Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy.

BACKGROUND: The purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy. METHODS: Between January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient. RESULTS: All of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up. CONCLUSIONS: In patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.

Reconstruction for facial nerve defects of zygomatic or marginal mandibular branches using upper buccal or cervical branches.

BACKGROUND: Many reconstructive methods for facial nerve defects have been described previously, such as the greater auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. Herein, we want to instruct a new technique of repairing facial nerve defects of zygomatic or marginal mandibular branches using upper buccal or cervical branches when we have to face segment defects of facial nerve with wide gaps between facial nerve stumps. METHODS: The distal part of the upper buccal or cervical branches with peripheral tissue was removed to repair the defects of zygomatic or marginal mandibular branches. Clinical and electromyographic examinations were employed to investigate the clinical efficacy of this method. RESULTS: Killed branches of facial nerve included 11 marginal mandibular branches and 16 zygomatic branches in 26 patients. The length of facial nerve defects ranged from 0.9 cm to 2.3 cm with a mean gap of 1.87 cm (SD, 0.89). Seventeen patients finally showed a superb facial function (grade I), 6 patients an excellent outcome (grade II), and 3 patients a good result (grade III). A fair or poor result (grade IV or V) was not observed. CONCLUSIONS: The essence of this method is equivalent to direct facial-facial nerve anastomosis which seems to be able to avoid synkinesis between the upper and lower face. We believe that this method is adaptable to the length of facial nerve defects less than 2 cm.

A comparison of mandible preservation method and mandibulotomy approach in oral and oropharyngeal cancer: A meta-analysis.

OBJECTIVE: This study aims to compare the prognoses outcomes of mandibular preservation method (MPM) and the mandibulotomy approach (MLA) in oral and oropharyngeal cancer (OOPC) patients. METHOD: We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov up to September 2016 to identify the studies that compared the prognoses of the MPM versus the MLA in OOPC patients. Two authors individually extracted the data and performed quality assessment. The surgical margins, overall survival rate, total and local recurrence rates, fistula formation, and other functional outcomes were evaluated. RESULT: Six studies with 309 patients were included in our analysis. No significant difference was found regarding the surgical margins, overall survival rate, total and local recurrence rates, and speech and tongue movement between the MPM and MLA groups. However, the MPM group showed a significantly lower fistula formation rate than the MLA group after the operation. CONCLUSION: These findings suggest that the MPM may provide a similar clinical outcome to the MLA, but that the MPM has a lower complication rate in the treatment of OOPC patients.

Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck.

The anteromedial thigh (AMT) perforator flap is usually thin, pliable, and nearly hairless, making it particularly suitable to repair defects of the head and neck. We studied the topography and outcomes of AMT perforator flaps in such defects after excision of tumours. We retrospectively reviewed the casenotes of 11 consecutive patients who had had reconstructions of the head and neck with the initial intent of using an AMT perforator flap from January 2010 to July 2011. For each patient we recorded the size and thickness of the flap; the length of the pedicle; and the number, external diameters, anatomical types, source vessels, and sites of the sizeable perforators. Of the 11 patients, 10 had successful reconstruction using AMT perforator flaps, but one had no AMT perforator big enough. The mean (range) number of sizeable perforators/flap was 1.3 (1-2), length of pedicle 10.6 (7-13) cm, and diameter of the artery 1.1(1.0-1.5) mm. Of the 13 sizeable perforators, 3 were direct and septocutaneous. The remaining ones were all musculocutaneous. Most of them were located in the middle third of the thigh. Primary closure of the donor site was achieved in all patients. One flap was successfully revised after compression of the perforator. All flaps survived with good functional and aesthetic outcomes. The free AMT perforator flap is suitable for reconstructions of the head and neck if a sizeable perforator can be found. The AMT flap may be used as a primary flap rather than as an alternative to the anterolateral thigh flap or a component of a chimeric flap.

[Implant-supported overdenture after pectoralis major myocutaneous flap reconstruction of tongue/floor of the mouth cancer:a case report].

