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1.
Quintessence Int ; 51(6): 464-472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32368764

RESUMO

Squamous cell carcinomas arising from keratocystic odontogentic tumors are a rare phenomenon in head and neck cancer, accounting for only 1.45% of oral squamous cell carcinomas, and are classified as primary intraosseous carninomas. This cancer is locally aggressive, has a high potential for recurrence, and requires radical resection and subsequent rehabilitation. This case report describes a patient diagnosed with this uncommon tumor who was treated by dental specialists at Mayo Clinic. During convalescence, orthodontic changes to the maxillary dental archform were observed secondary to alterations in the soft tissue equilibrium following mandibulectomy and reconstruction with a microvascular fibula free flap. This highlights the need for treatment plan adaptability, the role of orthodontists in maintenance or treatment of pre-resection archforms, and the interdisciplinary nature necessary in managing the complex oncologic, functional, and esthetic needs in patients undergoing treatment for head and neck cancer.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Bucais , Procedimentos Cirúrgicos Reconstrutivos , Fíbula , Humanos , Recidiva Local de Neoplasia
2.
Zhonghua Shao Shang Za Zhi ; 36(3): 219-223, 2020 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-32241048

RESUMO

Objective: To evaluate the clinical effects of anterolateral thigh free flap with fascia lata in the repair of dura mater defect after resection of head squamous cell carcinoma. Methods: From June 2016 to June 2018, Xijing Hospital of Air Force Medical University applied the free transplantation of anterolateral thigh flap with fascia lata to repair the dura mater defect of 12 patients with head squamous cell carcinoma, including 9 males and 3 females, aged from 35 to 74 years. The size of scalp soft tissue defects in patients after carcinoma resection ranged from 12 cm×10 cm to 24 cm×21 cm, and the size of dura mater defect of patients ranged from 7 cm×6 cm to 16 cm×14 cm. The size of flap of patients ranged from 14 cm×12 cm to 27 cm×24 cm, and the size of fascia lata ranged from 8 cm×7 cm to 17 cm×15 cm. The superficial temporal artery and middle temporal vein were connected by end to end anastomosis with the first musculocutaneous perforating branch of the descending branch of lateral femoral artery and its accompanying vein. The flap donor area was transplanted with autologous split-thickness skin graft from trunk and fixed with packing. Postoperative survival of flaps and skin grafts was observed. The patients were followed up regularly. The cranial magnetic resonance imaging was performed to observe the recurrence of intracranial tumors and dural integrity, shape of the flap and whether the donor site region was left with significant dysfunction were observed. Results: All the flaps and skin grafts survived well in 12 patients after surgery. Ten patients had primary healing at the edge of the flap suture; 2 patients had local sinus tract formation at the suture site of flap, with a small amount of cerebrospinal fluid leakage, and were recovered after outpatient dressing change. The patients were followed up for 10 to 36 months, and 3 patients with tumors involving in the dura mater sagittal sinus region had postoperative intracranial tumor recurrence. The tumor was resected again. All the patients had good dural integrity. The flaps of all patients were in good shape, and no obvious dysfunction remained in the flap donor site. Conclusions: Free transplantation of anterolateral thigh flap with fascia lata is an effective and reliable method to repair the dura mater defect following head squamous cell carcinoma resection. It can repair the scalp and dura mater defects caused by the invasion of squamous cell carcinoma and provide possibilities for skull reconstruction.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Dura-Máter , Fascia Lata/transplante , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coxa da Perna , Resultado do Tratamento
3.
Head Face Med ; 16(1): 3, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32127030

RESUMO

BACKGROUND: The reconstruction of large head and face missing structures in the craniofacial region in children is very challenging for plastic surgeons. Expanded local and expanded axial-pattern flaps are widely used for the reconstruction of large-area scars. Free flaps are used very cautiously in children. 3D printing technology is a new technology with great development potential. 3D printing technology is used to assist in individualizing titanium alloy restorations for prefabricated skull defect repair. This application has great advantages in the repair of large skull loss. However, it is crucial to choose appropriate techniques and treat deformities of the head and face with integrated approaches and collaboration among multiple departments. CASE PRESENTATION: This study proposes a method to combine the expanded flap method and 3D printing technology to achieve natural remodeling of the craniofacial region in a child. CONCLUSION: Large area of head and face missing structures can be reconstructed by using expanded skin flaps combined with 3D printing, and patients can get better new faces.


