Search

Background Although the deltoid flap is widely described as a thin flap, no studies have reported on the measurement of its thickness. Thus, this study aimed to measure deltoid flap thickness at different points using brightness-mode ultrasonography and report our initial clinical experience. Methods This study included 36 adults (26 males and 10 females; mean age: 34 years) with 72 healthy deltoid regions. Ultrasonography was employed to measure flap thickness at eight designated positions. The ultrasonography results were also applied clinically in 30 patients to evaluate its compatibility. Results The mean deltoid flap thickness was 5.14 ± 0.81 mm, with the thickest point being the emerging point of the flap pedicle. The subcutaneous fat gradually thinned toward the shoulder. No significant differences in the subcutaneous fat layer thickness were observed between the right and left sides, different ages, or the two sexes. Body mass index was the most critical factor related to flap thickness (p < 0.001). All deltoid free flaps were successfully transferred, resulting in good or excellent final clinical outcomes. Conclusion The ultrasonography results suggest harvesting the deltoid flap upward toward the shoulder area and across the acromion from the emerging position of the flap pedicle to optimize flap thinness. The results showed that besides the flaps that have been clinically well established, the deltoid flap should be considered a valuable alternative for reconstructing limb soft-tissue defects, particularly where thin flaps are required and favorable aesthetic results are crucial. [ABSTRACT FROM AUTHOR]

Background Autologous breast reconstruction (ABR) after mastectomy is increasing due to benefits over implant-based reconstruction. However, free flap reconstruction is not universally offered to patients of advanced age due to perceived increased perioperative risk. Methods Patients undergoing free flap breast reconstruction at our institution from 2005 to 2018 were included. Risk-adjusted logistic regression models were fit while controlling for demographic and comorbid characteristics to determine the association of age with the probability of venous thromboembolism (VTE), delayed healing, skin necrosis, surgical site infection (SSI), seroma, hematoma, hernia, and flap loss. Linear predictions from risk-adjusted logistic regression models were used to create spline curves and determine the risk of outcomes associated with age. Results A cohort of 2,598 patients underwent free flap breast reconstruction in the period examined. The median age was 51 with approximately 9% of patients being 65 or older. Increased age was associated with a greater risk of delayed healing, skin necrosis, and hematoma after surgery. There was no increased risk of medical complications such as VTE or complications such as flap loss, seroma, or SSI. Conclusion A set age cutoff for patients undergoing free flap breast reconstruction does not appear warranted. There is no difference in major surgical complications such as flap loss with increasing age. However, older age does predispose patients to specific wound complications such as hematoma, skin necrosis, and delayed wound healing, which should guide preoperative counseling. Further, medical complications do not increase with advanced age. Overall, however, the safety of ABR in older patients appears uncompromised. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the efficacy of non-detachable free-floating bone flap posterior cranial vault release (FFBF-PCVR) in syndromic craniosynostosis. A retrospective review was completed of subjects who underwent FFBF-PCVR at 4 time-points: within 3 months preoperatively, 7 days postoperatively, 3 months postoperatively and at the last follow-up postoperatively. Volumetric and craniometric data, the ratio of ventricular diameter, and the cerebellar tonsillar descent were measured after FFBF-PCVR by using computed tomographic and magnetic resonance imaging. A total of 19 patients underwent FFBF-PCVR. The mean age was 11.7 months (range 4–36 months). The mid cranial height, posterior cranial height, and anterior posterior diameter length significantly increased from preoperative to postoperative 7 days, from postoperative 7 days to postoperative3 months, and from postoperative 3 months to the last follow-up. There was a significant increase in pre- to 7 days postoperative intracranial volume (1195.21 ± 246.56 cm³, p < 0.001; respectively), 3 months postoperative intracranial volume (1228.03 ± 249.61 cm³, p < 0.001; respectively), and intracranial volume at last follow-up (1390.25 ± 219.99 cm³, p < 0.001; respectively). There was a significant increase in 7 days' postoperative to 3 months' postoperative intracranial volume (p < 0.001; respectively), and intracranial volume at last follow-up (p < 0.001; respectively). There was a significant increase in 3 months postoperative to intracranial volume at last follow-up (p < 0.001). The mean intracranial volume increased by an average of 36.6 percent (range, 18.1 to 79.2 percent) at last follow-up. The degree of hydrocephalus in the preoperative child was (45.77% ± 9.17%), and at the last follow-up after surgery, the degree of hydrocephalus was (35.02 ± 9.50%), p < 0.01). Preoperatively, 14 patients (73.7 percent) had radiographic evidence of Chiari malformation type I. The cerebellar tonsillar descent, measured using pre- and postoperative MRI, decreased in all patients after FFBF-PCVR (preoperative: 7.5 ± 1.4 mm, postoperative: 5.3 ± 1.7 mm; p = 0.001). FFBF-PCVR can efficiently expand the posterior cranial vault with only one surgical procedure. Moreover, it helps to relieve hydrocephalus and cerebellar tonsillar herniation. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the influence of medial femoral condyle (MFC) free flap harvest on donor site muscle strength and kinematic parameters of gait. The study included 30 patients treated for head and neck squamous cell carcinoma who underwent reconstruction with an MFC free flap. In each case, the donor site was the left thigh. A dynamometer was used to measure muscle strength, in isokinetic bilateral mode and with concentric contraction for the extension/flexion knee pattern, at 18 months postoperative. In addition, kinematic data were obtained and evaluated. On statistical analysis, no significant difference in muscle strength of the quadriceps muscle was found between the left involved and right uninvolved lower extremities (P = 0.124). Also, when comparing hamstring strength, no statistically significant difference was found between the left involved and right uninvolved sides (P = 0.210). Moreover, spatiotemporal gait parameters did not differ significantly between the involved and uninvolved legs (all P > 0.05), and no differences in kinematic or kinetic parameters were observed. This study reports the effects of MFC free flap harvest on the knee muscle strength and locomotion of patients. For most biomechanical parameters investigated, there was no effect (positive or negative). [ABSTRACT FROM AUTHOR]

Reconstructive surgeons often use a free radial forearm flap for nasal reconstruction when a forehead flap is not an option, but this flap has drawbacks. This article presents a series of patients with complex defects who underwent reconstruction with an anterolateral thigh (ALT) flap. Severe burns and cancer resection may lead to the loss of multiple anatomical units, including the entire nose and nearby structures. Multiple materials are required for reconstruction in those with complex total nasal defects involving adjacent areas. In this series of patients, a chimeric ALT flap was harvested and thinned to recreate the three-dimensional nasal structure and cover the adjacent area. Cartilage and alloplastic materials were used as the nasal framework, and the skin flap was folded for the mucosal lining. The results were good with an excellent contour, and no complications or airway obstruction were observed during follow-up. By thinning the ALT flap, this flap can be an alternative for complex reconstructions that require a facial or three-dimensional nasal structure. [ABSTRACT FROM AUTHOR]

