Hand Doppler flowmetry for surgical planning of pedicled flap in extensive full-thickness scalp reconstruction

Reconstruction of scalp defects can be performed with local flaps for medium to large defects (2–25 cm²) and microvascular free flaps for extensive full-thickness scalp reconstruction greater than 25 cm². Doppler flowmetry with its ability to exactly mark the course of arteries on the overlying skin, is a useful tool for the surgical planning of large local flaps. In our retrospective study conducted on 38 patients (all patients had malignancies or post-traumatic scalp defects), consisting of 39 total surgical procedures, we studied the impact of doppler ultrasonic flowmetry in the surgical planning for pedicled flaps in extensive full-thickness scalp reconstruction (>25 cm²) by evaluating overall flap survival rate. Nine different types of local flaps were employed in the scalp reconstruction: Superficial temporal artery (STA) pedicled rotation flap, STA pedicled transposition flap, STA islanded flap, bipedicled STA flap, bipedicled fronto-occipital flap, Supraorbital/Supratrochlear artery rotation flap, Supraorbital/Supratrochlear artery transposition flap, Occipital artery (OA) pedicled rotation flap, OA pedicled transposition flap. Before each surgical procedure a hand held doppler Huntleigh Diagnostic flowmeter with a 8 MHz probe was used to identify and follow the course of the arteries. Flap survival rate was 100%. No postoperative complications related to the flap were reported, while in two patients a partial skin graft failure occurred.     

Reconstruction of full-thickness cheek defects after cancer surgery

The value of various surgical techniques used to reconstruct full-thickness cheek defects is discussed. Small defects can be repaired with the use of local cervical skin flaps with a random vascular pattern. Axial pattern temporal flap is another choice, either alone or combined with a cervical flap. Whenever local tissues are not suitable (i.e. after irradiation or neck dissection) a transfer of distant myocutaneous island flap based on a pedicle of axial muscle vessels is a valuable alternative. Split skin graft may form a good intra-oral lining of such island flap.     

Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

Tumor resection causes damage in the head and neck which creates problems in swallowing,chewing,articulation,and vision,all of which seriously affect patients' quality of life.In this work,we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection.We discussed the anatomy,surgical technique,and the advantages and disadvantages of the flap.We found several benefits for the flap,such as,it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect;a two-team approach can be used because the donor site is far away from the head and neck;and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft.Thus,the medial tibial flap could replace the forearm flap for certain applications.     

Cheek-neck advancement-rotation flaps following Mohs excision of skin malignancies

The cheek-neck advancement-rotation flap has proved extremely useful for delayed reconstruction of the face following the microscopically controlled surgical excision (MCSE) of skin malignancies. We have recently used these flaps successfully to repair combined defects of the cheek and nose in eight patients, isolated cheek defects in six patients, combined defects of the cheek and lips in two patients, and isolated defects of the nose, temple, and an antral cutaneous fistula in each of three patients. Defects as large as 6.0 X 10.0 cm have been closed in one stage with this flap. This flap is extremely hearty and its scars can be well concealed. It is especially valuable in the elderly patient and should always be considered as one of the options for reconstruction of the face following MCSE of skin malignancies.     

43例喉复发转移癌的手术治疗

目的:探讨喉复发转移癌的手术治疗方法及临床疗效.方法:对1981年1月至2001年7月43例喉复发转移癌患者进行手术治疗.根据病变的不同情况采用颈清扫、喉部分切除术、全喉切除术、全咽喉食管切除术等,以胸大肌肌皮瓣、胸三角皮瓣、裂层皮片、胃上提、喉气管瓣等修复组织缺损.结果:自首次手术时计算,3年生存率为60.47%,5年生存率为41.89%.95.35%(41/43)的患者恢复了较好的吞咽功能.29例喉部分切除术后局部复发的7例患者保留了喉功能.结论:对喉复发转移癌行积极的手术治疗对提高患者的生存期和改善患者的生存质量有重要意义.     