Assuntos
Anormalidades Craniofaciais , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Criança , Anormalidades Craniofaciais/cirurgia , Cabeça , Humanos , Impressão Tridimensional , Crânio
4.
Oral Maxillofac Surg ; 24(2): 173-179, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32198652

RESUMO

PURPOSE: Free flaps have become the standard option in reconstructive surgery of the head and neck. Even though many authors have outlined the reliability of free transplants, there is an ongoing discussion about treatment options for patients bearing particular risks as previous irradiation treatment. In this analysis, we aim to address these patients with particular risk profiles by comparing different flap entity outcome parameters. METHODS: We retrospectively analyzed a cohort of 494 patients who underwent flap surgery between 2009 and 2018 in our department. Focusing on free microvascular transplants, we additionally analyzed the pectoralis major myocutaneous flap as the most frequently used vascular pedicled flap. Data analysis was performed by uni- and multivariate statistics. RESULTS: Overall flap success rate was 90%, with the radial forearm flap occurring to be most reliable (93%) in head and neck reconstruction. Previous radiation therapy (RT) and intraoperative revision of vascular anastomosis during primary surgery significantly resulted in impaired transplant outcome with a success rate of 91.8% (no RT) vs. 83.7% (RT), respectively. There was a negative linear correlation between incision to suture time and number of flaps per year (R2 = 0.67). CONCLUSIONS: Preoperative radiation therapy and intraoperative revision of anastomosis significantly impair outcome of microvascular flaps in the head and neck and oral cavity, whereas patient's age is not a predictor of flap failure. Increasing case number and experience reduces time of flap surgery as well as rate of complications and flap failure.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 99(5): e18810, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000381

RESUMO

Complex reconstruction skills in advanced head and neck cancer (HNC) could resolve the key problem of large defects after tumor resection. We combined the anterolateral thigh free flap, fascia lata flap, and greater saphenous vein graft in the reconstruction process of salvage surgery. Seven patients suffering from advanced HNC who experienced the failure of multiple therapeutic methods were enrolled in our study between June 2017 and January 2018. They all agreed to voluntarily undergo the tumor excision and complex reconstruction procedure we developed. The total flap size ranged from 20 × 13 cm to 30 × 15 cm. The length of the greater saphenous vein graft ranged from 4 to 11 cm. The hospitalization period ranged from 7 to 33 days. All of the flaps were viable, but in 1 patient, oral flap edge infection and necrosis necessitated partial debridement on day 7 postoperatively. All donor sites were closed primarily. We report our experience with this surgical method for complex reconstruction in advanced HNC patients.


Assuntos
Fascia Lata/transplante , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Veia Safena/transplante , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Medicine (Baltimore) ; 99(5): e18999, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000439

RESUMO

The intraoperative lung protective ventilation with low tidal volume, positive end expiratory pressure (PEEP) and intermittent lungs recruitment was found to decrease postoperative pulmonary complications. In this retrospective medical records study, we investigated the effects of lung protective ventilation on postoperative pulmonary outcomes among the patients received prolonged oral cancer combined with free flap surgery.We collected the medical records of the patients received oral cancer surgery with the operation time more than 12 hours from January 2011 to December 2015. We recordedFifty nine cases were included. Thirty cases received the lung protective ventilation and 29 cases received conventional ventilation. Compared to the patients received conventional ventilation, the patients received intraoperative lung protective ventilation showedIn conclusion, for the prolonged oral cancer combined with free flap surgery, the intraoperative lung protective ventilation improves postoperative pulmonary outcomes and decreases the duration of ICU stay.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Bucais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Respiração Artificial/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Estudos Retrospectivos , Volume de Ventilação Pulmonar
7.
Mymensingh Med J ; 29(1): 149-155, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915351

RESUMO

Reconstruction of total lip is a challenging task for a plastic surgeon. It becomes more complicated when there is loss of additional tissues like angle of mouth, buccal mucosa or floor of the mouth. Radial forearm flap with palmaris longus tendon provides an easier but reliable technique for three dimensional lip reconstructions with good functional and aesthetic outcome. In this short observational series we included 5 patients of total lip reconstruction and conducted at Sylhet MAG Osmani Medical College Hospital and Private Clinic of Sylhet, Bangladesh from January 2014 to December 2017. Among these one was a case of basal cell carcinoma of upper lip and rest was squamous cell carcinoma of lower lip. The mean age was 71 years. All the flaps survived and patients had normal speech and oral continence. Composite radial forearm flap with palmaris longus tendon is a good, reliable option for total lip reconstruction.


