Facial Transplantation: Nonimmune-Related Hyperacute Graft Failure-The Role of Perfusion Injury: A Case Report.

BACKGROUND: The aim of this study was to report the first case of acute facial allograft transplantation (facial allograft transplantation) failure with allograft removal and autologous free-flap reconstruction. METHODS: A 49-year-old female patient affected by neurofibromatosis type 1 with a massive neurofibroma infiltrating the whole left hemiface was planned for FAT for the left hemiface including the auricle, all skin and soft tissues from the temporal region, periorbital and nasal region, and up to the perioral area. The maxillary process of the zygomatic bone, left hemimaxilla, and hemimandible from contralateral parasyphysis to the incisura mandibulae were also included. RESULTS: Total surgical time was 26 hours. There were 2 intraoperative arterial thromboses that were solved with new anastomoses and sufficient flap perfusion. On postoperative day 2, the allograft became pale with suspected arterial occlusion and the patient returned to the operative room for exploration no flow into the FAT was found. The allograft was removed and the recipient site reconstructed with a skin-grafted composite left latissimus dorsi-serratus anterior flap. CONCLUSIONS: Hyperacute loss of FAT is a very dramatic event, and the activation of a backup surgical plan is crucial to save patient's life, give a reasonable temporary reconstruction, and return on the waiting-list for a second face transplantation.

Septum-Based Mammaplasties: Surgical Techniques and Evaluation of Nipple-Areola Sensibility.

BACKGROUND: The aim of the study was to describe details of surgical techniques and objectively evaluate nipple-areola (NAC) sensibility and viability of septum-based mammaplasties compared to not septum-based reduction techniques. METHODS: Data regarding NAC sensibility for static and moving one- and two-point discrimination were prospectively collected from 63 active group hypertrophic-breasted patients undergoing septum-based reduction mammaplasty preoperatively, at 6 and 12 months postoperatively, and from a control group of 60 patients who underwent not septum-based techniques. Fixed and mixed effect models were used for statistical analysis. RESULTS: Comparison of complications showed no significant differences between groups (p = 0.07). After adjusting the results of the active group according to type of sensory testing, it emerged that the threshold decreases by 10% (p = 0.0003) at 6 months and even reaches 43% (p < 0.0001) at 12 months. The results have been modulated according to age, since the variation is less marked when age increased, by 0.6% at 6 months and 0.8% at 12 months (p = 0.019). The effects of the BMI can only be seen at 12 months, with an increase by 1.3% per year (p = 0.033). Among septum-based techniques, the inferior-central pedicle showed better sensibility outcomes even if not significantly (p = 0.06). Comparison of NAC sensibility outcomes showed that active group had thresholds that were 48% lower when compared to those of the control group at 12 months postoperatively (p < 0.001). CONCLUSION: Septum-based mammaplasty gives optimal results in terms of NAC viability with a significant improvement of sensibility postoperatively. Comparative outcomes on sensibility were also significantly better than not septum-based techniques. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Double-barrel vascularized dual fibula transfer with epiphyseal growth plate for hip reconstruction: A case report.

We present a case report of a 10-year-old girl diagnosed with Ewing sarcoma treated with intra-articular wide resection of the right femur and reconstruction with a series-connected double-barrel bilateral vascularized fibula graft (db-BVFG), including fibular head for articulation with the acetabulum of the pelvic bone and preservation of the epiphyseal growth plates for eventual limb growth. No postoperative complications were observed and bone union was achieved with fibular graft hypertrophy, allowing for full weight bearing. Neither local recurrence nor metastasis was observed at 17-year follow-up. Range of motion degrees at last follow up: hip flexion 90 degree, extension 12 degree, abduction 31 degree, rotation 25 degree. Right versus left limb discrepancy was 60 mm. Db-BVFG may be an option for reconstruction of long femoral defects and hip joint restoration following tumor resection and inclusion of epiphysis within the graft is a viable option in pediatric patients to restore longitudinal growth of the reconstructed long bone.