Copyright of Plastic Surgery is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Head and neck free flap reconstruction presents challenges in managing intraoperative circulation, potentially leading to prolonged length of stay (PLOS). Limited research exists on the associations between intraoperative circulation and PLOS given the difficulty of manual quantification of intraoperative circulation time-series data. Therefore, this study aimed to quantify intraoperative circulation data and investigate its association with PLOS after free flap reconstruction utilizing machine learning algorithms. Methods: 804 patients who underwent head and neck free flap reconstruction between September 2019 and February 2021 were included. Machine learning tools (Fourier transform, et al.) were utilized to extract features to quantify intraoperative circulation data. To compare the accuracy of quantified intraoperative circulation and manual intraoperative circulation assessments in the PLOS prediction, predictive models based on these 2 assessment methods were developed and validated. Results: Intraoperative circulation was quantified and a total of 114 features were extracted from intraoperative circulation data. Quantified intraoperative circulation models with a real-time predictive manner were constructed. A higher area under the receiver operating characteristic curve (AUROC) was observed in quantified intraoperative circulation data models (0.801 [95% CI, 0.733–0.869]) compared to manual intraoperative circulation assessment models (0.719 [95% CI, 0.641–0.797]) in PLOS prediction. Conclusion: Machine learning algorithms facilitated quantification of intraoperative circulation data. The developed real-time quantified intraoperative circulation prediction models based on this quantification offer a potential strategy to optimize intraoperative circulation management and mitigate PLOS following head and neck free flap reconstruction. [ABSTRACT FROM AUTHOR]

Background. Removal of the rib and adjacent cartilage is a common step for exposure of the recipient chest vessels in free-flap breast reconstructions. However, this adds both short- and long-term morbidity to the procedure. We describe our experience in avoiding rib removal in microvascular breast reconstruction. Patients and Methods. We retrospectively reviewed recipient vessel preparation in free-flap breast reconstructions performed by a single surgeon (SGB). Results. A total of 556 consecutive patients, totaling 1106 flaps over 5 years, were assessed. Recipient vessels included IMA in 1068 flaps and internal mammary perforator in 38 DIEP flaps. Nine patients underwent bilateral DIEP flap breast reconstruction with a cross-chest anastomosis, where the IMA was the recipient. Also, the IMA was used in 171 patients who underwent breast reconstruction with stacked flaps. No instances of complete rib resection were reported. However, in two cases of delayed DIEP flap reconstruction without a history of radiation, resection of 20% of the rib was required for safe vessel preparation. No intraoperative complications were observed, and three flaps from different patients were lost (one PAP and two DIEPs). Conclusions. Microsurgery in free-flap breast reconstructions has greatly evolved in the past two decades. Exposure of the IMA recipient vessels typically involves the removal of a portion of the intercostal cartilage and the rib, allowing comfortable and safe management of the vasculature during dissection and anastomosis. Nonetheless, excessive removal often leads to short-term increased pain and long-term cosmetic and functional complications, such as a noticeable depression of the chest wall especially noted in thin patients with small flaps. Our approach can be safely employed to preserve the anatomy and decrease pain, allowing for outpatient performance of these procedures. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare two surgical techniques—the free flap of the superficial palmar branch of the radial artery (SPBRA) and the free venous flap (FVF)—to evaluate their efficacy and aesthetic outcomes in repairing finger tissue defects. The goal was to determine which procedure offers faster healing curves and better overall patient outcomes, ultimately improving the quality of life for individuals undergoing these surgeries. Materials and Methods: A retrospective study was conducted using the clinical database of Sanliurfa Mehmet Akif Inan Education and Research Hospital, University of Health Sciences, from 1 January 2019 to 1 January 2022. A total of 44 patients with finger tissue defects, excluding thumb defects, were randomly divided into two groups: 21 patients underwent the SPBRA free flap procedure and 23 patients underwent the FVF procedure. Primary endpoints included flap survival rates, sensory recovery rates, aesthetic satisfaction scores, and complication rates. Data were collected during preoperative assessments and postoperative follow-ups at 1, 3, and 6 months. Results: The SPBRA group demonstrated a higher success rate (95% vs. 92%) and greater patient satisfaction in terms of restoring normal appearance and function. The SPBRA technique also showed superior sensory recovery with a lower two-point discrimination score (mean SPBRA = 6 mm vs. mean FVF = 8 mm). Functional outcomes, assessed by the Michigan Hand Outcomes Questionnaire, indicated higher scores for the SPBRA group (85/100) compared to the FVF group (80/100). Additionally, the SPBRA procedure was associated with fewer complications, highlighting its effectiveness and safety. Conclusions: The findings suggest that the SPBRA free flap technique offers better outcomes than the FVF procedure for repairing finger tissue defects. It provides superior functional restoration, enhanced cosmetic satisfaction, and a lower rate of complications. These results support the preference for the SPBRA technique in addressing complex finger tissue defects and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Maxillofacial reconstruction with dental implants in microvascular tissue flaps aims to improve mastication. However, the quality of life (QoL) impact of this intervention is yet to be determined. This systematic review assessed the QoL impact of maxillofacial reconstruction with implant-supported teeth compared to no dental rehabilitation, removable dentures, and obturator (modified denture). Additionally, we examined instruments applied to measure QoL in maxillofacial reconstruction. Methods: Databases Ovid Medline and Embase, Scopus, Web of Science and Handle on QoL were searched. Cohort, case–control and randomized controlled trials (RCT) were narratively synthesized for QoL captured through validated instruments. Study methodological quality was assessed using Cochrane Risk of Bias 2 and Risk of Bias in Non-randomized studies of Exposure. Instruments underwent COSMIN content validity analysis. Results: Of a total of 2735 studies screened, the three included studies (two cohort and one RCT) showed improved QoL with maxillofacial reconstruction compared to obturator and no dental rehabilitation. However, these studies have high risk of bias due to confounding. None of the instruments achieved a sufficient relevance rating for maxillofacial reconstruction, having been designed for other target populations and there is no evidence on their content validity for this population, but the EORTC QLQ30 H&N35 satisfied more COSMIN criteria than the UW-QOL and OHIP-14. Conclusion: Although studies showed favourable QoL with maxillofacial reconstruction involving dental implants, these have high risk of bias and further studies are needed to establish the impact. Existing QoL instruments lack content validity and tailored instruments are needed for QoL evaluation in maxillofacial reconstruction. [ABSTRACT FROM AUTHOR]

Background: Radial forearm free flap (RFFF) is considered one of the workhorses in modern head and neck reconstruction surgery due to its technical simplicity, versatility and less time-consuming harvest. Methods: In this report, we present the case of a 56-year-old woman with sublingual squamous cell carcinoma (SCC) who underwent surgical resection and reconstruction of the defect with a RFFF. Results: The preoperative Allen test showed normal blood flow, and the ultrasound did not recognize any blood vessel abnormalities in the left arm. However, during the RFFF harvest, when the dissection of the pedicle came to the cubital fossa, there was no brachial artery bifurcation. While trying to find the bifurcation, the dissection almost came to the axillary region. Hence, the RFFF was converted to a pedicle flap and was pulled through to the intraoral defect where it was used for reconstruction. Conclusions: Hence, during the preoperative radiological ultrasound, besides the usual characteristics such as the radial artery diameter, flow and possible obstructions, it is also important to explore if there are any other anatomical abnormalities that could influence the operation. [ABSTRACT FROM AUTHOR]