Assuntos
Retalhos de Tecido Biológico , Lábio/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Bangladesh , Antebraço , Humanos , Neoplasias Labiais/cirurgia , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Tendões , Resultado do Tratamento
8.
Plast Reconstr Surg ; 145(2): 333-339, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985616

RESUMO

BACKGROUND: Rates of autologous breast reconstruction are stagnant compared with prosthetic techniques. Insufficient physician payment for microsurgical autologous breast reconstruction is one possible explanation. The payment difference between governmental and commercial payers creates a natural experiment to evaluate its impact on method of reconstruction. This study assessed the influence of physician payment differences for microsurgical autologous breast reconstruction and implants by insurance type on the likelihood of undergoing microsurgical reconstruction. METHODS: The Massachusetts All-Payer Claims Database was queried for women undergoing immediate autologous or implant breast reconstruction from 2010 to 2014. Univariate analyses compared demographic and clinical characteristics between different reconstructive approaches. Logistic regression explored the relative impact of insurance type and physician payments on breast reconstruction modality. RESULTS: Of the women in this study, 82.7 percent had commercial and 17.3 percent had governmental insurance. Implants were performed in 80 percent of women, whereas 20 percent underwent microsurgical autologous reconstruction. Women with Medicaid versus commercial insurance were less likely to undergo microsurgical reconstruction (16.4 percent versus 20.3 percent; p = 0.063). Commercial insurance, older age, and obesity independently increased the odds of microsurgical reconstruction (p < 0.01). When comparing median physician payments, governmental payers reimbursed 78 percent and 63 percent less than commercial payers for microsurgical reconstruction ($1831 versus $8435) and implants ($1249 versus $3359, respectively). Stratified analysis demonstrated that as physician payment increased, the likelihood of undergoing microsurgical reconstruction increased, independent of insurance type (p < 0.001). CONCLUSIONS: Women with governmental insurance had lower odds of undergoing microsurgical autologous breast reconstruction compared with commercial payers. Regardless of payer, greater reimbursement for microsurgical reconstruction increased the likelihood of microsurgical reconstruction. Current microsurgical autologous breast reconstruction reimbursements may not be commensurate with physician effort when compared to prosthetic techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Reembolso de Seguro de Saúde/economia , Mamoplastia/economia , Microcirurgia/economia , Adulto , Implante Mamário/economia , Implante Mamário/estatística & dados numéricos , Implantes de Mama/economia , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/economia , Neoplasias da Mama/cirurgia , Feminino , Retalhos de Tecido Biológico/economia , Humanos , Mamoplastia/estatística & dados numéricos , Massachusetts , Mastectomia/economia , Mastectomia/métodos , Medicaid/economia , Medicaid/estatística & dados numéricos , Microcirurgia/estatística & dados numéricos , Microvasos , Pessoa de Meia-Idade , Reoperação/economia , Reoperação/estatística & dados numéricos , Transplante Autólogo/economia , Estados Unidos
9.
J Craniomaxillofac Surg ; 48(1): 56-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31911012

RESUMO

OBJECTIVE: This study aimed to compare the complications at the donor site of supra- versus subfascially harvested anterolateral thigh perforator free flaps. METHOD: We searched PubMed, Web of Science, EMBASE, the Chinese BioMedical Literature Database (CBM) and the Cochrane Library until December 31, 2018, to identify studies that compared complications at the donor site of the supra- versus subfascially raised anterolateral thigh perforator free flaps. Two authors individually extracted the data and performed the quality assessments. Skin grafting, the rate of poor healing in the donor site, dysfunction at the donor site and sensory functions at the donor site were evaluated. RESULT: Seven studies with a total of 525 patients were included in our analysis. No significant differences were found regarding skin grafting and sensory functions between the 2 groups. However, in regard to the rate of poor healing and dysfunction at the donor site, the SPF group showed significantly better outcomes than the SBF group after the operation. CONCLUSION: Our meta-analysis suggested that, in regards to skin grafting and sensory recovery, the SPF and SBF groups were similar. With regard to donor site healing and functional recovery, the SPF group exhibited better outcomes than the SBF group.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Transplante de Pele , Coxa da Perna , Resultado do Tratamento
10.
Plast Reconstr Surg ; 145(2): 483-492, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985645

