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Introduction: Osteoradionecrosis (ORN) of the mandible is an unfortunate potential sequela of radiotherapy for head and neck cancer. In advanced cases of ORN, mandibulectomy, and free fibula flap reconstruction are required. We hypothesized that patients undergoing fibula free flap reconstruction and mandibulectomy for ORN pose unique challenges and experience more complications than patients undergoing fibula free flaps after oncologic mandibulectomy. Methods: After IRB approval, we created a database of all free fibula flaps for mandible reconstruction from April 2005 through February 2019. Medical records were retrospectively reviewed for patient and surgical characteristics and postoperative outcomes. Results: Four‐hundred seventy‐nine patients met the inclusion criteria (168 ORN vs. 311 non‐ORN patients). Propensity‐matching was performed based on age, BMI, smoking status, preoperative chemotherapy, and virtual surgery planning use, which yielded 159 patients in each group. ORN patients received more double‐skin‐island fibula flaps than non‐OR patients (20.8% vs. 5.7%, p < 0.001). Recipient artery other than the facial artery was utilized more commonly in ORN patients (42.1% vs. 17.0%, p < 0.001). In the unmatched cohort, ORN patients had higher rates of delayed wound healing (26.2% vs. 16.8%, p = 0.01) and surgical site infections (21.4% vs. 13.2%, p = 0.02). Rates of flap loss, return to the operating room, hematoma, operative time, and length of stay were similar between the groups. On logistic regression analysis, osteoradionecrosis was an independent risk factor for delayed wound healing. Conclusion: Based on these data, mandibular reconstruction with fibula flaps for osteoradionecrosis appears more complicated than mandible reconstruction following de novo cancer resection. Surgeons should anticipate employing two skin islands for intraoral and extraoral resurfacing, utilizing unconventional recipient vessels, and managing the delayed wound healing that ensues more commonly than non‐ORN patients. [ABSTRACT FROM AUTHOR]

Objective: Examine outcomes for lateral arm autologous tissue transfer in head and neck reconstruction. Study Design: Retrospective cohort study. Setting: Tertiary cancer center. Methods: All patients who underwent traditional lateral arm, extended lateral arm, and lateral forearm flaps for head and neck reconstruction from 2012 to 2022 were assessed. Disabilities of the arm, shoulder, and hand (DASH) was measured. Factors associated with complications and enteral or mixed diet were evaluated by multivariable regression. Results: Among 160 patients followed for a median of 2.3 ± 2.1 years, defects were 54% oral tongue, 18% external, 9% maxilla, 8% buccal mucosa, 9% floor of mouth, and 3% pharynx. Flap types (and median pedicle lengths) were 41% traditional lateral arm (8 cm), 25% extended lateral arm (11.5 cm), and 34% lateral forearm (14 cm). All donor sites were closed primarily; 19.6% and 0% of patients had increased DASH scores 2 and 12 weeks after reconstruction. Major complications occurred in 18.1% of patients, including 6.3% reoperation, 6.9% readmission, 3.7% fistula, and 1.8% flap loss. Complications were independently associated with peripheral vascular disease (odds ratio [OR]: 5.71, 95% confidence interval [CI]: 1.5‐21.6, P =.01), pharyngeal defects (OR: 11.3, 95% CI: 1.4‐94.5, P =.025), and interposition vein grafts (OR: 3.78, 95% CI: 1.1‐13.3, P =.037). Conclusion: The lateral arm free flap was safe, versatile, and reliable for head and neck reconstruction with low donor‐site morbidity. Complications occurred in a fifth of patients and were associated with peripheral vascular disease, pharyngeal defects, and vein grafts. [ABSTRACT FROM AUTHOR]

