Thinned anterolateral thigh cutaneous flap and radial fasciocutaneous forearm flap for reconstruction of oral defects: comparison of donor site morbidity.

PURPOSE: The thinned anterolateral thigh flap (tALT) has been utilized in clinical applications for soft tissue reconstruction. This flap has many advantages: no major artery is sacrificed; functional and esthetic results are often good. The purpose of this study is to investigate the esthetic outcome of the donor site after reconstruction of oral defects with tALT compared to the radial fasciocutaneous forearm flap (RFFF). PATIENTS AND METHODS: Between January 2003 and December 2005, 42 patients affected by oral squamous cell carcinoma (27 males, 15 females; age range: 34-82 years, mean age, 61.4 years) received microsurgical reconstruction. We treated 17 patients with RFFF and 25 cases with tALT. RESULTS: The RFFF group showed a success rate of 94.2% with only 1 total flap loss due to not reversible venous thrombosis. In the tALT group we accomplished a 100% flap survival. Functional results at donor site in the RFFF group showed a persistent forearm movement impairment in about 30% of cases and sensitivity alterations in skin graft area in 75% of patients; in the tALT group we noticed only a transitory gait impairment in 1 patient; no clinical signs of circulatory disturbance were observed and no sensory disturbance of the thigh was reported. CONCLUSIONS: In our experience, we found the thinned ALT cutaneous flap the ideal soft tissue flap in oral reconstruction. This flap presents functional results at the receiving site with the additional advantage of minimal donor-site morbidity and a high level of patient satisfaction.

Frontal bone fractures: new technique of closed reduction.

Fractures of the nasofrontal orbital complex account for 5% of all facial fractures. Mean hospitalization is usually longer than for other types of facial lesions, independent of the trauma responsible (road accidents, sport, falls, firearm wounds, and so on). The choice of treatment, usually dictated by the site and extent of the damage, is important because inadequate treatment may lead to immediate or subsequent complications. A conservative surgical technique for use in the treatment of non-comminuted frontal lesions is described, which consists of the closed reduction of the depressed fragments by means of a small percutaneous approach. Before surgery, a computed tomography scan is carried out with 2-mm slices both in the axial and coronal projections, mandatory to evaluate the orbital roof and frontal region. The peripheral limits of the frontal region fracture are marked on the skin, a punctiform incision made in the area of maximum depression, and a calibrated drill inserted. Two small holes are created in the center of the depressed fragment and two pins screwed in, both of a length to allow the surgeon an easy reduction maneuver. A radiographic evaluation is then performed to check the correct alignment of the previously depressed fragment, the two percutaneous pins removed, and two sutures applied, if necessary. This technique avoids the scarring often observed after the open reduction technique and, in selected cases, treatment may be carried out in neuroleptanalgesia reducing operating as well as hospitalization times and healthcare costs.