RESUMO

BACKGROUND: Hemifacial atrophy (Parry-Romberg syndrome) is an enigmatic craniofacial disorder characterized by progressive facial atrophy. Early age at onset is associated with significant skeletal involvement and jaw abnormalities. Standard reconstructive dogma dictates that the disease should "burn out," with at least 2 years of no disease progression, before pursuing reconstructive intervention. The purpose of this article is to present the senior author's (J.W.S.) experience treating preadolescent children with free soft-tissue transfer for reconstruction of progressing hemifacial atrophy, and to review surgical techniques in this patient population. METHODS: Pediatric free tissue transfer cases performed by the senior author were reviewed. Free tissue transfer using a circumflex scapular adipofasciocutaneous flap was performed to treat deformities arising from hemifacial atrophy. RESULTS: Thirty-six patients aged 3 to 6 years underwent free tissue transfer in the presence of progressing, active disease. Follow-up ranged from 7 months to 25 years. There were no cases of flap loss. In all patients, the disease process seemed to be altered, with no symptoms recurring to date. CONCLUSIONS: The authors believe that early microsurgical correction of hemifacial atrophy in children as young as 3 years is reliable and effective. The authors theorize that the interposition of vascularized, healthy tissue may alter or even halt the progression of disease, and may also prevent the skeletal hypoplasia classically seen in older patients. Further study incorporating autologous fat grafting as a control procedure may provide additional insight into this challenging disease process. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Hemiatrofia Facial/cirurgia , Retalhos de Tecido Biológico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Resultado do Tratamento
11.
Int J Oral Maxillofac Surg ; 49(1): 1-6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31296436

RESUMO

Better cancer treatment has led to a steadily growing population of cancer survivors suffering from late adverse effects after cancer treatment. The aim of this study was to investigate whether there has been an increase in free flap reconstruction due to osteoradionecrosis (ORN). A retrospective review was conducted to identify all consecutive head and neck free flap reconstructions performed over an 18-year period (1995-2012) at Karolinska University Hospital. A total of 235 free flaps were identified. Cases were divided into two groups: head and neck cancer reconstructions and ORN reconstructions. A comparison between the two groups showed longer survival (P<0.001) and higher rates of late complications (P<0.001) among ORN cases. ORN as an indication for reconstruction increased over time, from 7.0% of the total number of free flaps performed in 1995-2000, to 15.2% during the period 2001-2006, and to 27.3% in 2007-2012 (P<0.001). This, in accordance with the results of other studies, highlights the importance of the appropriate allocation of resources within the healthcare system to treat this patient group within the steadily increasing population of cancer survivors.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Estudos Retrospectivos
12.
Ann Otol Rhinol Laryngol ; 129(2): 195-200, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31578078

RESUMO

BACKGROUND: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation. OBJECTIVE: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis. RESULTS: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had improved objective facial symmetry. CONCLUSION: Herein, we demonstrate the first use of the sterno-omohyoid flap for successful facial reanimation. Overall, it is a novel flap in facial reanimation with many advantages over traditional flaps, including the potential to produce a more synchronous, dynamic smile while adding minimal bulk to the face. Future series will better elucidate the potential of the sterno-omohyoid flap.


Assuntos
Paralisia Facial/reabilitação , Paralisia Facial/cirurgia , Retalhos de Tecido Biológico , Adulto , Doença Crônica , Humanos , Masculino , Músculos do Pescoço/transplante , Sorriso
13.
Clin Oral Investig ; 24(1): 193-200, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31065813

