AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Functional Reconstruction of Complex Lip Defect with One Free Composite Anterolateral Thigh Fascia-
Cutaneous Flap
Institution where the work was prepared: Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Yur-Ren Kuo; Seng-Feng Jeng; Jir-Wen Yin, MD; Ching-Hua Hsien; Chang Gung Memorial Hospital in Kaohsiung
Introduction:
The anterolateral thigh flaps were used widely in reconstructing skin and mucosa defects after head and neck tumor resection. But when the defects involved
oral circumflex, the cosmetic and function results of traditional free flap reconstruction were not satisfied, that secondary commissuroplasty is usually needed.
Although some authors reported about reconstructing lower lip with radial forearm-palmaris longus tendon flap. However, the donor site morbidity is its major
disadvantage. In this study, we introduce a technique that can provide good oral competence by using vascularized fascia part of anterolateral thigh flaps.
Patients and Methods:
Twelve patients with complex lip defect due to composite resection of head and neck surgery during September 2004 to May 2006 was included in this study.
The oral sphincter was defined as a complete circumference (200 percent) formed by the upper lip (100 percent) and the lower lip (100 percent) as Jeng et al.
had described. The skin and lip defects including upper and lower lips were replaced by a free anterolateral thigh skin flap. The fascia part of flaps were used
to provide suspension of flap by anchorage to the remaining orbicularis oris muscle. The tension of fascia suturing was adjusted so that oral competence could
be achieved.
Results:
Eleven of them were male, and one patient was female. The average age was 52.8 years (ranged from 34 years to 58 years). The average area of defects
was96.9cm2, with 8 patients had through and through defect. Lip defect ranged from 50 percent to 120 percent (average 86%). The flap survival was 100
percent, with only one wound infection occurred. All patients had good to excellent oral competence during rest and eating. Six of the 12 patients received
thinning procedure of the flap during the operation another 5 of the 12 patients received debulked procedure secondarily. All the donor sites could be closed
primarily.
Conclusion:
We used the fascia part included in anterolateral thigh flap for providing a vascularized transposition. The fascia was anchored to remaining orbicularis oris
muscle so that the resting and dynamic oral competence was good to excellent. This technique provided an altertive of functional reconstruction of oral sphincter
in complex lip defect in one stage.
Prefabrication of Trachea for the reconstruction of hemilaryngectomy defects in unilateral laryngeal cancer
Institution where the work was prepared: KUL Leuven University Hospitals, Leuven, Belgium
Jan Jeroen Vranckx, MD; V. Vanderpoorten, MD, PhD; G Fabre; M Vandevoort; P. Delaere; KUL Leuven University
Background:
Every attempt must be made to avoid total laryngectomy in unilateral glottic cancer, because loss of speech and the need for a permanent stoma dramatically
alter the quality of a patients' life. For these unilateral cases, we defined a two-staged prefabrication protocol to vascularize a tracheal segment for the reconstruction
of the hemilarynx. In a prefabrication procedure, a vascular source is transposed into a non-axial area to provide an alternative blood supply through
neovascularization .This prefabrication step allows us to transfer the trachea as a vascularized U-shaped cartilaginous structure. Aim of this procedure is to preserve
one vocal cord, and thus speech, in cases were current surgical treatment usually consists of total laryngectomy.
Patients and Methods:
We treated 70 patients after a hemilaryngectomy with trachea prefabrication. The surgical technique and sequence of these two-stage procedures was substantially
modified in this series to allow for more rapid tumour resection during the first stage. The tumor resection is follwed by the trachea prefabrication
in the first stage using a radial forearm free flap with a proximal fasciocutaneous and a distal fascia segment. The fasciocutaneous part provides watertight
closure of the hemilaryngeal defect, while the fascia flap is wrapped around the required trachea segment for vascular induction. After an oncologic-safe 3-4
months, the prefabricated trachea segment is transplanted as a U-shaped cartilaginous-mucosal flap into the hemilaryngeal defect.
Results:
After the first operation the skin paddle of the radial forearm flap succeeded in a restoration of the sphincteric function. The mean time to oral intake for solids
was 9.0 days (SD = 2.6 d) and the mean length of hospital stay was 11.2 days (SD = 2.2 d). All patients were able to speak with the tracheal cannula in place.
All laryngeal functions were restored after the second operation. The mean time to oral intake for solids was 8.2 days (SD = 5.2 d). The mean time to oral
intake for liquids was 16.6 days (SD = 6.3 d), and the mean length of hospital stay was 9.6 days (SD = 2.3 d). The mean time to closure of the tracheostomy
and removal of the gastric tube was 27.0 days (SD = 5.8 d).
Conclusion:
Prefabrication of a tracheal segment by a vascularized radial forearm free flap allows for tracheal autotransplantation to optimally reconstruct extended hemilaryngectomy
defects. This technique leads to sparing speech in unilateral glottic cancer.
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