Introduction: The lateral forearm flap (LFF) is a thin fasciocutaneous flap with a donor site that can be closed primarily. Methods: A retrospective analysis of donor site morbidity and hand function was performed in patients who underwent a radial forearm flap (RFF), ulnar artery perforator flap (UAPF), or LFF. Flap thickness was evaluated radiographically in 50 control patients. Results: Of 134 patients (lateral forearm flap: n = 49, RFF: n = 47, UAPF: n = 38), the LFF demonstrated significantly faster return to baseline hand grip strength (3 months vs. 12 months in RFF and UAPF; p < 0.001), had significantly fewer donor site complications (6.1% compared to 6.4% in RFF and 28.9% in UAPF; p = 0.003) and fewer sensory deficits (2.0% compared to 6.4% in RFF and 15.8% in UAPF sites; p = 0.013). The radiographic study confirmed the LFF to be the thinnest of all upper extremity flap options. Conclusions: The LFF is an excellent forearm‐based flap option with thin, pliable tissue and low donor site morbidity. [ABSTRACT FROM AUTHOR]

Background: Postoperative complications are an independent predictor of poor survival across several tumors. However, there is limited literature on the association between postoperative morbidity and long‐term survival following total laryngectomy (TL) for cancer. Methods: We conducted a retrospective review of all TL patients at a single institution from 2008 to 2013. Demographic and clinical data were collected and analyzed, including postsurgical outcomes, which were classified using the Clavien‐Dindo system. Multivariable Cox regression analyses were performed to identify factors associated with overall survival (OS) and disease‐free survival (DFS). Results: A total of 362 patients were identified. The mean age was 64 years, and the majority of patients were male (81%). The median follow‐up interval was 21 months. Fifty‐seven percent of patients had received preoperative radiation, and 40% had received preoperative chemotherapy. Fifty‐seven percent of patients underwent salvage TL, and 60% underwent advanced reconstruction (45% free flap and 15% pedicled flap). A total of 136 patients (37.6%) developed postoperative complications, 92 (25.4%) of which were major. Multivariable modeling demonstrated that postoperative complications independently predicted shorter OS (hazard ratio [HR], 1.50; 95% CI, 1.16‐1.96; P =.002) and DFS (HR, 1.36; 95% CI, 1.05‐1.76; P =.021). Other independent negative predictors of OS and DFS included positive lymph node status, preoperative chemotherapy, comorbidity grade, and delayed adjuvant therapy. Severity of complication and reason for TL (salvage vs primary) were not shown to be predictive of OS or DFS. Conclusion: Postoperative complications are associated with worse long‐term OS and DFS relative to uncomplicated cases. Patient optimization and timely management of postoperative complications may play a critical role in long‐term survival. Postoperative complications are negative predictors of long‐term overall and disease‐free survival in patients who undergo total laryngectomy for laryngeal cancer. Patient optimization and timely management of postoperative complications may play a critical role in long‐term survival. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Risk factors and techniques for free flap salvage in head and neck reconstruction are poorly described. Methods We conducted a retrospective review of all head and neck free flaps performed from 2000 to 2010. Results Overall, 151 of 2296 flaps (6.6%) underwent salvage for microvascular complications. Age, comorbidities, surgeon experience ( p = .88), vein grafts, and supercharging ( p = .45) did not affect flap salvage. Muscle-only flaps ( p = .002) were associated with significantly worse outcomes. Coupled venous anastomoses were superior to handsewn anastomoses ( p = .03). Arteriovenous thrombosis had worse outcomes than a venous or arterial thrombosis alone ( p < .0001). Anticoagulation, thrombolytics, and thrombectomy did not improve survival. Multiple takebacks ( p = .003) and late takebacks (>3 days) had significantly worse outcomes ( p = .003). Flap salvage was 60.3% successful with 60 total flap losses (2.6%). Conclusion Although flap salvage should be attempted, multiple attempts are not recommended, especially for muscle-only flaps. Combined arteriovenous and late thrombosis has a dismal prognosis regardless of different salvage techniques. © 2015 Wiley Periodicals, Inc. Head Neck 38: E771-E775, 2016 [ABSTRACT FROM AUTHOR]

