The 5th world symposium for lymphedema surgery-Recent updates in lymphedema surgery and setting up of a global knowledge exchange platform.

The successful completion of the 5th World Symposium for Lymphedema Surgery (WSLS) marks another milestone in the development and advancement of the management of lymphedema. We present our experience in organizing such a scientific lymphedema conference as well as a summary of seven variable live surgeries used for treating lymphedema. An update of current knowledge and determination of future direction in the treatment of lymphedema was made possible via WSLS 2016. J. Surg. Oncol. 2017;115:6-12. © 2016 Wiley Periodicals, Inc.

The versatility of profunda femoral artery perforator flap for oncological reconstruction after cancer resection-Clinical cases and review of literature.

BACKGROUND: The profunda feomris artery perforator (PAP) flap was recently revisited and gains popularity as an alternative method of autologous breast reconstruction. The purpose of this article is to demonstrate that PAP flap can be used reliably for reconstruction of various soft tissue defects. METHODS: A total of 55 free PAP flaps and 16 pedicle PAP flaps were transferred in 63 patients. Each case was reviewed to verify a PAP flap was performed identifying defect location, flap size, flap design, and postoperative complications. RESULTS: Seven flaps in five patients underwent breast reconstructions, 48 patients underwent head and neck reconstructions using free PAP flaps. The mean perforator number was 1.9, and the average pedicles length was 9.7 cm. The majority of perforators were musculocutaneous, and the others were septocutaneous. The mean ischemia time was 121.4 min. Minor complications included wound poor healing, flap partial necrosis, and pedicle vessels problems. Sixteen pedicle PAP flaps were transferred in 10 patients for vulvar reconstruction. Minor complications included urinary tract infection, poor wound healing, wound infection, hematoma. CONCLUSIONS: The anatomy and number of perforators of PAP flap are reliable with adequate pedicle length. This flap can be an excellent option for reconstruction of most soft tissue defects. J. Surg. Oncol. 2016;114:193-201. © 2016 Wiley Periodicals, Inc.

A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery.

BACKGROUND: Chimeric anterolateral thigh free flaps (ALT) have been commonly used for head and neck defects, which require two epithelial lined surfaces. However, because of unpredictable vascular anatomy, it is a challenge to consistently elevate large chimeric flaps with multiple perforators based on the Lateral Circumflex Femoral Artery (LCFA). Here, we present our method to reliably harvest a chimeric flap from the ALT territory and investigate its long-term outcomes when used in the reconstruction of extensive head and neck defects. METHODS: A prospective review of practice consisting of 27 patients, between January 2011 and April 2019, with extensive through-and-through head and neck defects, which require dual paddle flaps underwent reconstruction with chimeric ALT harvested with a portion of distal vastus lateralis. The age of the patients ranged from 32 to 68 years (mean 53.2 years). RESULTS: Flap length ranged from 17 to 30 cm (mean, 25.6 cm). The mean flap area was 261.6 cm2 (range, from 225 to 340 cm2). The mean ischemia time was 162.9 min (range, from 59 to 269 min). At a mean follow-up time of 33.4 months (range, from 4 to 91 months), four patients died of cancer recurrence. For the other 23 patients, 4 required revision to achieve better cosmetic lip competence. All flaps survived with two recorded returns to theater for pedicle exploration associated with partial flap loss only. CONCLUSION: Harvesting the chimeric ALT with a portion of vastus lateralis distally negates the need for tenuous intramuscular perforator dissection. It is a reliable option for head and neck surgery, which require composite reconstruction. Using this technique produces a good functional cosmetic outcome. It also allows large defects to be reconstructed in a single sitting with free tissue transfer.

Free profunda femoris artery perforator flap as a first-line choice of reconstruction for partial glossectomy defects.

BACKGROUND: Free profunda artery perforator (PAP) flap has recently been brought back for head and neck reconstruction. During the course of 1 year, we performed this procedure for reconstruction of partial glossectomy defects with excellent results. METHODS: From January through December 2015, 21 patients underwent partial glossectomy reconstruction with PAP flaps. Demographics, surgical technique, anatomic variations, success rates, complications, and characteristics are described. Swallowing and speech results after reconstruction are evaluated. RESULTS: No donor-site complications were observed. Two cases presented complications potentially related to the flap (1 hematoma and 1 prolonged intubation) that were treated successfully. Deglutition and speech assessment resulted in fair to excellent swallowing capacity in all patients. Speech score resulted 4/5 to 5/5 in all patients at 3-month follow-up. CONCLUSION: The PAP flap should be considered one of the first-line options for hemiglossectomy reconstruction, receiving special consideration in the high-risk population in which future complex reconstructions could be needed. © 2016 Wiley Periodicals, Inc. Head Neck 39: 737-743, 2017.

Comparison of Posteromedial Thigh Profunda Artery Perforator Flap and Anterolateral Thigh Perforator Flap for Head and Neck Reconstruction.

BACKGROUND: The anterolateral thigh perforator flap is a common workhorse flap for head and neck reconstruction. The authors present an alternative method using the posteromedial thigh profunda artery perforator flap and compare its characteristics, outcomes, donor-site morbidity, and donor-site cosmesis with those of the anterolateral thigh perforator flap. METHODS: Between May of 2013 and July of 2014, 41 patients undergoing head and neck reconstruction consisting of 18 posteromedial thigh profunda artery perforator flaps and 23 anterolateral thigh perforator flaps were included in this study. Thirty-eight of the patients were men, and the patient age ranged from 32 to 76 years (mean, 54.5 years). RESULTS: The success rate was 100 percent. The mean number of perforators was significantly higher in the profunda artery perforator flap group (2.0 versus 1.5). There was no significant difference in flap elevation time (66.3 minutes versus 60.7 minutes), pedicle length (9.8 cm versus 10 cm), flap area (166.1 cm versus 156.8 cm), flap width (7.7 cm versus 7.7 cm), reexploration rate, recipient-site complication rate, or donor-site complication rate. Based on patient self-assessment, the profunda artery perforator flap group had significantly better donor-site cosmesis than the anterolateral thigh perforator flap group (satisfaction rate, 100 percent versus 70 percent). CONCLUSIONS: The posteromedial thigh profunda artery perforator flap is a good alternative for head and neck reconstruction. It offers flap size, pedicle length, flap elevation time, and success rate comparable to those of the anterolateral thigh perforator flap. It has more perforators and better donor-site cosmesis than the anterolateral thigh perforator flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.