Donor site morbidity remains a significant concern in free flap microsurgery, with implications that extend beyond immediate postoperative outcomes to affect patients' long-term quality of life. This review explores the multi-faceted impact of donor site morbidity on physical, psychological, social, and occupational well-being, synthesizing findings from the existing literature. Particular attention is given to the functional limitations, sensory deficits, aesthetic outcomes, and chronic pain associated with commonly utilized free flaps. Advancements in surgical techniques, including nerve-sparing and muscle-sparing methods, as well as innovations, like perforator flaps, have demonstrated the potential to mitigate these morbidities. Furthermore, the integration of regenerative medicine strategies, such as stem cell therapy and fat grafting, and technological innovations, including virtual reality rehabilitation and biofeedback devices, has shown promise in enhancing recovery and minimizing long-term complications. Despite these advances, challenges persist in standardizing QoL assessments and optimizing donor site management. This review emphasizes the need for a holistic, patient-centered approach in reconstructive microsurgery, advocating for further research to refine current strategies, improve long-term outcomes, and develop robust tools for QoL evaluation. By addressing these gaps, reconstructive surgeons can better align surgical objectives with the comprehensive well-being of their patients. [ABSTRACT FROM AUTHOR]

Objective: To share the functional outcome of free vascularized fibular flap for shoulder reconstruction using Toronto Extremity Salvage Score (TESS). Study Design: Descriptive Cross-sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2023. Methods: All the patients presented with biopsy proven sarcoma involving proximal humerus were included in this study. Informed consent for data collection was obtained. Patient data regarding demographics, tumor location, extent of lesion, reconstruction and complications was collected from patient records. Six month follow up was done to assess functional recovery of the patient. Toronto Extremity Salvage Score (TESS) was used 6 months post-operatively to assess recovery of the patient using TESS questionnaire. Patient data was analyzed in using an open source software, GNU PSPP version 2.0.0. Results: A total of 11 patients were included in this study. Mean age of the patients was 15±3.5 years. Eight patients (72.7%) were male while 3 (27.3%) were female. Two patients has post-operative bleeding and 1 patient had fracture of fibula. Average TESS score was 61±7.71 years. Eight patients (72.7%) reported a good TESS score while 4 (27.3%) patients scored poor on TESSS Questionnire. Conclusion: Reconstruction of shoulder in sarcoma patients is a complex problem. Both prosthetic and biological reconstructive options present their own set of issues. In our experience, the use of free vascularized fibular flap (FVFF) presents a much better option with lower rate of infection and on average good Toronto Extremity Salvage Score (TESS) Scores. [ABSTRACT FROM AUTHOR]

Reconstruction of the chin region represents a technical challenge due to its three-dimensional configuration and its location close to the mouth. It requires both a functional approach by restoring mobility and an aesthetic approach by restoring the perioral furrows. For men who want to wear a beard, it becomes more difficult to choose the donor site for hairy skin. In that case, strategies of full thickness skin graft or pre-expanded loco-regional flaps are unusable. We propose here a functional, aesthetic and hairy reconstruction by performing a pre-expanded temporal free flap which allowed to resolve the problem of adjacent cervical contractures and to restore an integrated the bearded chin subunit. [ABSTRACT FROM AUTHOR]

Although the concept of the "fix and flap" approach, in which definitive fracture fixation and flap coverage are completed in a single procedure at the earliest opportunity may seem ideal for the treatment of Gustilo type IIIB open fractures, the individual circumstances of patients, such as polytrauma or multiple fracture cases may not allow for the immediate fracture fixation and flap coverage ("fix and flap" approach). In our hospital, patients with Gustilo type IIIB open fractures are treated with definitive internal fixation of the fracture followed by staged flap coverage ("fix followed by flap" protocol) when the "fix and flap" approach was not feasible due to the patient's condition or difficulty in coordinating surgery schedules. The "fix followed by flap" protocol provides benefits in terms of flexibility in adjusting the surgical timetable, simplifying the planning of flap coverage following fracture fixation, and minimizing individual surgical invasion. We reviewed 10 cases of severe open fractures treated with the "fix followed by flap" protocol and evaluated their outcomes. All surgical procedures, including wound debridement, fracture fixation, and flap coverage, were performed by orthoplastic surgeons specializing in both fracture surgery and microsurgery including soft tissue reconstruction. All free flaps survived, and no partial necrosis was observed. None of the patients developed postoperative deep infection up to the last follow-up. Fracture union was achieved in all patients with or without autologous bone grafts. The median time for union was 9.4 months (range, 4–12 months). This study presents favorable outcomes of treatment for Gustilo type IIIB open fractures with fracture fixation followed by staged flap coverage ("fix followed by flap" protocol). Despite a delay in flap coverage, the consistency of treatment provided by orthoplastic surgeons may have contributed to the favorable outcomes in this study. [ABSTRACT FROM AUTHOR]

Scalp reconstruction, particularly with complex defects and infection risks, often favors microvascular free flaps. However, this method can result in unavoidable alopecia and undesirable aesthetics. This report describes a novel case where hair transplantation via follicular unit extraction (FUE) was applied to a free myocutaneous flap. A 44-year-old woman with Moyamoya disease suffered intracerebral hemorrhage a decade ago. Craniotomies and autologous bone cranioplasties led to wound dehiscence, with subsequent failed local flaps and skin grafts, and identification of a methicillin-resistant Staphylococcus aureus infection. The final scalp defect, measuring 13 × 9 cm, was reconstructed using a free myocutaneous latissimus dorsi flap. Nine years post-surgery, a 1,500-unit FUE hair transplantation procedure was conducted. The transplanted hair exhibited robust survival with adequate blood supply, achieving a satisfactory 80 to 85% survival rate at 12 months. This resulted in a notable improvement in the patient's external alopecia, with reported high levels of satisfaction. Free flaps offer a valuable method for scalp defect reconstruction; however, they may not ensure optimal aesthetic satisfaction due to alopecia. Nonetheless, successful FUE hair transplantation on a myocutaneous free flap can yield satisfactory aesthetic results. [ABSTRACT FROM AUTHOR]

Background The purpose of this review is to characterize themes among the five reconstructive microsurgery articles achieving the highest Relative Citation Ratios (RCRs) published in the past 20 years in the top journals. In doing so, researchers may be better informed on how to propose salient research questions to impact the field and understand future directions in plastic surgery. Methods A cross-sectional study was conducted with articles published in the top three journals based on the Impact Factor: Plastic and Reconstructive Surgery, Journal of Reconstructive Microsurgery, and Annals of Plastic Surgery. A search strategy with controlled vocabulary and keywords was conducted in PubMed to extract all reconstructive microsurgery (RM) articles published between 2002 and 2020. A two-stage screening process to include only RM studies was performed, with a third reviewer moderating discordances. Articles' RCR data were extracted from the National Institutes of Health iCite. The top five articles with the highest RCRs were selected for analysis. Results We identified three features reflecting educational and clinical trends within RM that might be representative of super-performance in plastic surgery journals. These include (1) relevance to high-yield techniques in RM such as tissue flap procurement, indications, and outcomes, (2) identification of gaps in current knowledge of these topics, and (3) use of media and algorithms to provide clear recommendations. Conclusion Researchers hoping to have an impactful contribution should pose research questions that address these key themes. The RCR index is a valuable tool to appreciate performance within microsurgery literature and clinical trends within the field. [ABSTRACT FROM AUTHOR]