Selective reconstructive options for the anterior skull base

Carcinomas of the ethmoid, frontal, or maxillary sinuses sometimes invade the anterior skull base. It is necessary to perform en-bloc resection for this invasive carcinoma according to the concepts of surgical treatment for head and neck cancer. The anterior skull base consists of two parts, the orbital roof as the lateral portion and the roofs of the frontal sinus, ethmoid sinus, and/or sphenoid sinus as the central portion. Selective reconstructive options for the anterior skull base depend on the size of the defect of the skull base. A dural defect is repaired by a fascia lata or a pericranial flap. After the dura has been tacked up, reconstruction of the anterior skull base is performed simultaneously with augmentation of the defect of extracranial structures. Larger defects that consist of both central and lateral portions with orbitomaxillary structures are reconstructed by a bulky musculocutaneous flap such as a rectus abdominis or latissimus dorsi flap. The bony reconstruction of supraorbital structures is also to be considered esthetically. On the other hand, intraorbital tissues are basically preserved in cases of central defects of the anterior skull base. These defects are reconstructed by a free forearm flap or a local flap such as a de-epithelialized midline forehead flap or a pericranial flap. We have selected and applied these flaps in 37 patients as reconstructive options for the anterior skull base since 1989. Eleven of the 37 patients had larger defects and 26 had central defects. De-epithelialized midline forehead flaps were used in 20 patients and were recognized to be a very useful and reliable reconstructive option for central defects of the anterior skull base.     

应用游离股前外侧皮瓣修复头颈部软组织缺损

背景与目的：股前外侧皮瓣（ALT）对供区创伤小,有独特优点,但目前临床应用还不常见。本文探讨应用ALT皮瓣修复头颈部软组织缺损的临床价值。方法：回顾2004年11月至2008年5月期间于中山大学肿瘤医治中心20例应用ALT皮瓣修复重建头颈部软组织缺损的病例资料。总结皮瓣切取的技术细节。报告术中解剖和成功率。结果：20例游离股前外侧皮瓣修复头颈部软组织缺损均获成功。ALT皮瓣血管蒂长介于5～14cm,平均9．9cm。切取的面积介于（4～9cm）×（6～16cm）。皮肤穿支的解剖类型分为肌间隔穿支4例（占20％）,肌皮穿支16例（占80％）。股前外侧皮瓣用于修复的头颈部缺损包括口腔内黏膜缺损14例（其中修复舌体及口底9例、口颊黏膜3例、硬腭1例、以及磨牙后区黏膜1例）．面部及颈部皮肤缺损6例。皮瓣供区除1例以外均可一期缝合。结论：股前外侧皮瓣是头颈部各种软组织缺损修复重建中一个很有价值和应用潜力的供区,具有成功率高,对供区影响小的特点。     

应用折叠型游离股前外侧皮瓣修复面颊贯通性缺损12例

目的：探讨折叠型游离股前外侧皮瓣在修复面颊贯通性缺损中的临床应用效果。方法：2010年1月至2014年10月,在中山大学附属肿瘤防治中心应用折叠型游离股前外侧皮瓣修复12例面颊贯通性缺损的患者。分析获取游离股前外侧皮瓣的手术过程、血管吻合技巧以及皮瓣存活率。结果：11例皮瓣存活,1例因术后静脉血栓形成而坏死。在12例患者中,游离股前外侧皮瓣的供区均一期缝合,供区的线性瘢痕隐蔽性好,且供区大腿的功能不受影响。结论：游离股前外侧皮瓣具有良好的可塑性,折叠后可同时修复面颊贯通性缺损的内侧及外侧,具有供区并发症少、外观易接受及患者满意率高的优点。     

带蒂肌皮瓣在肢体软组织肉瘤术中皮肤缺损修复中的临床应用

目的：探讨带蒂肌皮瓣在肢体软组织肉瘤术中皮肤和肌肉创面缺损修复中的临床应用。方法回顾性分析32例肢体软组织肉瘤切除术中皮肤及肌肉创面缺损行带蒂肌皮瓣修复的临床资料、手术方式和预后。结果术后病理切缘阴性率100豫。术后获得随访26例,随访时间8（2~11）个月,Ⅱ、Ⅲ期肉瘤局部控制率为82豫、76豫,皮瓣修复成活率为95豫。结论规范化的肢体软组织肉瘤手术可降低肿瘤局部复发率,但常致术中皮肤及肌肉创面缺损无法直接缝合,而带蒂肌皮瓣是常用的重要创面缺损修复手段,成功的创面修复可明显提高患者术后的生活质量。     

Free muscle transfer with split thickness skin graft coverage in head and neck reconstructive surgery

Sixteen patients (eight females and eight males) who underwent microsurgical free tissue transfers for head and neck reconstruction are reviewed. In this series, the flap reconstruction was completed on eleven patients with extra-oral defects and five with intra-oral defects. Split thickness skin graft coverage was used in all cases. The rectus abdominis free muscle flap was used in nine patients and the latissimus dorsi free muscle flap in seven patients. The choice of tissue reconstruction was decided by the size of the surgical defect. There were no failures of the tissue transfers and skin grafts. In skilled hands, free tissue transfer provides a reliable method of head and neck reconstruction, with a low incidence of recipient and donor site complications. In extra-oral defects, coverage of free muscle transfer with split thickness skin grafts, results in a better colour match than musculocutaneous flaps, and complements the appearance and pliability of the free muscle flap.