RESUMO

OBJECTIVES: Increasingly, aging societies pose a challenge, particularly in the most developed countries. This trend leads to an increasing group of old and very old patients presenting unique requirements and challenges. One of these challenges consists in reassessment and adaption of established treatment strategies for the elderly patients. There is an ongoing discussion taking place among cranio-maxillo-facial surgeons about the appropriate extent of reconstructive flap surgery for old patients. MATERIALS AND METHODS: This monocentric retrospective cohort study investigated 281 reconstructions with microvascular flaps by comparing the risk for a negative outcome, which was defined as revision, flap loss, and patient death, between three subgroups of elderly patients and younger patients. The three subgroups of elderly patients were defined as-1: young old (65-74 years), 2: old (75-84 years), and 3: oldest old (≥ 85 years). The group of the younger patients was defined by age between 50 and 64 years. Data were obtained within a defined period of 42 months. RESULTS: Significant correlations with a negative outcome were found for the variables stay on IMC/ICU, multiple flaps, and radiotherapy prior surgery. Our data showed no significant correlation between age and a higher risk for a negative outcome. CONCLUSION: Defect reconstruction with microvascular flaps in old patients is not related with a higher risk for a negative outcome. CLINICAL RELEVANCE: Independently of age, treatment with microvascular flaps is an option for all operable patients, with an indication for oncologic surgery. For optimal therapy planning, individual patient resources and preferences should be considered instead of chronologic age.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento
14.
J Surg Oncol ; 121(1): 168-174, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31168837

RESUMO

BACKGROUND AND OBJECTIVES: In patients with lymphedema, the disruption of the lymphatic network increases skin turgor and fibrosis of subcutaneous tissue, delays wound healing, causing recurrent ulcerations and infections. In these cases, management of ulcers can be challenging. METHODS: Between January 2016 and June 2018, patients presenting with lymphedema were enrolled at our Institution. We selected patients with severe lymphedema and ulcers of lower limbs and we performed a surgical approach, involving free gastroepiploic lymph nodes and omentum flap, harvested through laparoscopy. RESULTS: We enrolled 135 patients presenting for lymphedema. Among them, 10 eligible cases underwent excision of the ulcer and reconstruction with omentum flap. Mean age was 57.8 years and average follow-up 24.1 months. Circumferences and skin tonicity significantly decreased from the preoperative period. Lymphoscintigraphy showed improvement of the lymphatic drainage and restoration of lymphatic network. No episodes of infection were recorded in the postoperative period. CONCLUSIONS: Our combined procedure merges free flap techniques and lymphedema surgery: omentum covers the defect while providing a new source of lymph nodes, improving the lymphatic networks of the affected limb. This technique can highly increase the quality of life of the patient in a single-stage operation with fast recovery and low donor site morbidity.


Assuntos
Retalhos de Tecido Biológico/transplante , Úlcera da Perna/cirurgia , Linfonodos/transplante , Linfedema/cirurgia , Omento/transplante , Idoso , Doença Crônica , Feminino , Retalhos de Tecido Biológico/cirurgia , Humanos , Úlcera da Perna/complicações , Linfonodos/cirurgia , Linfedema/complicações , Masculino , Pessoa de Meia-Idade
15.
Clin Implant Dent Relat Res ; 22(1): 91-95, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31777154

RESUMO

OBJECTIVES: The current pilot study aims to report short-term experience as it relates to acute radiotherapy treatment outcomes comparing patients with immediate dental implants in fibula free flap reconstructions to a historical cohort of patients with fibula free flap reconstructions without dental implants. MATERIALS AND METHODS: A retrospective review of patients who underwent segmental mandibulectomy, reconstruction with fibula free flaps, and adjuvant radiotherapy with (n = 10) and without immediate dental implants (n = 10) at a tertiary cancer center from 2015 to 2018 was performed (IRB #17-271). Incidence of postoperative complications, time to initiation of radiation therapy, development of acute toxicity, and patient reported outcome data were recorded. The radiation plans were evaluated to identify the mean and maximum doses received by the mandible and oral cavity as well as the locations of radiation global hot spots. RESULTS: There was a similar number of postoperative complications in both cohorts, with three events in the case group and two events in the control group. Patients with dental implants reported less trismus than control patients. Evaluation of the radiation treatment plans revealed similar median radiation global hot spots in both groups. CONCLUSIONS: The current study suggests that the presence of dental implants does not increase the risk of complications following surgery or during radiation treatment. Implants do not alter radiation dosimetry but do appear to positively impact early patient quality of life. Although longer follow-up is needed, based on this preliminary experience, cancer patients should be offered this type of reconstruction without fear of impacting radiation timing or delivery.