Background Free flaps are essential for limb salvage in patients with lower extremity (LE) trauma; however, significant donor-site morbidity could impact functional outcomes. This study compares postoperative ambulatory function between contralateral and ipsilateral free flap harvest in LE traumatic reconstruction. Methods A retrospective review was performed on patients who underwent LE reconstruction at a level 1 trauma center from 2009 to 2022. Flap characteristics, injury history, and ambulatory function were collected. Flap harvest laterality was determined in relation to the injured leg. The flaps were categorized as either fasciocutaneous or those that included a muscle component (muscle/myocutaneous). Chi-squared and Mann–Whitney tests were used for statistical analysis. Results Upon review, 173 LE free flaps were performed, of which 70 (65.4%) were harvested from the ipsilateral leg and 37 (34.6%) were from the contralateral leg. Among all LE free flaps, the limb salvage rate was 97.2%, and the flap survival rate was 94.4%. Full ambulation was achieved in 37 (52.9%) patients in the ipsilateral cohort and 18 (48.6%) in the contralateral cohort (p = 0.679). The average time to full ambulation did not vary between these cohorts (p = 0.071). However, upon subanalysis of the 61 muscle/myocutaneous flaps, the ipsilateral cohort had prolonged time to full ambulation (6.4 months, interquartile range [IQR]: 4.8–13.5) compared with the contralateral one (2.3 months, IQR: 2.3 [1.0–3.9]) p = 0.007. There was no significant difference in time to full ambulation between flap harvest laterality cohorts among the fasciocutaneous flaps (p = 0.733). Conclusion Among free flaps harvested from the ipsilateral leg, fasciocutaneous flaps were associated with faster recovery to full ambulation relative to muscle/myocutaneous flaps. Since harvesting muscle or myocutaneous flaps from the ipsilateral leg may be associated with a slower recovery of ambulation, surgeons may consider harvesting from a donor site on the contralateral leg if reconstruction requires a muscle component. [ABSTRACT FROM AUTHOR]

Background Postoperative new-onset atrial fibrillation (AF) has been shown to be associated with increased surgical morbidity and mortality following cancer ablation surgery. However, evidence of new-onset AF's impact on surgical outcomes in head and neck cancer patients undergoing tumor ablation and microvascular free tissue transfer remains scarce. This study aims to evaluate the association between AF and surgical outcomes in these patients. Methods We enrolled head and neck cancer patients who underwent tumor ablation reconstructed with microvascular free tissue transfer from the National Health Insurance Research Database (NHIRD). Patients were grouped into the following: (1) without AF, (2) new-onset AF, and (3) preexisting AF. The groups were matched by propensity score based on age, gender, cancer stage, and comorbidities. The primary outcome was postoperative complications, whereas all-cause mortality was the secondary outcome. Results In total, 26,817 patients were included in this study. After matching, we identified 2,176 (79.24%) patients without AF, 285 (10.37%) with preexisting AF, and 285 (10.37%) with new-onset AF. Our results demonstrated that the free flap failure rate was twofold escalated in patients with new-onset AF (9.8%) compared to those without AF (5.4%) or preexisting AF (5.3%; p = 0.01). However, we did not identify significant differences among other postoperative complications across groups. Additionally, we found that the risk of all-cause mortality was significantly elevated in patients with preexisting AF (p < 0.001) compared to those without AF or new-onset AF. Conclusion Our study demonstrated that new-onset AF is associated with an increased risk of flap failure and could serve as a predictor. On the other hand, all-cause mortality in patients with preexisting AF was significantly elevated. Close postoperative monitoring in patients with new-onset and preexisting AF is crucial to identify any potential adverse effects. [ABSTRACT FROM AUTHOR]

Background: Extramammary Paget's disease (EMPD) is a rare intra‐epidermal adenocarcinoma, and reconstruction of the penoscrotal region remains a clinical challenge. The superficial circumflex iliac artery perforator (SCIP) flap has been successfully used as a free flap, while its application as a propeller flap in the reconstruction of penoscrotal EMPD defect is rarely reported. The objective was to evaluate the safety and efficacy of the SCIP propeller flap in the reconstruction of penoscrotal defects in EMPD. Methods: Between September 2010 and August 2022, consecutive patients diagnosed with penoscrotal EMPD were enrolled. All patients underwent penoscrotal EMPD excision and reconstruction with SCIP propeller flap combined with other flaps or skin grafts on individual defects. Demographic information, surgical parameters, postoperative complications, patient satisfaction, and recurrence rates were analyzed. Results: Twenty‐four patients (mean age, 73 ± 8.8 years; mean BMI, 23.98 ± 3.62 kg/m2) with 33 SCIP propeller flaps (mean size 120.1 cm2; range, 24–208 cm2) were included, and the mean defect size was 67.4 cm2 (range, 12–255 cm2). The mean operative duration was 385.4 ± 146.8 min. Fifteen patients received autologous full‐thickness skin grafts, and four received other flaps simultaneously. All flaps survived without total or partial loss, and all donor sites achieved primary closure, though local hematoma (one case) and limited skin graft necrosis (two cases) were observed. All patients experienced complete wound healing and maintained penoscrotal morphology and function without recurrent lesions over a mean follow‐up of 59 months. Conclusions: The SCIP propeller flap seems a safe and effective reconstructive method for penoscrotal EMPD. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Introduction: The reconstruction of extensive scalp defects often requires free tissue transfer, offering single-stage and reliable reconstruction. The aim of this study is to evaluate the outcomes of free tissue transfer in scalp reconstruction. Patients and Methods: Thirteen patients were included in the study. Patient age, gender, smoking status, comorbidities, defect etiology, the specific type of flap used, the chosen recipient artery and vein, the need for revision, and flap success were reviewed. Results: The majority of the patients were male (76.9%). Defect reconstruction was performed using the latissimus dorsi musculocutaneous flap in 10 (71.4%) cases, which was followed by anterolateral thigh (ALT) and vertical rectus abdominis flaps. Two patients needed expansion of latissimus dorsi flaps. Superficial temporal vessels were used as recipient vessels in most patients. Three patients required anastomosis revision, all of which resulted in flap success. Conclusion: The high success rate observed in this study may be attributed to close monitoring of patients in the postoperative period and quick, early decision-making for revisions when necessary. The latissimus dorsi flap is the best option when large area coverage is needed, while the ALT flap is preferred when minimizing donor site morbidity is a priority. The vertical rectus abdominis myocutaneous flap offers the advantage of a long pedicle for anastomosis, though it comes with higher donor site morbidity. The superficial temporal artery and vein are reliable recipient vessels for scalp reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Heterotopic ossification (HO) is a rare occurrence in bony free flaps used in head-and-neck reconstructive surgery. HO is an incidental finding, described as a rare phenomenon in the literature. The periosteal theory is one of the most emphasized physiopathological descriptions for HO. This study aimed to address the causes, outcomes, and prevention of HO. Methods: This retrospective study included 30 patients undergoing reconstructive surgery for head-and-neck bone defects using bony free flaps. The patients underwent postoperative clinical examinations and computed tomography imaging. The age, sex, indications for reconstruction, ossification time, symptoms, and clinical findings were collected and reviewed. Results: The reviewed medical records showed that 5 patients developed HO after reconstruction with bony free flaps. Free fibula flap was used in 4 patients, whereas free medial femoral condylar flap was used in 1 patient. Conclusion: Clinical signs of HO were not observed in any patient. A modified approach with preservation of the periosteum is recommended in selected patients to avoid HO. Surgical ossification removal should be performed only in patients with symptoms. [ABSTRACT FROM AUTHOR]

Resection, reconstruction, and rehabilitation of the mandible impact function and health related quality of life (HRQOL). In this study, we aimed to understand the impact of delayed versus immediate dental implant placement. A cross-sectional and prospective study was conducted including patients who underwent reconstruction of the mandible via osseous vascularised bone flaps and dental implants. The FACE-Q Head and Neck Cancer module and the MD Anderson Dysphagia Inventory and Speech Handicap Index were used to evaluate HRQOL. A total of 187 implants were placed in 52 patients, of which 44 patients (85%) completed questionnaires. Immediate dental implant placement was associated with superior FACE-Q appearance (p = 0.02), oral competence (p = 0.004), smile distress (p = 0.03), and satisfaction with information (p = 0.004). Dentoalveolar rehabilitation through the placement of immediate dental implants at the time of surgery was found to be associated with higher HRQOL scores related to appearance, eating and drinking, oral competence, and smile. [ABSTRACT FROM AUTHOR]

