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The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons. [ABSTRACT FROM AUTHOR]

Skeletal muscle regeneration (SMR) encompasses a sequence of events that unfolds after injury to muscle fibers. Nearby satellite cells become activated and function as precursor muscle cells by proliferating and differentiating into myoblasts, which eventually fuse to form myotubes and ultimately mature muscle fibers. Compared to other forms of mesenchymal repair, SMR has higher morphologic heterogeneity with the potential to show histopathologic similarities to sarcomas and other malignancies. It is important to recognize SMR and settings in which this can occur to avoid misdiagnosis. We report two cases where a diagnosis of SMR was made from tissue taken from locations previously treated with Mohs micrographic surgery followed by myofascial flap reconstruction. In both cases, histopathologic features identified with hematoxylin and eosin as well as immunostaining were used to support the diagnosis of SMR. These cases highlight the importance of recognizing this clinic entity to ensure accurate diagnosis. [ABSTRACT FROM AUTHOR]

With the advent of modern endoscopes and a better anatomic understanding of the skull base, the indications of endonasal approaches are increasing. These procedures may be complicated by high rates of postoperative cerebrospinal fluid (CSF) leak, and reconstruction of the defect remains challenging. In the anterior skull base, vascularized grafts have been reported as superior in preventing CSF leakage and infection. The Hadad-Bassagasteguy flap, being a pedicled flap, is our first line flap to reconstruct the skull base. When we were not successful with this flap, we resorted to different flaps. We modified the originally described temporoparietal fascial flap by Fortes et al and applied clinically. The objective of this paper is to briefly describe the modification of the flap and to review the clinical outcome. From 2014 to 2018, in 6 cases of CSF leak with the appropriate indication, we used the temporoparietal myofascial flap repair that is a modification of the temporoparietal fascial flap by Fortes et al. We took all the 6 patients in our study and followed them up. All of the 6 repairs were successful, and no CSF leak was found just after the operation in 6- to 48-month follow-up. We recommend our modified novel temporoparietal myofascial flap as a very good option in case of failed cases of postoperative CSF leak. [ABSTRACT FROM AUTHOR]

Background: Complex ventral incisional hernia repair represents a challenging clinical condition in which biologically derived graft reinforcement is often utilized, but little long-term data inform that decision. Urinary bladder matrix (UBM) has shown effectiveness in diverse clinical settings as durable reinforcement graft material, but it has not been studied over a long term in ventral incisional hernia repair. This study evaluates the clinical, radiographic, and histological outcome of complex incisional hernia repair using UBM reinforcement with 12-70 months of follow-up.Methods: A single-arm, retrospective observational study of all ventral incisional hernia repairs utilizing UBM reinforcement over a 6-year time frame by a single surgeon was performed. Patients were assessed in long-term follow-up clinically and with the Carolina Comfort Scale. A subset of patients was assessed with abdominal wall ultrasound or CT scan. Three patients had abdominal wall fascial biopsies years after the incisional hernia repair with UBM graft, and the histology is analyzed.Results: 64 patients underwent repair of complex incisional hernias with UBM graft reinforcement by a single surgeon. 42 patients had concomitant procedures including large or small bowel resection, excision of infected mesh, evacuation of abscess or hematoma, cholecystectomy, or panniculectomy with abdominoplasty. 16 patients had ostomies at the time of repair. Median follow-up time is 36 months, with a range of 12-70 months. Nine patients (14%) have required surgical repair of a recurrent hernia, and a tenth patient has a recurrence that is managed non-surgically, for a total recurrence rate of 15.6% over the entire time frame. Median time to recurrence was 32 months, and a Kaplan-Meier freedom from recurrence curve is depicted. 28 patients have undergone ultrasound or CT assessments of the abdominal wall which demonstrate radiographic fascial integrity 12-70 months after repair. Three patients have been re-explored for unrelated reasons in the years following ventral incisional hernia repair with UBM, and full thickness fascial biopsies demonstrate a robust remodeling response histologically similar to native myofascial tissue. No patients have developed graft infection, fistulization to the graft, or required graft explantation. Carolina Comfort Scale assessment of 45 patients 3 years after the repair averaged 16 out of a possible 115.Conclusion: In 64 patients undergoing complex ventral incisional hernia repair with UBM reinforcement, all have experienced successful resolution of complex clinical conditions and 15.6% of these repairs have recurred at a median follow-up of 3 years. Three full-thickness biopsies of the repaired fascia years later shed light on a promising remodeling response which may signal strength and durability comparable to native fascia. [ABSTRACT FROM AUTHOR]

