Floor plan - 2013 Annual Meeting - American Association for Hand ...

Using Free Style Proximal Radial Forearm Free Flaps while Preserving Radial Artery for
Reconstructions of Burn hand and Head and Neck Defects
Institution where the work was prepared: Chang Gung Memorial Hospital, Taipei, Taiwan
Jeng-Yee Lin, MD; Wei-Chao Huang; David C.C. Chuang; Fu-Chan Wei; Chang Gung Memorial Hospital
PURPOSE:
Although radial forearm free flaps are commonly used for a variety of reconstructions, the associated morbidity remains a concern. The
most notable problems are related to the conspicuousness of a distal forearm skin graft and radial artery sacrifice. In this study, we
describe harvesting a proximal radial forearm free flap while preserving radial artery and describe its indications and limitations.
Materials and
METHODS:
From November, 2002 through October, 2006, 4 patients had burn related injuries of the hand and 3 patients had the oral defect after
head and neck surgery that were reconstructed using proximal radial forearm free flaps (6 males, 1 female) in the free style fashion. The
perforator pedicle of the flap was confirmed and chosen intraoperatively. The radial artery was preserved in all cases. Either the septocutaneous
or myocutaneous perforator that nourished the flap was chosen for microsurgical anastomosis to the recipient vessels. The
average dimension of the flap was 4cm x 8.5 cm. All but one donor site was closed primarily. One patient had intentionally delayed
wound closure 10 days after reconstruction.
RESULTS:
Six flaps survived with good functional and aesthetic outcomes. One flap used for buccal reconstruction failed due to arterial thrombosis.
There were only minor complaints regarding the proximal forearm donor site.
CONCLUSION:
Proximal radial forearm free flaps are suitable for reconstruction of both hand and head and neck defects. In highly selected situations,
use of free style proximal radial forearm free flap allows preservation of the radial artery and primary donor site wound closure.
Voice Reconstruction Utilizing the Free Ileo-Ileocecal Valve Free Flap with a Patch of Cecum
Institution where the work was prepared: E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
Samir Mardini, MD1; Hung-Chi Chen, MD, FACS2; Christopher J. Salgado, MD2; (1)Mayo Clinic, (2)E-da/I-I Shou
University Hospital
PURPOSE:
Voice reconstruction following laryngectomy has been performed with a variety of methods, many of which divert air from the trachea
to the esophagus or neo-esophagus and subsequently to the mouth where articulation takes place. Intestinal flaps including jejunum,
ileocolon and skin flaps have been utilized for this purpose with reasonable outcomes. A newly designed flap from the ileocecal region
has been used for the purpose of reconstructing voice with or without reconstruction of a partial esophageal defect.
METHODS:
19 patients between July 2004 and May 2006 with a previous history of laryngectomy underwent voice reconstruction with the ileo-ileocecal
valve flap with a patch of cecum and were included in this study. The ileum was used for creation of a voice tube, the ileocecal
valve prevented the occurrence of regurgitation and the patch of cecum was used to reconstruct the esophageal defect. Clinical evaluation,
a chart review and questionnaires were conducted. Voice evaluation was based on a modified version of the 5-point Likert scale,
where 1 indicated the patient could not produce any voice and 5 indicated a very good outcome. Swallowing function was evaluated
using a 7-point Likert like scale, where 1 indicated severe complaints and an inability to swallow, and 7 indicated satisfactory swallowing
without any complaints.
RESULTS:
All flaps survived. One patient developed an esophagocutaneous fistula. Two patients had prolapse of ileal mucosa at the voice tube
trachea junction, and two patients had regurgitation of liquid into the voice tube. All patients were able to produce voice (Mean 3.5;
based on the modified Likert scale). All patients were able to eat a solid diet (Mean 6; based on the modified Likert scale)
CONCLUSIONS:
Utilizing intestinal flaps for the reconstruction of voice following laryngectomy is a method that can achieve good outcomes. The ileoileocecal
valve flap with a patch of cecum has the advantages that intestinal flaps have to offer with minimal complications at the donor
site and good results of voice and swallow function.
196