The functional and aesthetic reconstruction of the mandible can be achieved by using the double-barrel vascularized free fibula flap. The purpose of this study was to use multiple integrated techniques to more effectively reconstruct the mandible, some contains of our unique ideas. 21 patients were included in this study. Computed tomography (CT) data of the patient's mandible and fibula were acquired preoperatively. Individualized surgical simulation was performed by using computer-aided surgical simulation (CASS) technology, about 6 kinds of integrated 3D design ideas were simultaneously perfectly transferred to real surgery. The accuracy of reconstruction was evaluated by superimposing the postoperative and preoperative image of mandible, measuring the linear and angular deviation of landmarks between the planned and actual outcomes. The mandibular reconstruction was effectively performed on all patients, and the result analysis showed that the surgical plan was precisely performed. The facial contours of the postoperative patients were harmonized and the largest mean linear and angular differences were 1.47 ± 0.31 mm and 3.97 ± 0.63°, respectively. This study system illustrates how to select and position the fibula for reconstruction of various types of segmental mandibular defects by using double-barrel vascularized free fibula flap. It will provide valuable guidance and enhance the accessibility and efficiency of mandibular defects treatment. [ABSTRACT FROM AUTHOR]

Epithelioid osteoblastoma (EOB) is a rare, benign bone tumor characterized by the proliferation of atypical epithelioid osteoblasts within a vascular stroma. It typically presents as a slow-growing painful mass and requires careful differentiation from more aggressive lesions like osteosarcoma for appropriate management. We present a case of an otherwise healthy 30-year-old man who presented with a mandibular EOB measuring 23 cm × 17 cm x 19 cm, causing significant disfigurement and functional impairment. Surgical management involved radical resection and immediate reconstruction using an osteocutaneous fibula free flap. The case emphasizes the importance of multidisciplinary care, advanced surgical planning, and the impact of socioeconomic factors on healthcare access and outcomes. • Largest documented mandibular EOB at 23.5 cm with delayed diagnosis. • Use of VSP for precise surgical planning and reconstruction. • Complex resection with fibula free flap reconstruction. • Case emphasizes the impact of socioeconomic factors on delayed care. • Multidisciplinary approach vital for managing large bone tumors. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Objectives: The perioperative interplay between blood pressure, vasopressors, and macrocirculation is well established. However, in the context of free flap surgery, the potential impact of these factors on microvascular flow remains elusive. The aim was to evaluate the impact of norepinephrine administration on the microcirculation of free flaps. Methods: Postoperative systolic blood pressure (sBP), norepinephrine infusion rates (NIRs), and free flap microcirculation were monitored prospectively and analyzed retrospectively in patients receiving free flap surgery who required postoperative intermediate (IMC) or intensive care (ICU). Blood flow, hemoglobin oxygenation (SO2), and relative hemoglobin levels (rHbs) were measured over a period of 24 hours post-anastomosis by laser-doppler flowmetry and white light spectroscopy using the "Oxygen to See" device (O2C, LEA Medizintechnik, Gießen, Germany). Multivariate analysis was performed to determine the impact of NIR on microvascular flow, adjusting for several confounding factors. Subgroup analysis was conducted by categorizing into three groups based on patients' postoperative sBP. Results: Flaps were performed in 105 patients with a mean age of 61.46 ± 16.29 years. Postoperatively, an increase in microvascular flow over time was observed across all free flaps, while NIR decreased and sBP maintained stable values. Multivariate analysis revealed that the time post-anastomosis (B = 3.76, p < 0.001), SO2 (B = 0.55, p < 0.001), rHb (B= −0.79, p < 0.001), female gender (B = 29.25, p = 0.02), and no previous radiation therapy (B = 41.21, p = 0.04) had a significant impact on postoperative microvascular flow in free flaps. NIR, sBP, smoking status, old age, and ASA score showed no significant impact on free flap flow. Further, NIR showed no significant impact on microvascular flow in any of the subgroups investigated. Conclusions: These findings support the safety of using norepinephrine for maintaining stable blood pressure without compromising microvascular flow, offering valuable guidance for postoperative management. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: The thumb is crucial for the aesthetic and functional aspects of the upper extremity. A crushed thumb injury can be particularly challenging, especially for individuals with high demands. Currently, there is no consensus on the best approach for treating a crushed thumb. The scapular flap, vascularized by the subscapular artery system, shows great potential as a free flap option. This report aims to highlight the use of a triple flap procedure to preserve the function of the crushed thumb. Case Report: A 47-year-old man had a severe injury to his left hand, resulting in significant soft tissue damage in the thenar region, an amputated thumb, and multiple fractures in the phalanx and metacarpal bones. The case was managed using a combination of scapular, parascapular, and osteo-cutaneous parascapular flaps. The first surgery focused on debridement and preserving viable structures, while the second surgery, performed 3 days later, involved the creation of a triple flap, utilizing the circumflex scapular artery and thoracodorsal artery as skin paddles. The flap remained viable, and 6 months postoperatively, the patient regained significant strength and functionality in his left hand. Conclusions: This case demonstrates that severe hand injuries with thumb amputation require a strategic approach based on wound condition and reconstruction feasibility. Triple flaps can be an effective option for such injuries. This report highlights the challenges of treating severe hand crush injuries and emphasizes the importance of personalized surgical approaches for optimal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a predictive model for identifying vascular crises following free tissue flap transplantation in patients undergoing surgery for oral and maxillofacial tumors. Methods: This retrospective cohort study utilized medical records from the Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, covering the period from January 2014 to December 2021. The analysis included 1,786 cases, divided into a training group (n = 1,251) and a validation group (n = 535). Variables included demographic factors, clinical characteristics, and surgical details. Univariate and multivariate logistic regression analyses were performed to identify significant predictors, which were then incorporated into a nomogram. The model's performance was assessed using the concordance index (C-index), receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Results: The incidence of vascular crisis was 5.8% in the training group and 4.9% in the validation group. Significant predictors included tissue flap width, D-dimer levels, preoperative hemoglobin, hemoglobin difference before and after surgery, and type of venous anastomosis. The nomogram showed strong predictive performance with an AUC of 0.780 in the training group and 0.701 in the validation group. Calibration curves indicated excellent fit, and DCA demonstrated clinical applicability. Conclusion: A user-friendly model was developed for detecting vascular crises in oral and maxillofacial tumor patients. This model exhibits robust discriminative ability, precise calibration, high specificity, and significant clinical applicability, effectively identifying high-risk patients prone to vascular crises. [ABSTRACT FROM AUTHOR]

We present the case of a 36-year-old male patient with a posttraumatic composite defect of the lower two-thirds of the anterior aspect of the left leg with exposed necrotic tibia in an old, neglected type 3b fracture of the tibia of 9-month duration. The options for definitive soft-tissue cover include microvascular free tissue transfer and cross-leg flaps. In trauma cases, the surrounding tissue is usually damaged, and the recipient vessels are frequently implicated, ruling out the use of a microvascular free flap. Cross-leg flaps are unachievable due to large defect sizes and lack of appropriate donor tissue. In this case report, we highlight the use of cross-leg microvascular free anterolateral thigh (ALT) flap cover for the composite leg defect. By presenting our case, we aim to advocate the clinical application of cross-leg free flap surgery in vessel-depleted limbs as a safe and viable option. [ABSTRACT FROM AUTHOR]