Tips and tricks for DIEP flap breast reconstruction in patients with previous abdominal scar.

The aim of this study was to analyze outcomes of patients who had prior abdominal operations and underwent DIEP flap breast reconstruction and to describe technical strategies to insure well-vascularized flap-harvest minimizing abdominal donor-site complications. All patients who underwent DIEP flap breast reconstruction between 2004 and 2014 were reviewed and divided into a control group (CG) and a scar group (SG). Patient demographics, operative details, flap and donor-site complications were analyzed and compared. For all of the scars, DIEP flap design was not modified, but a standardized approach was developed according to the type and location of the scar, available vascular pedicle, perforator locations, and the required flap tissue for breast reconstruction. Two hundred and eighty patients underwent 292 flaps in CG and 107 underwent 111 flaps in SG. Pfannenstiel, McBurney, laparoscopic, midline and subcostal were the most common previous incisions. There were no significant differences between groups regarding demographics, flap and mastectomy weight, active smoking, or radiation status (P > 0.05). No significant differences were observed in DIEP flap loss (P = 0.909), partial flap loss (P=0.799), or fat necrosis (P=0.871) and in the rate of abdominal donor-site complications between groups (P > 0.05). SG had a significantly higher mean operative time than CG (P=0.034). Medial raw was a negative risk-factor for flap complications, while BMI (>25.1 kg/m2 ) and smoking-history were significant predictors for donor-site complications. With careful preoperative planning and appropriate technical strategies, successfully DIEP flap breast reconstruction can be performed without increased flap and donor-site complications in patients with preexisting abdominal scars. © 2015 Wiley Periodicals, Inc. Microsurgery 37:282-292, 2017.

Time-dependent factors in DIEP flap breast reconstruction.

BACKGROUND: The process of harvesting and performing microsurgical anastomosis may lengthen deep inferior epigastric artery perforator (DIEP) flap breast reconstruction affecting results and patient safety. The aim of the study was to investigate the associations between predictors and operative time (OT). METHODS: Between 2004 and 2016, 336 immediate and 68 delayed unilateral reconstructions were performed in 404 patients. Age, weight, height, body mass index (BMI), nulliparity, or pluriparity condition were collected to determine the impact of patient characteristics on OT. Flap weight, mastectomy type, flap zone, perforator number, venous anastomoses, recipient vessels selection, reconstruction timing, contralateral symmetrization, and a dedicated anesthesiologist were analyzed as possible predictors. RESULTS: Mean OT was 289 min (range, 150-550 min). Using univariate analysis, for each increment of BMI value and patient weight OT increased, respectively, 3.5- and 1.4 min (97.5% CI: 1.768-5.145, 97.5% CI: 0.739-1.949; P < 0.001). Skin-sparing mastectomy (SSM) (97.5% CI: 2.487-36.637; P = 0.025), perforator number, and venous anastomoses (97.5% CI: 24.468-43.690, 97.5% CI: 24.843-50.492; P < 0.001) negatively influenced OT while nipple-sparing mastectomy (NSM) reduced OT of 22.7-min (97.5% CI: -40.333 to -5.098; P = 0.012). The use of circumflex scapular vessels as recipients reduced OT of 75.4-min while internal mammary vessels (IMV) increased OT of 55.8-min (97.5% CI: -88.631 to -62.209, 97.5% CI: 22.918-88.642; P < 0.001). A dedicated anesthesiologist and the learning curve (LC) reduced OT, respectively, of 39.63-min and of 13-min for every year (97.5% CI: -57.119 to -22.137, 97.5% CI: -14.666 to -11.898; P < 0.001). Using multivariate regression, LC was a negative predictor while SSM, perforators number, superficial epigastric vein, IMV, and flap weight were positive predictors (P < 0.001). CONCLUSIONS: The increase of flap weight, related perforators number, and venous drainage negatively influence OT. LC meaning systematic approach for surgery can optimize DIEP flap surgery efficiency.