The aim of the present study was to construct Tissue-engineered laryngeal cartilage with a hollow, semi-flared shape using a poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHH) scaffold. Porous PHBHH was prepared and formed into a hollow, semi-flared shape, and the cell-material composites were cultured for one week in vitro prior to implantation in vivo. Cells of the nine rabbits of the experimental group were filled and encapsulated in the myofascial flap-shaping material composite for in situ implantation. The three rabbits in the control group were treated with the shaping material without the chondrocytes. Cartilage regeneration was assessed at six, 12 and 18 weeks after surgery. In the experimental group, the shape and porosity of the material were ideal, the cells exhibited good adhesion with the material and the myofascial flap blood supply was rich. The engineered laryngeal cartilage with the hollow, semi-flared shape was ideally formed, and the cartilage formed at six weeks after the surgery. Further maturation of the cartilage was observed at 12 and 18 weeks after the surgery. PHBHH was a suitable material for the formation of a hollow, semi-flared shape with good cellular compatibility. Myofascial flap filling and wrapping can be used to build tissue-engineered laryngeal cartilage with a hollow, semi-flared shape. [ABSTRACT FROM AUTHOR]

The vascular iliac myofascial flap is a compound flap with the deep circumflex iliac artery (DCIA) as the vascular pedicle, carrying the iliac bone and parts of the internal oblique, external oblique and muscle-fascial tissue that cover the surface of the iliac crest and inside the iliac bone. The aim of this study was to advocate a feasible surgical strategy for maxillofacial surgeons through our review of clinical applications and to improve the quality of life of patients after the operation. In recent years, Stomatology Hospital of Wuhan University has performed dozens of vascularized iliac myofascial flaps, not only to repair jaw defects but also to complete the repair of intraoral soft tissue defects. 20 patients were followed up. These patients with jaw tumors who received a vascular iliac myofascial flap to repair compound defects of the jaw from 2018 to 2020. The Quality of Life Questionnaire-Head and Neck Cancer-37 (QLQ-H&N37) was used to evaluate their speech function (Z=-0.061, P>0.05) and postoperative aesthetics (Z=-2.824, P<0.05). All patients obtained good surgical results and satisfaction in terms of aesthetics and function. The successful reconstruction of these cases prove that the vascularized iliac composite flap with myofascial tissue is a reliable flap for the reconstruction of maxillofacial defects., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

A case report of a 41-year-old man who had a delayed pharyngo-esophageal perforation without instrumentation failure 7 years after anterior cervical spine plating is presented and the literature on this issue is reviewed. This injury resulted from repetitive friction/traction between the retropharyngo-esophageal wall and the cervical plate construct leading to a pseudodiverticulum and perforation. Successful treatment of the perforation was obtained after surgical repair using a sternocleidomastoid muscle flap. This case stresses the necessity of careful long-term follow-up in patients with anterior cervical spine plating for early detection of possible perforation and the use of muscle flap as the treatment of choice during surgical repair. [ABSTRACT FROM AUTHOR]

Background. Many methods of glottic reconstruction have been described for patients undergoing vertical partial laryngectomy to reestablish the glottic integrity. Methods. Fifteen patients with T2 squamous cell carcinoma of the glottis were included in this prospective clinical trial. All patients were treated by vertical partial laryngectomy with laryngeal reconstruction by platysma myofascial flap. The surgical procedure and flap design were described. Vocal function was assessed by videolaryngostroboscopy and subjective and objective voice analysis before and after surgery. Results. Complete neoglottic closure and acceptable voice quality were obtained by platysma myofascial flap in all cases. No statistically significant difference was found between the preoperative and postoperative acoustic parameters. Conclusions. Platysma myofascial flap provides the basic requirements for laryngeal reconstruction with its own favorable characteristics and also allows complete glottic closure without interfering with respiration and deglutition. This technique may be an effective alternative achieving an acceptable quality of voice. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005 [ABSTRACT FROM AUTHOR]