Traditionally, burn reconstructions have been performed by the use of skin grafting or local flaps. Recently free flaps are being used with increasing frequency. Although not very common in the head neck region, free flaps are mostly used for secondary reconstructions of cervicofacial contractures. We report the role of free flaps in postburn facial reconstructions, excluding neck and scalp burns. Sixteen free flaps used for postburn facial reconstructions were reviewed retrospectively, during the period between 2003 and 2023. The etiology, indications, timing, location, choice of the flap, type of reconstruction, and outcomes were analyzed. Indications and type of reconstructions were categorized to correlate with flap choice. The age of the patients ranged between 8 and 40 years. The etiology included electrical burns in six cases, flame burns in eight cases, and acid burns in two cases. Nine defects were in the central part of the face including the nose and the chin. Two primary and 14 secondary reconstructions were performed using free flaps from lateral thigh in 11 cases, lateral arm in 2 free flaps cases, radial forearm in 2 free flaps cases, and the posterior auricular flap in 1 case. There were no total flap failures. Secondary procedures were needed in 10 of 13 evaluable patients. Free flaps provide a good and safe option for selective postburn reconstructions in the face. The choice of flap mainly depends on the indication and type of reconstruction needed, apart from the availability of donor tissue and the surgeon's preference. Complex reconstructions may need larger and composite flaps to replace the components. Multiple secondary procedures are needed to achieve the objectives. [ABSTRACT FROM AUTHOR]

Background Patients with congenital or acquired penile defects face significant psychological trauma. Various methods for penile reconstruction have been described of which the free radial artery forearm flap using the tube-within-tube design is found to be the most commonly used. We have assimilated the best practices described at different times in our bid to standardize the technique and have strived to make it reproducible. The reconstructed phalluses with this method can withstand the test of time, allowing the patients to lead a normal life. Materials and Methods We conducted a retrospective review of the past 16 years and collected data for all radial forearm free flap phalloplasties. We have modified the design originally described by Biemer. The urethra is kept 1 cm longer than the shaft and the proximal 5 mm of the prospective urethra is not sutured to allow for spatulation of the urethral anastomosis. Results A total of nine patients were included out of which six patients had congenital malformations, two had traumatic injuries, and one had penile carcinoma. Six out of the nine patients had implants placed which were wrapped in fascia lata graft. One of these patients experienced displacement of the implant which needed to be repositioned. Three patients faced postoperative complications. All patients had tactile and erogenous sensation at the tip of the glans at the end of 1 year and all patients could micturate while standing. One patient's esthetic and functional outcome was compromised. One of the married patients has fathered a child through normal sexual intercourse. Conclusion Radial forearm phalloplasty done by this technique allows us to achieve consistently stable functional and esthetic outcomes. We firmly believe that this standardized protocol for penile reconstruction could be of great benefit to patients as well as to the treating reconstructive surgeon in their quest to achieve a completely rehabilitated patient. [ABSTRACT FROM AUTHOR]

A 21-year-old male laborer sustained bilateral degloving injury of the hands with multiple digital amputations and devascularized digits. After X-rays, preliminary debridement was done, when digital amputations were completed, including index ray amputation on both sides. The next day, two anterolateral thigh (ALT) flaps and one second toe transfer were done to restore coverage in the palm and the web and reconstruct the lost thumb. This ensured both coverage and thumb length on the right side, but on the left side the procedure was terminated with flap transfer only. After 3 months, the other second toe was harvested with a dorsalis pedis flap for reconstruction of the left thumb, and a free gracilis flap was done for optimal donor site coverage in the donor left foot. Evaluation after 2 years showed functional hands with reasonable power grasp, pinch grip, and dexterity to manipulate small and large objects that permitted an independent living. [ABSTRACT FROM AUTHOR]

Background/Objectives: Robot-assisted microsurgery (RAMS) has been introduced into the field of plastic surgery in recent years. It potentially offers enhanced precision and control compared to traditional methods, which is crucial for complex microvascular tasks in free flap reconstructions. We aim to analyze our experiences with robotic-assisted microsurgery in the field of upper extremity free flap reconstruction. Methods: This prospective study evaluated the efficacy and safety of the Symani Surgical System for free flap reconstructions in 16 patients with upper extremity defects at our institution from February 2023 to March 2024. Operating times were compared to a matched, historical cohort. We collected data on surgical outcomes, operative times, and complication rates, following strict adherence to the Declaration of Helsinki. Results: Our cohort primarily involved male patients (81%) with defects mostly located on the hand (81%). The anterolateral thigh flap was the most commonly used free flap (14/16, 88%). The average operative time was 368 ± 89 min (range: 216–550 min). No complete or partial flap losses were observed, but one flap required revision surgery due to arterial thrombosis. Major complications occurred in 13% of the cases. The average anastomosis time was 31 ± 12 min (range: 20–35 min) for arterial end-to-end anastomoses and 33 ± 13 min (range: 20–60 min) for arterial end-to-side anastomoses. Venous anastomoses required, on average, 20 ± 6 min. Operating times were not significantly longer when compared to the historical cohort (p = 0.67). Conclusions: We were able to show comparable outcomes to conventional microsurgery, while requiring more time for the microsurgical anastomoses. The study highlights the need for larger, controlled trials to better understand the benefits and limitations of robotic assistance in microsurgical reconstruction of the upper extremity. [ABSTRACT FROM AUTHOR]

Oral cancer often presents in advanced stages, requiring complex surgical interventions. The bipedal pectoralis major myocutaneous (PMMC) flap is a commonly used alternative to the gold standard free flaps for reconstruction in resource-constrained settings. However, large donor sites may necessitate split-thickness skin grafting (STSG), leading to aesthetic challenges. This study explores using the thoracoabdominal flap (TA) for a large donor site closure following PMMC flap harvest in advanced oral cancer reconstruction. A retrospective analysis was conducted on twelve patients with advanced oral cancer with extensive skin involvement. The TA flap was utilised to achieve tension-free closure of the donor site. Patient demographics, clinical features, treatment stage, operative details, and postoperative complications were meticulously recorded. All patients had advanced oral cancer, with seven having left-sided disease and five having right-sided disease. The TA flap closure resulted in minimal complications, with two patients developing seromas and one experiencing marginal necrosis during the postoperative period. The innovative TA flap technique is useful in closing extensive donor sites following PMMC flap harvest for advanced oral cancer cases. It offers advantages such as improved cosmetic outcomes and fewer complications than split-thickness skin grafting. [ABSTRACT FROM AUTHOR]