Tips and Tricks to Improve Clinical and Aesthetic Outcomes in Latissimus Dorsi Flap Breast Reconstruction.

Background The aim of this study is to present technical strategies to decrease donor-site complications, to optimize breast shaping, and to achieve symmetry in one-stage procedure in latissimus dorsi (LD) flap reconstruction. Methods Between 2004 and 2014, a retrospective review was performed on LD flap reconstructions. Demographics, reconstructive details, clinical and aesthetic outcomes were collected and analyzed. Patients were divided in historical control group (HCG) and new strategy group (NSG). In HCG, a horizontal/oblique LD skin paddle (SP) was drawn; only LD muscle was harvested for the implant pocket; and a contralateral symmetrization was planned without any algorithm. In NSG, a transverse LD-SP was centered on the middle to lower bra strap area; a double-layer muscle coverage was used to create the implant pocket; and a planning algorithm was developed to achieve symmetry. Results A total of 418 breast reconstructions were performed on 296 patients. The two groups were homogeneous regarding demographics, mastectomy weight, and implant volume (p > 0.05). No differences were observed in the incidence of a contralateral surgery, mean hospitalization time, and mastectomy skin flap and nipple-areola complex complications (p > 0.05), while surgical revision of the balancing procedure was more common in HCG than NSG (p = 0.001). Overall, donor-site morbidities occurred in 50 cases including 3 (1%) seroma in NSG and 17 (14.1%) in HCG, and 8 (2.7%) wound dehiscence in NSG and 18 (14.5%) in HCG (p = 0.001). Mean number of take backs to the operating room for secondary procedure was statistically significant between the groups in favor of NSG (p = 0.001). Conclusion Careful preoperative planning and adoption of appropriate reconstructive strategies can improve clinical and aesthetic outcomes in LD flap breast reconstruction at long-term follow-up. Level of Evidence This is a level III, therapeutic study.

Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic Results.

Background Correlation among age, clinical, and aesthetic outcomes in implant-based and autologous breast reconstructions was investigated. Methods Between 2004 and 2014, a retrospective study was performed on patients who underwent reconstruction following mastectomy. Patients were divided in group A (< 50 years), group B (≥ 50-59 years), group C (≥ 60-69 years), and group D (≥ 70 years). Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and length of stay were assessed using chi-square and Kruskal-Wallis H analysis considering p ≤ 0.05 as significant. Pre- and postoperative photographs were taken to grade aesthetic results by patients and blinded plastic surgery team. Results A total of 993 patients underwent 1,251 breast reconstructions, of which 356 (28.5%) were implant-based, 402 (32.1%) pedicled-flap, 445 (35.6%) free-flap, and 48 (3.8%) fat-graft reconstructions. There were 316 (25.2%) complications, of which 124 (34.8%) in implant-based, 74 (18.4%) in pedicled-flap, 111 (24.9%) in free-flap, and 2 (4.2%) in fat-graft reconstructions. Mean length of stay was 5.4 days without significant difference between age groups (p = 0.357). The incidence of overall complications was not significantly related to age, ASA class, smoking history, and previous radiotherapy. Body mass index was a significant predictor (p = 0.001), but odds ratio (OR: 1.2) demonstrated only a minimal increase in risk. Implant-based reconstruction was associated with a higher risk for complications compared with the other ones (OR: 2.5, p = 0.001). Patient and surgeon aesthetic surveys demonstrated an overall positive opinion in all age groups for each reconstructive option. Conclusion Advanced age should not be considered a risk factor for breast reconstruction, while implant-based technique was associated with a higher risk for complications compared with autologous that may provide older women with greater benefits.

One-stage DIEP flap breast reconstruction: Algorithm for immediate contralateral symmetrization.