Background While a large body of literature exists involving normative measurements for the craniofacial skeleton, few have analyzed the necessary dimensions that are pertinent in reconstruction using microvascular free flaps. Methods Cephalometric analysis was performed using 3-dimensional CT scans from 70 adults. Relevant dimensions of the fibula were obtained from a subset of 20 patients. Results Normative cephalometric values, including various distances and angles, for the mandible and maxilla were obtained and compared to the dimensions of the fibula. Comparisons were made between measurements from men and women, and patients with full dentition and edentulous patients. Schematics for designing mandibular and maxillary reconstructions are presented. Conclusion When premorbid craniofacial anatomy cannot be discerned in the setting of extensive trauma or tumor involvement, normative dimensions may be a helpful guide for flap design and should be in the armamentarium of surgeons engaged in complex head and heck reconstruction. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background Mandibular osteoradionecrosis is the most devastating complication after radiation therapy for head and neck malignancies. Quality of life (QOL) after surgical treatment is unclear. Methods A retrospective cohort analysis (1997-2007) was conducted of all patients treated at our institution for stage II and III mandibular osteoradionecrosis. Nineteen of 35 patients responded to a modified University of Washington QOL questionnaire. Twenty had undergone reconstruction using free flaps, and the remainder with plates, plates and local flaps, or debridement alone. Results Complications included 3 infections, 5 with hardware, 5 flap-specific, and 1 nonunion. Four patients had recurrent squamous cell carcinoma (SCC). The factors of greatest concern to patients were appearance, swallowing, and chewing. Average overall QOL was good to very good, and very good compared to preoperative. Conclusion Despite a 37% complication rate, a multidisciplinary team approach with adequate debridement, resection, and reconstruction can greatly improve QOL. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Classic tissue engineering paradigms are limited by the incorporation of a functional vasculature and a reliable means for reimplantation into the host circulation. We have developed a novel approach to overcome these obstacles using autologous explanted microcirculatory beds (EMBs) as bioscaffolds for engineering complex three-dimensional constructs. In this study, EMBs consisting of an afferent artery, capillary beds, efferent vein, and surrounding parenchymal tissue are explanted and maintained for 24 h ex vivo in a bioreactor that preserves EMB viability and function. Given the rapidly advancing field of stem cell biology, EMBs were subsequently seeded with three distinct stem cell populations, multipotent adult progenitor cells (MAPCs), and bone marrow and adipose tissue-derived mesenchymal stem cells (MSCs). We demonstrate MAPCs, as well as MSCs, are able to egress from the microcirculation into the parenchymal space, forming proliferative clusters. Likewise, human adipose tissue-derived MSCs were also found to egress from the vasculature and seed into the EMBs, suggesting feasibility of this technology for clinical applications. We further demonstrate that MSCs can be transfected to express a luciferase protein and continue to remain viable and maintain luciferase expression in vivo. By using the vascular network of EMBs, EMBs can be perfused ex vivo and seeded with stem cells, which can potentially be directed to differentiate into neo-organs or transfected to replace failing organs and deficient proteins. [ABSTRACT FROM AUTHOR]

Hypertrophic scars occur following cutaneous wounding and result in severe functional and esthetic defects. The pathophysiology of this process remains unknown. Here, we demonstrate for the first time that mechanical stress applied to a healing wound is sufficient to produce hypertrophic scars in mice. The resulting scars are histopathologically identical to human hypertrophic scars and persist for more than six months following a brief (one-week) period of augmented mechanical stress during the proliferative phase of wound healing. Resulting scars are structurally identical to human hypertrophic scars and showed dramatic increases in volume (20-fold) and cellular density (20-fold). The increased cellularity is accompanied by a four-fold decrease in cellular apoptosis and increased activation of the prosurvival marker Akt. To clarify the importance of apoptosis in hypertrophic scar formation, we examine the effects of mechanical loading on cutaneous wounds of animals with altered pathways of cellular apoptosis. In p53-null mice, with downregulated cellular apoptosis, we observe significantly greater scar hypertrophy and cellular density. Conversely, scar hypertrophy and cellular density are significantly reduced in proapoptotic BclII-null mice. We conclude that mechanical loading early in the proliferative phase of wound healing produces hypertrophic scars by inhibiting cellular apoptosis through an Akt-dependent mechanism. [ABSTRACT FROM AUTHOR]

Presents an overview of a study which examined the effect of pulsed electromagnetic fields (PEMF) on angiogenesis in order to elucidate a potential mechanism for its therapeutic effect. Effects of PEMF on endothelial tubule formation; Role of PEMF in endothelial formation; Impact of PEMF on vivo angiogenesis.