Segmental resections of the mandible may cause severe functional and aesthetic problems due to continuity loss. The morbidity after mandibular resection can be minimized after microvascular transfer of vascularized bone grafts. Although free flaps have become the gold standard in the past decades for reconstruction of oral cavity defects, regional flaps can also be a reliable option in certain cases, especially for those belonging to the lower socioeconomic corridor and or with coexisting chronic comorbidities which will not allow lengthier procedures. (Milenović A, Virag M, Uglešić V, Aljinović-Ratković N (2006) The pectoralis major flap in head and neck reconstruction: first 500 patients. J Cranio-Maxillofacial Surg 34(6):340–343); (Sabri A (2003) Oropharyngeal reconstruction: current state of the art. Current opinion in otolaryngology & head and neck surgery. 11(4):251–254); (Porcuna DV, Vintró XL, Vilas ML, Olmo AP, Ayala JM, Agustí MQ (2008) Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps. Acta Otorrinolaringologica (English Edition) 59(6):263–268) There are a very few reports of early oral cancers being reconstructed by PMMC flap. In this article, however, we have exclusively reviewed 247 cases of early oral cancer requiring marginal mandibulectomy and their reconstruction with PMMC flap thus justifying the name, the "workhorse flap" even in early oral cancers. This is a retrospective analysis of 5-year patient data collected from our institutional data register of 247 patients undergoing marginal mandibulectomy and reconstruction with PMMC flap between April 2017 to June 2022. No flap loss was reported. No cases were re-explored either for hematoma or for congestion. All patients recovered uneventfully. Although, in this era, free flaps dominate in the soft tissue reconstruction and PMMC is used only in certain advanced oral cancers, our study proves that it can be used safely in effectively in early oral cancer patients as well. Being a quicker procedure, PMMC flap reconstruction should be considered as a valid alternative in early oral cancers requiring marginal mandibulectomy, to overcome the increasing oral malignancy patient load belonging to low socioeconomic regions. To the best of our knowledge, this is the largest data ever published. [ABSTRACT FROM AUTHOR]

Background: A microsurgical auricular flap represents a single-step technique for the reconstruction of full-thickness defects of the ala nasi. To achieve the best surgical outcomes, it is essential to have an exhaustive knowledge of the vascular network to improve the management of the surgical flap. This study aimed to provide an anatomical and surgical guide for a well-designed reconstruction of the ala nasi using a free preauricular flap. Methods: In this study, three fresh-frozen and two formalin-fixed human head specimens injected with red silicone rubber to enhance the arterial facial system were used. The reconstruction of the full-thickness defect of the ala nasi was performed using a microsurgical auricular flap technique, with the dimensions of the ala nasi and the preauricular flap duly noted. In addition, anatomical dissections were conducted, during which the positions and diameters of the main donor and recipient vessels were measured. Results: A presurgical evaluation was performed to define the flap design. A comparison of the shape and mean dimensions of the ala nasi defect (height 9.66 ± 1.40 mm; thickness 3.52 ± 0.53 mm) and the preauricular flap (height 8.50 ± 2.68 mm; thickness 3.92 ± 1.29 mm) indicated that this flap was an optimal option for the reconstruction of the ala nasi. The surgical procedure involved the full-thickness removal of the ala nasi, and the harvesting and insertion of the preauricular flap. The anatomical measurements demonstrated that the facial artery and veins were the optimal recipient vessels, with a diameter of >1 mm (2.08 ± 0.56 and 2.85 ± 0.74 mm), suitable for anastomosis with the superficial temporal artery and vein (1.86 ± 0.58 and 1.66 ± 0.15 mm). In addition, the postsurgical evaluations indicated a slight mean difference in the thickness (1.14 ± 0.65 mm) and height (1.68 ± 1.18 mm) between the ala nasi and helix and a satisfactory VAS score (7.9 ± 0.57). Conclusions: Our surgical and anatomical data provide compelling evidence in favour of free preauricular flap reconstructions of the ala nasi. This procedure allows for the correct choice of recipient vessels and the creation of a well-designed surgical flap. [ABSTRACT FROM AUTHOR]

Background: Traditional microvascular anastomosis can be timeconsuming, which raises the risk of thrombosis. Damage to the endothelium during the process triggers a repair mechanism that involves platelet aggregation, smooth muscle cell proliferation, and thickening of the endothelium. Microvascular anastomosis plays a vital role in free flap transfers and replantation surgeries. Although standard suturing remains the preferred technique, it presents challenges due to its technical difficulty, extended duration, and potential for vessel wall trauma. Fibrin glue, derived from a combination of autologous cryoprecipitate and thrombin, was originally introduced for peripheral nerve repair in humans. The success of these early uses led to its expanded application in areas such as wound closure, skin grafting, and osteotomy healing. This study aims to evaluate the effectiveness of fibrin adhesive in addressing these challenges within the context of microvascular anastomosis. Methods: This experimental study included 22 male Sprague-Dawley albino rats, the rats were divided into two groups Group (1): Experimental group, we used 4 core sutures with 9/0 polypropylene placed 90 degrees from each other and 0.1 ml of fibrin glue at site of anastomosis. Group (2): As a control group we used the standard repair technique of the transected artery by 5-8 primary sutures with 9/0 polypropylene. Results: The use of fibrin adhesive significantly decreased both the number of sutures required and the time needed to complete the anastomosis. The immediate and long-term patency rates were not adversely affected by the application of fibrin glue. Histological analysis of the anastomosed vessels revealed no significant differences between the two techniques. Conclusions: In conclusion, the application of fibrin adhesive did not produce any adverse effects in microvascular anastomosis. The authors advocate for using fibrin adhesive in clinical settings, particularly in more complex cases where multiple microvascular anastomoses are necessary. [ABSTRACT FROM AUTHOR]

Background: Head and neck reconstruction following ablative surgery results in alterations to maxillofacial anatomy and function. These postoperative changes complicate dental rehabilitation. Methods: An innovative modular, stackable guide system for immediate dental rehabilitation during mandibular reconstruction is presented. The virtual surgical planning was performed in Materialise Innovation Suite v26 and Blender 3.6 with the Blenderfordental add-on. The surgical guides and models were designed and manufactured at the point of care. Results: The duration of the surgery was 9 h and 35 min. Good implant stability (>35 Ncm) and a stable occlusion were achieved. After 9 months of follow-up, the occlusion remained stable, and a mouth opening of 25 mm was registered. The dental implants showed no signs of peri-implant bone loss. Superposition of the preoperative planning and postoperative position of the fibula parts resulted in an average difference of 0.70 mm (range: −1.9 mm; 5.4 mm). Conclusions: The in-house developed stackable guide system resulted in a predictive workflow and accurate results. The preoperative virtual surgical planning was time-consuming and required extensive CAD/CAM and surgical expertise. The addition of fully guided implant placement to this stackable guide system would be beneficial. More research with longer follow-ups is necessary to validate these results. [ABSTRACT FROM AUTHOR]

Hyperactive delirium with agitation following head and neck surgeries with free tissue transfer reconstruction (HNS-FTTR) represents a critical and potentially life-threatening postoperative complication. Although preoperative risk assessment is important, no established risk screening tool has been developed to accurately predict its occurrence. In this retrospective observational study, we examined 192 consecutive patients who underwent HNS-FTTR between August 2019 and January 2024. We assessed the effectiveness of the existing delirium risk screening system, the DELirium Team Approach program which includes factors such as age ≥ 70 years, presence of brain disorders, dementia, alcohol consumption habits, a history of delirium, and use of benzodiazepines. Additionally, we explored the association between each risk factor and the onset of delirium. Delirium occurred in 43 patients (22.4 %). The risk screening tool effectively predicted the occurrence of hyperactive delirium after HNS-FTTR (OR: 8.316; 95 % CI: 2.205–36.060; p = 0.004), with a sensitivity of 95.3 % and a specificity of 28.9 %. Multivariate analysis revealed age ≥ 70 years (OR: 2.179; 95 % CI: 1.058–4.662; p = 0.0383) and alcohol consumption habits (OR: 2.554; 95 % CI: 1.260–5.268; p = 0.0098) as significant independent risk factors. Our findings suggest that the risk screening system evaluated in this study appears to be sensitive, simple, and effective for the preoperative prediction of hyperactive postoperative delirium following HNS-FTTR. [ABSTRACT FROM AUTHOR]