The aim of this study was to investigate clinical and aesthetic results of simultaneous contralateral balancing procedures in unilateral DIEP flap reconstructions by means of a symmetrization algorithm. Between 2004 and 2013, 335 patients underwent DIEP flap breast reconstruction with 48 patients (mean age 51.8 years, range 32-69 years) undergoing contralateral procedure. Patients were divided in Group-A including 31 cases who underwent one-stage procedure and Group-B including 17 cases who underwent staged procedure. A symmetrization algorithm was proposed to plan immediate breast reduction/mastopexy. The groups were homogeneous regarding patient's age, BMI, mastectomy and flap weight (P > 0.05). All flaps survived. No complications were observed to the mastectomy skin flaps and to the reduction mammaplasty/mastopexy procedures in both groups. The mean operation time was 5 h in Group-A while 5 h and 37 min in Group-B (P = 0.0682). Contralateral procedures included 23 breast reductions and 8 mastopexies in Group-A, while 10 breast reductions and 7 mastopexies were performed in Group-B. Two and 6 patients required revision of the balancing procedure in Group-A and Group-B, respectively. The follow-up time was 47.3 months (range 14-120 months) in Group-A and 91.3 months (range 41-110 months) in Group-B. Volume, upper/lower pole shape, projection, breast mound placement, IMF, symmetry, overall appearance, and general satisfaction sub-items obtained high-score evaluation without significant difference between the two groups (P > 0.05). One-stage DIEP flap reconstruction by means of the symmetrization algorithm resulted in comparable aesthetic outcomes and patient satisfaction to a staged procedure.

Sensate anterolateral thigh perforator flap for ischiatic sores reconstruction in meningomyelocele patients.

Recidivating pressure sores are a frequent complication in meningomyelocele patients because of their limitation in motility and their scarce ability to monitor the pressure applied on insensate areas while seated. We report the utilization of the sensate pedicled anterolateral thigh perforator flap for reconstruction of ischiatic sores in meningomyelocele patients. Between May 2011 and September 2013, five patients underwent transfer of a sensate pedicled anterolateral thigh flap, by an intermuscular passageway through the upper thigh, to reach the ischial defect. Flap was properly harvested from the thigh after assessment of the lateral cutaneous femoral nerve sensitive area with the Pressure-Specified Sensory Device. In all cases the flap reached the ischial defect harmlessly, healing was uneventful with no immediate nor late complications. Each patient showed persistence of sensitivity at the reconstructed area and no recurrent ischiatic sore was observed at mean follow-up of 26.4 months. The sensate pedicled anterolateral thigh flap is a valuable solution for coverage of recurrent ischial sores in meningomyelocele patients, in which pressure consciousness is fundamental. The intermuscular passageway allows to reduce the distance between flap's vascular pedicle origin and the ischial defect, hence to use the more reliable skin from the middle third of the anterolateral thigh.

DIEP flap sentinel skin paddle positioning algorithm.

Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free-tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand-held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward. Skin paddle (SP) position was preoperatively drawn following mastectomy type incisions; in skin-sparing mastectomies types I-III a small SP (sSP) replaces nipple-areola complex; in skin-sparing mastectomy type IV, SSP is positioned between wise-pattern branches while in type V between medial/lateral branches. In case of nipple-sparing mastectomy SSP is positioned at inframammary fold or in lateral/medial branches of omega/inverted omega incision if used. Three hundred forty-seven DIEP flap breast reconstructions were reviewed and stratified according to SP type into group A including 216 flaps with large SP and group B including 131 flaps with SSP and sSP. Sixteen flaps (4.6%) were taken back for pedicle compromise, 13 of which were salvaged (81.25%), 11 among 13 from group A and 2 among 3 from group B. There was no statistical difference between the groups concerning microvascular complication rate (P = 0.108), and time until take-back (P = 0.521) and flap salvage rate (P = 0.473) resulted independent of SP type. Our results suggest that early detection of perfusion impairment and successful flaps salvage could be achieved using SSP for buried DIEP flap monitoring, without adjunctive expensive monitoring tests.

The axillary versus internal mammary recipient vessel sites for breast reconstruction with diep flaps: a retrospective study of 256 consecutive cases.