Patients with oral cancer, undergoing ablative surgery, were left with severe deformities and dysfunction. Although the defect can be repaired by flap transplantation, there were still difficulties to restore normal oral structure and function of the oral cavity. In these instances, rehabilitation of mastication and occlusion is of the utmost importance. This article described the procedure that implants were inserted and bar/clips retained overdenture was applied to a patient who underwent reconstruction with pectoralis major myocutaneous flap after cancer ablation surgery. The patient's oral structure and functions was recovered, and the quality of life was greatly improved.

[Perforator-based chimeric anterolateral thigh flap for head and neck reconstruction after en bloc resection].

PURPOSE: To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection. METHODS: A retrospective review was performed of perforator-based chimeric anterolateral thigh (ALT) flap for head and neck reconstruction since December of 2007 to March of 2011. 66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery(d-LCFA). 32 flaps were used for the mobile tongue and floor of mouth reconstruction, 30 flaps for base of the tongue and parapharyngeal walls, two for the buccal skin, one for hemimandible and one for parotid. The muscular flap were used to eliminate the dead space of submandibular area. Flaps size ranged from 7cm±4cm to 16cm±7cm and muscular flap was 3cm±4cm approximately. The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized. RESULTS: All 65 flaps survived completely and the total survival percentage was 98.5%. Only one flap failed and was removed 5 days postoperatively. No complications(fistula, infection, hematoma, seroma et al) were observed in recipient and donor sites. Two anteromedial thigh flaps (AMT) were used for reconstruction due to no sizable perforators in the ALT region. All cases were followed up for 0.5-3 years. The flaps didn't atrophy after six months and the contour was satisfactory. The functions of speech and swallow were recovered well. All the donor sites were closed primarily and the scar was not obvious. The leg's function recovered well. CONCLUSIONS: Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap. A chimeric flap including multiple components can meet the requirements of three-dimensional reconstruction. Perforator-based chimeric anterolateral thigh flap is one of the best choices for complex head and neck reconstruction after en bloc resection.

[Anteromedial thigh perforator flap an ideal alternative flap for anterolateral thigh flap without suitable perforator].

PURPOSE: To find a reliable alternative flap with minimal donor site morbidity for anterolateral thigh flap (ALT) without suitable perforator. METHODS: From December 2007 to February 2011, 2 of 64 patients underwent tongue and floor of mouth reconstruction with an anteromedial thigh flap with the initial intent of using an anterolateral thigh flap. One was a perforator flap and the size was 7cm×4cm , the other was a perforator-based chimeric flap including a slender of rectus femoris island and a 14cm×6cm skin paddle. Both of the AMT flap pedicles were medial branch of descending branch of lateral circumflex femoral artery (d-LCFA) and the pedicle length was 10 to 12cm. RESULTS: The flaps survived completely and no complications occurred in recipient and donor sites. The two patients were followed up for 0.5 to 12 months. The functions of speech and swallow recovered well. The donor site was closed primarily and scar was not obvious. The leg's function recovered well. CONCLUSION: AMT flap is a reliable alternative flap with minimal donor site morbidity when there is no suitable perforator in anterolateral thigh region.

[Clinical application of unimportant branches of facial nerve to repair important ones].

PURPOSE: To study the feasibility and clinical effect of repairing important branches of facial nerve (zygomatic and marginal mandibular branches) with unimportant ones (upper buccal and cervical branches). METHODS: The defect of zygomatic and marginal mandibular branches was repaired with upper buccal and cervical branches, respectively. After the length of facial nerve defect was measured, the distal part of the upper buccal and cervical branches with peripheral tissue was used to repair the defect. Under operating microscope, nerve anastomosis was performed with 9-0 suture. 5 cases suffering from defect of marginal mandibular branches were repaired with cervical branches, and 7 cases with defect of zygomatic branches were repaired with upper buccal branches. RESULTS: In 5 cases suffering from defect of marginal mandibular branches, 2 cases recovered in 3 months, and 3 cases recovered in 6 months; In 7 cases suffering from defect of zygomatic branches, all recovered in 3-4 months. CONCLUSION: Repair of defect of zygomatic and marginal mandibular branches with upper buccal and cervical branches is feasible and the result is acceptable.