Assuntos
Implantes Dentários , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Neoplasias Mandibulares , Procedimentos Cirúrgicos Reconstrutivos , Transplante Ósseo , Humanos , Mandíbula , Projetos Piloto , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
16.
J Craniomaxillofac Surg ; 48(1): 43-48, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31818687

RESUMO

OBJECTIVE: There is lack of standardized management and mobilization strategies after oral and maxillofacial reconstruction surgery. We used prospective randomized controlled trials to explore improvements in postoperative mobilization protocol in such patients. METHODS: A total of 149 patients were randomly divided into tracheotomy control group A (38 cases) and test group A (37 cases), nontracheotomy control group B (38 cases) and test group B (36 cases). Test group patients sat up in bed on the 2nd day after surgery and performed off-bed activity on the 3rd day, whereas control group patients sat up in bed on the 4th day postoperatively and performed off-bed activity on the 6th day. Objective evaluation included free flap success rate, postoperative complications, sleep time, and catheter removal time, among other parameters. Subjective evaluation included postoperative pain and comfort evaluation. RESULTS: The success rate of free flaps was 97.3% in test group A and 100% in the other groups. In terms of mean sleep time, 4.6 ± 1.0 h in test group A, which was longer than 4.1 ± 1.0 h in control group A (P = 0.034); 5.7 ± 1.4 h in test group B, which was longer than 4.9 ± 1.7 h in control group B (P = 0.026). Early activity makes catheter removal time (tracheal incision, nasogastric tube, urethral catheter) shorter and gets higher comfort evaluation scores in both test groups versus control groups (P < 0.05). CONCLUSIONS: The early mobilization protocol for patients undergoing free flap reconstruction was safe, and can effectively improve sleep, shorten the catheter indwelling time, and increase the patient's comfort level.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Bucal , Deambulação Precoce , Humanos , Dor Pós-Operatória , Estudos Prospectivos
17.
J Craniofac Surg ; 31(1): e103-e107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31842069

RESUMO

OBJECTIVE: Cranioplasty is essential because cranial defects cause cosmetic and functional problems, and neurologic sequalae in patients. However, reconstruction options are limited in patients with unfavorable conditions. This study aimed to review our experience with skull defect reconstruction using autogenous bone with sagittal split rib bone grafts or latissimus dorsi rib myoosseocutaneous free flaps. METHODS: Patients who underwent autogenous bone graft for cranial defect coverage from December 2011 to November 2015 at our institution were reviewed. Rib bone graft or latissimus dorsi rib myoosseocutaneous free flaps were done to cover the defect. The patient follow-up period ranged from 3 months to 7 years. RESULTS: There were 6 patients, with 9 surgeries. Two cases of latissimus dorsi rib myoosseocutaneous free flap procedures were performed in 2 patients and 7 sagittal split rib bone grafts were performed in 6 patients. There were no postoperative infections in any patients, despite 4 patients had previous surgical site infection histories. Two patients with neurologic sequalae showed improvement after the surgeries. CONCLUSION: Sagittal split rib bone graft and latissimus dorsi rib myoosseocutaneous free flap procedures could be fine options for calvarial reconstruction of defects under the unfavorable conditions of bilateral cranial defects or previous infection history.


Assuntos
Retalhos de Tecido Biológico/cirurgia , Costelas/transplante , Crânio/cirurgia , Músculos Superficiais do Dorso/transplante , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Transplante Autólogo
18.
J Craniofac Surg ; 31(1): e89-e92, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31881595

RESUMO

OBJECTIVE: This study aimed to investigate the efficacy and success rate of the anterolateral thigh flap (ALT) in reconstructing total maxillectomy defects. METHODS: This retrospective study involved patients with total maxillectomy defects, who underwent free ALT reconstruction from June 2005 to October 2014. RESULTS: The study included 72 patients (43 males and 29 females; age range, 7-77 years; mean age, 43 years). Four patients experienced major complications related to surgery: total flap loss in one patient, partial flap necrosis requiring reoperation in one patient, hematoma requiring operative evacuation in 1 patient, and diplopia requiring reoperation in 1 patient. Two patients experienced minor complications: partial flap loss healed by secondary intention with local wound care, and donor site suture rupture in 1 patient healed by secondary intention. Six patients died because of cancer-related death (after local recurrence or metastatic disease). The defects in 5 patients involved the facial skin for which the ALT was segmented into three parts to reconstruct the facial skin, nasal lining, and oral lining. The defects in 4 patients involved the orbital floor for which a segment of tensor fascia lata was included with the flap on the same pedicle and used to repair the orbital floor. In the remaining patients, the free ALT flap, including a segment of vastus lateralis, was used to repair the maxillary defect and fill the dead space. All but one of the surviving patients were satisfied with their final appearance postoperatively. CONCLUSION: The free ALT flap with or without fascia lata to repair the orbital floor is safe, reliable, and acceptable for reconstructing total maxillectomy defects.