The reconstruction of post-ablative maxillary defects is controversial. It is accepted that quality of life indicators are poorer for maxillary reconstruction compared with mandibular reconstruction. One factor highlighted is that of post-treatment trismus. Rates of trismus are reviewed comparing free tissue transfer to that of prosthetic obturation. A retrospective review was undertaken comparing rates of trismus at twelve months post-surgery between free tissue transfer and prosthetic obturation. A total of 85 patients were identified who met the inclusion criteria. Both reconstruction techniques were significant for developing trismus, with a higher rate in the free flap reconstruction cohort than the prosthetic obturation cohort by a factor of 2.51. Modern reconstructive head and neck surgery has moved away from 'filling a hole' to a more bespoke, patient-specific reconstruction. The evidence presented here should allow the reconstructive surgeon to better discuss outcomes with patients when considering surgical options for Class II maxillary defects. [ABSTRACT FROM AUTHOR]

Desmoplastic fibroma (DF) is a benign yet locally aggressive intraosseous tumour rarely encountered in the mandible. It often mimics other oral lesions. Familial adenomatous polyposis (FAP) is a condition in which individuals tend to develop multiple colorectal polyps, which may convert to colorectal cancer unless treated. FAP has various colonic and extra-colonic manifestations, including oral manifestations. A case of DF of the mandible in a 5-year-old child is presented here. The patient remained free of recurrence 4 years after segmental resection and immediate reconstruction with a fibula free flap. Subsequent genetic testing revealed FAP, implicating DF as an early oral manifestation. A review of the existing literature emphasizes the challenges in diagnosing DF and its association with FAP, stressing the importance of comprehensive assessment and genetic screening in suspected cases. [ABSTRACT FROM AUTHOR]

Background: The scapula free flap is becoming increasingly more utilized in head and neck reconstruction due to its natural geometry and soft tissue versatility. This study reviews the incidence rate, risk factors, and treatments of complications of scapula donor site morbidity. Methods: A review was performed for articles published between October 1990 and November 2022 in Medline (OVID), PubMed, Web of Science, and CENTRAL. After screening, 24 articles meeting the criteria were included. Results: Overall, 660 head and neck surgeries with the scapula donor bone across 24 studies were included. Twenty studies of 612 scapula free flaps reported a pooled postoperative complication rate of 10.7%, with no major complications. Seven studies of 199 scapula reconstructions showed a mean Disability of Arm, Shoulder and Hand (DASH) score of 14.39/100. Conclusion: With its low rate of morbidity, the scapula flap presents itself as a good alternative for patients at risk for poor healing. [ABSTRACT FROM AUTHOR]

Background: Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon. Methods: Multi‐institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103). Results: Majority were gunshot wounds (GSW; 85%, n = 88) and motor vehicle accidents (11%, n = 11). Majority underwent osseous reconstruction (82%, n = 84). FF failures (9%, n = 9/103) occurred in GSW patients (100%, n = 9/9) and when multiple subsites were injured (89%, n = 8/9). Preoperative antibiotics correlated with lower rates of a neck washouts (4% vs. 19%) (p = 0.01) and 30‐day readmissions (4% vs. 17%) (p = 0.02). Conclusions: All FF failures occurred in the setting of a GSW and the majority involved multiple subsites. Preoperative antibiotics correlated with lower rates of postoperative washout procedures and 30‐day readmission. [ABSTRACT FROM AUTHOR]

Background: Trismus therapy is often delayed after jaw reconstruction to avoid hardware failure or non‐union. The aim of this study is to document the forces that have been applied to patients undergoing free flap reconstruction of the oral cavity in the 12 months following oral cavity reconstruction, and to analyze the associations between force and maximal interincisal opening (MIO) over time. Methods: Participants with trismus after free flap reconstruction of the oral cavity completed a 10‐week jaw stretching program using Restorabite™. Primary outcome measures included the minimum and maximal force applied by a trismus device during rehabilitation, MIO, bone union, and health‐related quality of life outcomes up to 12 months postoperatively. Results: A mean of 20.6 Newtons (N) was used during passive exercises and 38.9 N during active exercises was used during trismus therapy. The mean increase in MIO for the 45 participants after 10 weeks, 6 months, and 12 months of therapy was 8.4 mm (p < 0.001), 12.6 mm (p < 0.001), 12.7 mm (p < 0.001), respectively. There was no significant difference in the mean minimal (p = 0.37) or mean maximal (p = 0.08) force applied between those who underwent osseous free flap reconstruction compared to fasciocutaneous only, respectively. In patients who underwent osseous reconstruction, 25 (67.6%) had complete bone union and 12 (32.4%) had partial union at 12 months postsurgery. Conclusions: In participants undergoing osseous free flap reconstruction, there was no association between the force applied to the rates of bone union. Further research to define safe and optimal loading may benefit patients undergoing jaw reconstruction. [ABSTRACT FROM AUTHOR]

Background and Objectives: The lateral arm flap has been a very useful choice for the reconstruction of small to medium-sized defects, such as in the hands, extremities, and oral head and neck area. Its versatile characteristics and surgical feasibility allow this flap to be widely applied, but its reconstructive potential in the facial subunit after tumor ablation procedures has never been reported. In this study, we aimed to utilize the advantages of this flap to carry out facial temple subunit defect reconstruction. Materials and Methods: Between 2020 and 2023, 12 patients underwent temple reconstruction with lateral arm free flaps after wide malignant tumor excisions. There were seven women and five men, and the mean patient age was 60.6 years. Among the patients with cancer, six had squamous cell carcinoma, five had basal cell carcinoma, and one had myxofibrosarcoma. All flaps were elevated under general anesthesia. Alprostadil (PGE1, Eglandin®, Mitsubishi Tanabe Korea, Seoul, Republic of Korea) was administered postoperatively. Results: All flaps were the fasciocutaneous type, with sizes that varied from 3 cm × 4 cm to 5 cm × 7 cm (average size: 22.7 cm2). The average pedicle length was 6.1 cm. The versatility of the lateral arm flap enabled successful coverage in all cases, with no specific complications. Good functional outcomes and good ranges of motion in the donor arms were observed after surgery. Conclusions: The authors successfully verified the advantages of lateral arm flaps in the treatment of medium-sized facial temple subunit defects. [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma (OSCC) causes considerable morbidity and mortality rates, posing a major global health burden. The management of the OSCC is multidisciplinary, but still the gold standard is surgical resection and reconstruction of the postablative defect. The appearance of secondary primary OSCC is not uncommon; however, it is quite rare that it appears on the skin of the flap that was used for reconstruction during the previous surgical therapy. Methods: We present three cases in which a secondary primary OSCC appeared on the skin of two radial forearm free flaps and two on regional pectoralis major flaps. Results: Our case series show that, although relatively rare, there is a chance of a secondary primary tumor on the flap used for intraoral reconstruction after the first oncological reconstruction. According to the latest and available literature, there is still no explanation of the underlying mechanism that leads to this occurrence. Conclusions: The learning point of this case series should be that, aside from the neck metastasis or recurrence of the primary oral cancer, the clinicians should also bear in mind that the flap itself should be physically examined in detail. [ABSTRACT FROM AUTHOR]