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

Limiting Complications and Complexity of the Transverse Upper Gracilis Flap in Breast
Reconstruction
Institution where the work was prepared: University of Manitoba, winnipeg, Canada
Edward Wayne Buchel; Thomas E.J. Hayakawa; University of Manitoba
PURPOSE:
The Transverse Upper Gracilis (TUG) flap has become a reliable second choice for autologous breast reconstruction. Complications
associated with the TUG flap still limit it's routine use. Our institution has evolved it's technique over the past several months in an
attempt tp decrease these complications. The purpose is to highlight the complications associated with the Transverse Upper Gracilis
(TUG ) flap in breast reconstruction and suggest changes in technique to limit the complications and complexity of the operation.
METHODS:
A retrospective review of the microsurgical data base over the past 24 months was completed on all patients having a TUG flap for
breast reconstruction. Complications related to the donor site and reconstruction site were quantified. Video documentation of the harvesting
technique and patient positioning was also completed.
RESULTS:
31 Free TUG flaps in 25 patients were performed for immediate and delayed breast reconstruction. All patients did not have abdominal
tissue available for autologous tissue transfer. One complete failure occurred secondary to a harvesting error. All other flaps survived.
Fat necrosis was noted in 11 flaps (35.4%) of whom 3 underwent secondary revision of small superior contour irregularities. Donor
site complications occurred in 8 donor sites ( 25.8%) with 1 requiring a return to the operating room for closure her wounds.
CONCLUSION:
The TUG flap is quickly becoming an excellent second choice for autologous tissue breast reconstruction. While fat necrosis and donor
occurred frequently early on in our experience, changes in technique have limited these complications while decreasing the complexity
of the operation.
LEARNING OBJECTIVES:
Review the harvesting techniques of the TUG flap. Highlight complications specific to the TUG flap and technique changes to decrease
these complications.
Outcome of Radical Excision and Microsurgical Reconstruction in Patients with Recurrent
Oromucosal Cancer and Secondary Primary Cancer
Institution where the work was prepared: Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
Emre Gazyakan, MD, MSc; Holger Engel, MD; Jung-Ju Huang, MD; Huang-Kai Kao, MD; Ming-Huei Cheng, MD, PhD;
Chang Gung Memorial Hospital
INTRODUCTION:
Recurrent oromucosal cancer and secondary primary cancer are predominant destructive cancers with significant morbidity and mortality.
In most cases it leads to major midface- and mandibular-defects. Although the extensive defects are posing a challenge to the
microsurgeon the possibilities for reconstruction should outweigh the fear of radical tumor resection to minimize recurrence. In the case
of recurrence most patients are still treated with chemo- and/or radiotherapy alone. This study was to investigate the outcome of radical
excision with microsurgical free tissue coverage for recurrent oromucosal cancers.
MATERIAL/METHODS:
Between 1999 and 2005, 45 men and 1 woman with a median age of 49.4 years with oromucosal cancer underwent radical excision with
106 microsurgical free tissue transfers. Indications were recurrence, osteoradionecrosis and plate exposure. Patients with recurrence
who received a second or third radical excision with microsurgical free tissue coverage were included in this study. The outcome was
compared in the rate of recurrence, the overall survival rate and the operative complication rate. A comprehensive follow up was available
for a minimum of 48 months.
RESULTS:
The initial TNM staging showed T1 in 7, T2 in 13, T3 in 12 and T4 in 14 cases. N0 was shown in 22, N1 in 13 and N2 in 11 patients respectively.
13 Patients received postoperative radiation. Twenty-nine out of 46 patients (63%) were recurrent. Of these, 18 (39%) had disease
recurrence at primary site and 11 (24%) developed a secondary primary tumor. No patient had distant metastasis in the mean 48 months
of follow up. Most recurrences occurred within the first 12 months. These patients underwent the same surgical approach for the second
time (20 anterior lateral thigh flaps (ALT) and 9 radial forearm flaps). Of these 29 patients, 3 (10%) developed for the second time
recurrence. Two patients had a third tumor and one had local recurrence. In all cases an ALT-flap was performed. 5 patients (17%) were
lost to follow up due to disease related death. The rest of the 24 patients (83%) are currently without recurrence. Surgical complications
included flap failure (3.8%) and anastomosis insufficiency (1.9%) among others.
DISCUSSION:
Microsurgical free tissue transfer for recurrent oromucosal cancer and secondary primary cancer had a high success rate, minimal complications
and a survival rate of 83% in 48 months. Aggressive wide tumor excision followed by microsurgical reconstruction after recurrence
is a good option.
201