The aim of this study is to present our experience on the use of various recipient sites for deep inferior epigastric perforator (DIEP) flap breast reconstruction and compare them by means of objective data. Two hundred fifty six DIEP flap breast reconstructions, performed between March 2004 and May 2011, were retrospectively analyzed. Only unilateral reconstructions were included in the study and divided into three groups depending on the recipient site choice: internal mammary vessels (IMV) (n = 52), thoracodorsal vessels (TDV) (n = 109), and circumflex scapular vessels (CSV) (n = 95). Clinical records of each patient were reviewed to acquire relevant data such as operative time, postoperative complications, and use of a second vein anastomosis. CSV group showed a statistically significant lower operative time (4.92 ± 0.54 hours) compared to TDV (5.67 ± 1.01 hours) and IMV groups (6.75 ± 1.09 hours) (P < 0.001). Second vein anastomosis was performed in 84 cases (88.1%) of CSV, in 85 cases (77.9%) of TDV, and in 18 cases (35.1%) of IMV groups (P < 0.001). No significant differences were observed among groups regarding risk factors and complications (P > 0.05). The axillary vessels seem to be the ideal recipient site because of reduced operative time and increased possibility to perform a second vein anastomosis. Among them, CSV can be safely used due to following advantages: easy dissection, larger vessel caliber, and optimal flap insetting. Moreover, their location does not expose them completely to radiotherapy consequences.

Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face.

Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21-month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P = 0.028) and texture (P = 0.021) match, shape (P = 0.047) and bulkiness (P = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face.

Breast Reconstruction with Delayed Fat-Graft-Augmented DIEP Flap in Patients with Insufficient Donor-Site Volume.

BACKGROUND: Microvascular reconstruction provides natural, lasting breasts that can be integrated easily into body image but most thin patients are often not ideal candidates because of inadequate donor-site volume. The purpose of this study was to present our experience in delayed augmented DIEP flaps with large fat-volume transfer. METHODS: From 2010 to 2014, 20 consecutive patients were prospectively enrolled for delayed fat-graft-augmented DIEP flaps (active group, AG) and matched with a control group (CG) submitted to the same procedure without fat-injection. Patient's age, mastectomy and flap weight, number of take-backs to the theater for secondary procedures, total treatment period (TTP), and complications were collected and analyzed. Patient and surgeon surveys rated aesthetic outcomes. Continuous and categorical variables were analyzed using student t test and Kruskal-Wallis test, respectively. A value of p ≤ 0.05 was considered statistically significant. RESULTS: The groups did not differ in age and mastectomy weight (p > 0.05). The AG had a smaller BMI and flap weight (p < 0.05). Comparison of the mean number of take-backs (1.5 in AG vs. 1.4 in CG) and mean TTP (8.6 months in AG vs. 8.9 months in CG) did not show a significant difference (p > 0.05) between groups. Volume, upper/lower-pole shapes, projection, breast mound placement, IMF, symmetry, overall appearance, and general satisfaction sub-items obtained high-score evaluation without a significant difference between groups (p > 0.05). CONCLUSION: Delayed fat-graft-augmented DIEP flaps can be offered to patients with insufficient donor-site volume and medium/large breasts. In comparison with the same technique without fat grafting, no additional take-backs and no prolonged TTP were required to achieve pleasing aesthetic results. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Accidental injury of the latissimus dorsi flap pedicle during axillae dissection: types and reconstruction algorithm.

The intra-operative latissimus dorsi (LD) pedicle damage during axillary lymph-node dissection by the general surgeon is a rare complication leading to flap failure and poor outcomes. The authors present their experience on this topic and develop a classification of the thoracodorsal (TD) pedicle injuries and reconstruction algorithm. Pedicle damage of LD occurred in five cases, three of which were experienced during immediate breast reconstruction and two observed in patients who underwent prior surgery. In two cases the thoracodorsal vein (TDV) was damaged in its proximal segment, thus end-to-end anastomosis was performed between distal stump of TDV and circumflex scapular vein (CSV). In one case the TDV required simple microsurgical repair while in other two cases the severe damage of vein and artery required more complex surgical strategies in attempt to salvage the flap. Four cases completely survived with one case of rippling phenomenon. One case had partial flap necrosis that required subtotal muscle resection. Based on these cases, the authors have developed a reconstruction algorithm in attempt to repair LD pedicle damage while preserving breast reconstruction. Taking into account its anatomical conformation, TD pedicle injuries are classified in four different types and available options are suggested for all of them according to the anatomical site and to the mechanism and timing of injury.

