the free flap donor sites. Flap necrosis due to venous thrombosis occurred in only one instance.