Comparison of outcomes between single- and multiple-perforator-based free perforator flaps: A systematic review and meta-analysis.

BACKGROUND: Perforator-based free perforator flaps have become an important tool for the reconstruction of tissue defects. The effect of the number of perforators on the outcomes of perforator flaps has been widely debated. This study aimed to compare the outcomes of single- and multiple-perforator-based free perforator flaps in free-flap reconstruction. METHODS: We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov between January 2000 and June 2021 to identify studies that reported data on the outcomes of free perforator flaps. Two authors individually extracted data and performed quality assessment. Outcomes, including partial flap loss, total loss, fat necrosis, arterial insufficiency, venous insufficiency, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications, were evaluated. RESULTS: Thirty-two studies with 2498 flaps were included in our analysis. No significant difference was found in the rates of partial loss and arterial insufficiency of flaps, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications. However, the multiple-perforator group showed significantly lower rates of total loss (relative risk [RR] = 1.08, 95% confidence interval [CI]: 0.78-1.79, p = .754), fat necrosis (RR = 1.79, 95% [CI]: 1.36-2.36, p = .000) and venous insufficiency (RR = 1.72, 95% CI: 1.07-2.79, p = .026) than the single-perforator group. CONCLUSION: The rates of total loss, fat necrosis and venous insufficiency in the multiple-perforator group were lower than those in the single-perforator group. Hence, we recommend that multiple perforators be included in the free perforator flap when appropriate, to yield better clinical outcomes in reconstruction.

Sialendoscopy-Assisted Treatment of Stensen's Duct Injury: A Case Series.

PURPOSE: To evaluate the clinical value of sialendoscopy in the treatment of Stensen's duct injury. PATIENTS AND METHODS: A total of 5 patients with Stensen's duct injuries who had been treated from December 2017 to April 2019 were included in the present study. The operations were performed with the help of a sialendoscope. All patients were followed for 6 months. RESULTS: The distal end of the ductal system was found precisely with the use of the sialendoscope, and the proximal end was identified by the location of the distal end. The end-to-end anastomosis was performed successfully. None of the patients complained of salivary gland fistula at the 6-month follow-up examination. CONCLUSIONS: The stumps of the ductal system could be precisely and effectively located with the help of a sialendoscope.

Evaluation of Sialendoscopy-Assisted Treatment of Submandibular Gland Stones.

PURPOSE: The aim of the present study was to evaluate the therapeutic efficiency of sialendoscopy-assisted operations in the treatment of submandibular gland stones. MATERIALS AND METHODS: The data from 8 patients with sialolithiasis who underwent sialendoscopy from August 2015 to January 2016 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China) were retrospectively reviewed. All the patients had undergone preoperative technetium-99m pertechnetate salivary gland scintigraphy. The results revealed that the salivary glands exhibited normal or slightly reduced uptake and excretion dysfunction. Computed tomography examinations revealed stones located in the intraductal area near the glands or in the branches that could not be removed owing to their deep locations within the mouth. Therefore, an endoscope was inserted, the stones were located intraductally using sialendoscopy, and a transcervical incision was made to remove the stones and preserve the submandibular gland. RESULTS: The stones were completely removed, and the submandibular gland was preserved in all cases. The patients recovered well postoperatively, and no complications developed. CONCLUSIONS: Our results suggest that sialendoscopy-assisted sialolithectomy is an effective and safe surgical technique for the removal of proximal and intraglandular submandibular gland stones. The patients' quality of life had obviously improved postoperatively.

Risk Factors for Free Flap Outcomes: A Retrospective Study of 318 Free Flaps for Head and Neck Defect Reconstruction.

OBJECTIVES: This study was conducted to identify the risk factors for free flap outcomes in head and neck reconstruction. METHODS: A retrospective review of 318 free flaps were used for head and neck reconstructions in 317 patients over seven years. The patient characteristics, surgical data, and flap outcomes were recorded. The impact of risk factors related on the outcomes of free flaps were analyzed using single and multivariate analysis. RESULTS: For single factor analysis, 295 free flaps for the first reconstruction were included. Hypertension and the type of recipient vein are associated with venous thrombosis (P = .018, P = .047). Hypertension, type of free flap, recipient artery, and recipient vein were associated with the incidence of re-exploration (P = .009, P = .011, P = .017, P = .021). Hypertension had an obvious effect on the flap survival (P = .005). For multivariate analysis, hypertension (odds ratio = .166, 95% confidence interval: .043 - .636; P = .009) was a statistically significant risk factor for flap survival. For types of recipient artery and vein, selecting two venous anastomosis (one of IJVS and one of EJVS) had the minimum incidence of venous thrombosis (2.2%), and selecting facial artery, single vein (one of IJVS), and two veins (one of IJVS and one of EJVS) for anastomosis had lower incidence of re-exploration, which were 4.4%, 2.9%, and 6.0%, respectively (P < .05). CONCLUSIONS: Risk factors as hypertension, type of free flap, recipient artery and vein should be paid more attention in the free flaps for head and neck reconstructions. We believe proper measures will lead to better results in head and neck reconstruction.

Advantages of submandibular gland preservation surgery over submandibular gland resection for proximal submandibular stones.

OBJECTIVES: This study sought to compare surgical outcomes after the removal of submandibular gland (SMG) stones via 2 different surgical methods. MATERIALS AND METHODS: From June 2015 to July 2016, a total of 40 patients with SMG stones were selected from the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China), and were randomly assigned to 2 groups. Twenty patients underwent sialendoscopy-assisted stone removal via extraoral incision with preservation of the SMG, and 20 patients underwent traditional SMG resection. The outcomes of the 2 surgical procedures were assessed. RESULTS: The operation time and hospital stay were shorter in the SMG preservation group than the SMG resection group. There were no significant differences in stone size or location between the groups. The mean visual analog scale (VAS) score was lower in the SMG preservation group than the SMG resection group. All patients in the SMG resection group exhibited varying degrees of scarring and concave deformity on the face and neck, whereas all patients in the SMG preservation group retained intact facial morphology. CONCLUSIONS: Sialendoscopy-assisted stone removal with preservation of the SMG exhibited many advantages relative to traditional SMG resection.