A new approach to the correction of upper lid ptosis suspension by a frontalis myofascial flap performed on 133 patients (155 eyes) is presented. In a relatively large series of patients, it has proved to be a simple and reliable technique which produced pleasing results. The indications, operative technique, and specific points to be noted during surgery are discussed. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Salvage laryngectomy after failed organ preservation often has a high complication rate, pharyngocutaneous fistulas being the most common. These fistulas increase morbidity, prolong hospitalization, and potentially delay adjuvant treatment. Fistula rates in the literature range from 3% to 65%. Use of the pectoralis flap to prevent fistula formation has been adopted as a common practice at our institution. A review of our experience using the overlay myofascial showed a higher than desired complication rate. The aim of this study is to assess whether the use of integrated myocutaneous flap results in a lower fistula rate. Study Design A retrospective review of 30 patients followed by a pilot study of 10 patients. All underwent salvage laryngectomy after failed organ preservation. Methods The operation notes of 40 laryngectomy patients were analyzed. The patient/tumor characteristics, pretreatment, neck dissection, flap type, and fistula rate were documented. Results The patient sample was 25% female. All patients received prior radiotherapy, but only 37.5% received prior chemoradiation. Neck dissections were performed in 80% of these patients, 76% of the myocutaneous group, and 84% of the myofascial group. Advanced tumor stage was found in 42% of the myofascial group and 52% of the myocutaneous group. Five of the 19 myofascial patients developed a fistula, whereas seven of the 21 myocutaneous patients developed a fistula. Conclusions The use of the pectoralis myocutaneous flap (PMCF) in this pilot series did not show a lower rate of fistula; other alternatives should be pursued to decrease this complication. Evidence Level 4. Laryngoscope, 124:1615-1617, 2014 [ABSTRACT FROM AUTHOR]

Free tissue transfer has become the gold standard for reconstruction within the head and neck. However, there are still many instances where pedicled locoregional flaps are the optimal reconstructive option. When myofascial tissue is needed, several options have been described throughout the literature. Various trapezius flaps have been used, although these have variable vascular anatomy and significant donor site morbidity. The pectoralis major myofascial flap has become a mainstay in head and neck reconstruction for its ease of harvest and reliability but suffers from similar issues with donor site morbidity. The pedicled latissimus dorsi flap (PLDF) is another reliable option that has been used for multiple different ablative sites within the head and neck. The thin, pliable structure of the latissimus dorsi makes it a viable option for many defects, and recent reports also support its feasibility for use in an interdisciplinary two-team approach. Furthermore, the donor site morbidity of the PLDF is minimal compared to other similar myofascial options. In this article, we describe the surgical considerations and operative techniques for PLDF transfer along with a review of its associated donor site morbidity., Competing Interests: Conflicts of interest All authors declared that there are no conflicts of interest.

A maioria dos retalhos utilizados na reconstrução dos grandes defeitos pós-tratamento cirúrgico isolado ou associado à radioterapia no câncer da cabeça e pescoço levou os autores a estudar a viabilidade do RMF em 14 pacientes, atendidos no Serviço de Cabeça e Pescoço do Hospital Celso Pierro, PUCCAMP, Campinas. Todos eram portadores de lesões epidermóides avançadas no estádio IV, localizadas na boca (dez), hipofaringe (dois), laringe (um) e pescoço (um). Através do teste exato de Fisher (p< 0,05), aferiu-se a existência ou não da relação da viabilidade do RMF com a idade, estado nutricional, tratamento prévio. Nestes 14 pacientes, foram empregados 16 retalhos, 13 deles viáveis (81,2%) e três (18,8%) com necrose total, não havendo associação entre a viabilidade e a necrose e a idade (p=1,0). Quanto à relação com o tratamento prévio com quimioterapia (três casos) e radioterapia (dois casos), estes não foram significantes (p=0,547).

The aim of the present study was to construct tissue-engineered laryngeal cartilage with a hollow, semi-flared shape using a poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHH) scaffold. Porous PHBHH was prepared and formed into a hollow, semi-flared shape, and the cell-material composites were cultured for one week in vitro prior to implantation in vivo . Cells of the nine rabbits of the experimental group were filled and encapsulated in the myofascial flap-shaping material composite for in situ implantation. The three rabbits in the control group were treated with the shaping material without the chondrocytes. Cartilage regeneration was assessed at six, 12 and 18 weeks after surgery. In the experimental group, the shape and porosity of the material were ideal, the cells exhibited good adhesion with the material and the myofascial flap blood supply was rich. The engineered laryngeal cartilage with the hollow, semi-flared shape was ideally formed, and the cartilage formed at six weeks after the surgery. Further maturation of the cartilage was observed at 12 and 18 weeks after the surgery. PHBHH was a suitable material for the formation of a hollow, semi-flared shape with good cellular compatibility. Myofascial flap filling and wrapping can be used to build tissue-engineered laryngeal cartilage with a hollow, semi-flared shape.