Assuntos
Seios Paranasais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Coxa da Perna/cirurgia , Adolescente , Adulto , Idoso , Criança , Craniotomia , Feminino , Retalhos de Tecido Biológico , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Adulto Jovem
19.
J Craniomaxillofac Surg ; 48(1): 67-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31874805

RESUMO

INTRODUCTION: The amount of fluids administered intraoperatively seems to influence the postoperative outcome, and especially the transfusion of red blood cell concentrates (RBC) are known to have an increased risk of postoperative complications. This prospective study focuses on patients planned with microvascular free flap reconstruction and investigates the effect of various types and amounts of volumes given intraoperatively and on the intensive care unit with regard to overall postoperative complications. MATERIAL AND METHODS: In this prospective study, 52 consecutive patients planned for reconstruction with microvascular free flaps were included. Intraoperatively administered volumes including blood products were documented by the anesthesiologists as well as volumes given during the intensive care unit stay. Postoperative complications were registered for the entire hospital stay. Statistical analysis was carried out correlating the amount and type of volumes with the incidence of postoperative complications. RESULTS: The intraoperative use of RBC showed a close to statistically significant increased risk of postoperative complications (mean/SD concentrates: 0.5/1.1 [no complications] vs. 1.0/1.4 [complications], p = 0.058). In a multivariate analysis with stepwise selection the use of human albumin, gelatin, or Ringer's acetate showed no correlation with complications. The overall blood loss, however, had no significant influence on the incidence of complications (mean/SD ml: 1187/761 [no complications] vs. 1004/600 [complications], p = 0.37). The use of noradrenalin during reconstructive surgeries with microvascular flaps bears statistically no increased risk of failure (mean/SD µg/kg/min: 36/23 [no flap loss] vs. 22/15 [flap loss], p = 0.289) or complications (mean/SD µg/kg/min: 34/22 [no complications] vs. 35/23 [complications], p = 0.807). CONCLUSION: In our investigation, the use of crystalloids and colloids seems to have no influence on the postoperative outcome, but the use of RBC may have an increased overall incidence of postoperative complications. A careful hemostasis to limit the use of RBC remains essential despite available options of substitutions. The use of infusion-pump-administered noradrenaline seems valuable to sustain a stable circulation during surgeries with microvascular free flaps and may have no negative impact on postoperative complications.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Eritrócitos , Humanos , Norepinefrina , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
20.
J Craniomaxillofac Surg ; 48(1): 90-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31874806

RESUMO

BACKGROUND: The vessel-depleted, irradiated, and frozen neck, as well as severe atherosclerosis of recipient vessels represent challenging problems in free flap transfer. Extracorporeal free flap perfusion theoretically allows free flap reconstructions in the absence of local donor vessels, but is associated with a number of technical issues. In this study, a novel technique is presented using a commercially available system for extracorporeal membrane oxygenation (ECMO), modified for small blood volumes. METHODS: After preclinical testing, an ECMO system certified for lung support was used to establish blood flow through the flap's artery with oxygenation, decarboxylation and warming of diluted packed blood cells. Venous blood was allowed to flow passively into a separate container. Perfusion was performed for 15 min at intervals of 4 h over 4-6 days. RESULTS: Five patients with soft tissue defects requiring free flap reconstruction were included. Either primarily thinned anterolateral thigh (ALT) flaps (n = 3) or radial forearm flaps (n = 2) were used. We observed infection of the perfusate, with consequent subtotal flap loss, in one patient, complete epithelial loss in two patients, venous congestion in one case, and almost uneventful healing in the fifth patient. With conservative wound care and a split thickness skin graft in one case, stable wound coverage was achieved in all patients except one, who had secondary healing. None of the patients required a second flap for sufficient coverage. CONCLUSIONS: The technique described is associated with the risks of infection, flap congestion, nutritive hypoperfusion, and consequent tissue loss. Nevertheless, stable defect closure seems to be achievable even in patients with depleted recipient vessels.


Assuntos
Oxigenação por Membrana Extracorpórea , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Transplante de Pele , Coxa da Perna
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