Total breast reconstruction using autologous fat grafting following nipple-sparing mastectomy in irradiated and non-irradiated patients.

BACKGROUND: Although autologous microvascular reconstruction following nipple-sparing mastectomy (NSM) is considered one of the best reconstructive choices, this procedure cannot be offered to all patients. The aim of this study was to define a fat grafting protocol for successful reconstruction following NSM and to assess its reliability in irradiated and non-irradiated patients. MATERIALS AND METHODS: Twenty-one patients were prospectively enrolled and stratified in Group-A (11 non-irradiated) and Group-B (10 irradiated) NSMs comparing clinical and aesthetic outcomes. A fat grafting protocol was used to standardize the procedure. Continuous and categorical variables were analysed using the Student t test and the Kruskal-Wallis test, respectively. A value of p ≤ 0.05 was considered statistically significant. RESULTS: The groups were homogeneous in terms of demographics (p > 0.05), while number of sessions, mean volume of the first two treatments, and overall injected volume showed significant differences (p < 0.001; p < 0.001; p = 0.002). Volume, shape, position of the breast mound, IMF and scar location subscales obtained high score evaluations without a significant difference between the groups (p > 0.05), whereas the skin texture subscale showed a lower score evaluation in Group-B than in Group-A (p = 0.001). Although a significant difference for total subscales was in favour of Group-A (p = 0.001), the global score had a high rate evaluation in both groups (p = 0.132). Inter-rater reliability showed substantial agreement among all categories, total and global scores. CONCLUSIONS: To the best of our knowledge, this is the first prospective series of fat transfer reconstructions following NSM using a systematic approach. Although further studies are required, it may be considered an effective option whenever flap reconstruction cannot be performed. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Permanent latissimus dorsi muscle denervation in breast reconstruction.

BACKGROUND: A retrospective analysis of our series of denervated latissimus dorsi (LD) breast reconstructions showed a high incidence of postoperative LD contraction. Anatomical studies with a prospective clinical trial are set up to outline a successful denervation procedure. METHODS: Fifteen fresh cadavers were dissected to study thoracodorsal nerve course. Subsequently, 40 consecutive LD breast reconstructions were divided randomly in equal groups and underwent either distal (group A) or proximal (group B) nerve resection and clipping. The presence of postoperative contraction was evaluated clinically and instrumentally at 2-year follow-up. Statistical analysis of data was performed by Fisher exact test. RESULTS: Cadaver dissections showed distal branching of thoracodorsal nerve in 20% of cases. Incidence of postoperative LD contraction was 35% (7/20) in group A and 0% in group B. A significantly lower rate of contraction in group B was demonstrated (P = 0.004). CONCLUSIONS: Type B proximal nerve resection allows for effective denervation reducing incidence of postoperative contraction (P = 0.004).

Stensen duct relocation after cheek mucosa tumor resection.

Cheek mucosa cancer might surround Stensen meatus requiring preservation and relocation of the duct. Sialodochoplasty is necessary to avoid subsequent stricture, cheek swelling, and obstructive sequelae that could make following oncologic follow-up difficult. We report a simple successful technique of parotid duct cannulation and relocation in a 77-year-old woman who underwent cheek mucosa tumor resection for squamous cell carcinoma and free fasciocutaneous forearm reconstruction. Ability of milk clear saliva from the duct orifice after 6 weeks from surgery was assessed clinically, and no fistula or swelling was experienced. Stensen duct cannulation and relocation are a useful adjunctive procedure in the treatment of oral mucosa cancer, preserving salivary gland function while not compromising cancer resection.