Vastus lateralis myofascial free flap in tongue
reconstruction

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SUMMARY

In the last decade, the antero-lateral thigh free flap (ALT) has become the most popular free flap for tongue reconstruction because of less donor site morbidity and better cosmetic outcomes. However, fascio-cutaneous ALT may be insufficient to reconstruct major tongue defects, while its muscular-cutaneous variant (using the vastus lateralis muscle) may be too bulky. The present study describes our preliminary experience of tongue reconstruction with vastus lateralis myofascial flap, which could potentially offer unique advantages in head and neck reconstruction including adequate bulk when needed, optimal functional results and obliteration of dead space thus preventing fistulas and infections with minimal morbidity.

RIASSUNTO

Nell'ultimo decennio il lembo antero-laterale di coscia (ALT) è diventato il lembo libero più utilizzato nella ricostruzione della lingua, dal momento che esso è caratterizzato da bassa morbidità a livello del sito donatore e da migliori risultati estetici. Tuttavia, l'ALT fascio-cutaneo può essere insufficiente nella ricostruzione nei difetti maggiori (es. glossectomia totale) mentre la sua variante muscolo-cutanea (che include il muscolo vasto laterale)' può essere troppo voluminosa. Scopo dello studio è quello di descrivere la nostra esperienza preliminare nella ricostruzione della lingua utilizzando il lembo libero mio-fasciale di vasto laterale che potrebbe a nostro parere offrire notevoli vantaggi nella ricostruzione testa-collo come: possibilità di confezionare un lembo voluminoso quando necessario, ottimi risultati funzionali, obliterazione di spazi morti con prevenzione dello sviluppo di fistola e infezione con minima morbidità a livello del sito donatore.

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A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients.

Matthew M Hanasono, Peirong Yu, Roman J Skoracki (2009)

The anterolateral thigh free flap may be harvested as a fasciocutaneous perforator flap or as a myocutaneous flap by including variable amounts of the vastus lateralis muscle. The authors sought to determine the donor-site morbidity associated with both types of flap dissection. Between 2005 and 2008, the authors performed 220 reconstructive operations using the anterolateral thigh free flap. Complications and donor-site function were evaluated prospectively. Variable amounts of vastus lateralis muscle were harvested with the flap in this series: 25 percent included no muscle, 38 percent included minimal muscle, 33 percent included the superficial half of the muscle, and 4 percent included the entire muscle. The motor nerve to the vastus lateralis muscle was spared during dissection of the flap pedicle in 78 percent but required division in 22 percent. Complications included seroma (5 percent), wound dehiscence (2 percent), hematoma (1 percent), infection (1 percent), neuroma (1 percent), and partial skin graft loss (1 percent). Eighty-four percent of patients reported a sensory loss in the distribution of the lateral femoral cutaneous nerve. Weakness or instability was reported by 8 percent of patients at their initial postoperative visit but resolved in all patients within 6 months. All patients regained their postoperative level of activity. The anterolateral thigh free flap is associated with a low rate of complications and functional morbidity. Even when the motor nerve to the vastus lateralis is divided, or substantial amounts of thigh fascia or vastus lateralis muscle are included in the flap design, all patients return to their preoperative level of function.

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Step-by-step mandibular reconstruction with free fibula flap modelling

R. Pellini, G. MERCANTE, G. SPRIANO (2012)

SUMMARY The functional and aesthetic outcomes after segmental mandibular resection are closely related to the technique used during mandibular reconstruction with bone graft. The fibula free flap approach allows the possibility of using bone with/without skin for restoring the defect. Here, we aimed to establish the preplating technique for oromandibular reconstruction in a step-by-step fashion, based on 41 patients. The surgical technique is expounded in 8-10 steps. Preplating, plate removal, resection, replating, template modelling, contouring and fixation of the fibula represent the key points of the procedure. In this report, we show that the preplating and template modelling method is easy, does not incur extra costs and can be successfully used for mandibular reconstruction with bone graft. Functional and aesthetic results confirm the feasibility and reproducibility of the technique.

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The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon's experience in 92 cases.

P. Böni, B. BIANCHI, A. Ferri … (2012)

Applications of the free anterolateral thigh (ALT) musculocutaneous flap have been largely underestimated compared with indications for fasciocutaneous or perforator flaps. In this article, the authors critically review the experience of a single surgeon with the free ALT musculocutaneous flap for head and neck reconstruction, focusing on its applications in different cephalic areas and on advantages and disadvantages of this technique. Ninety-two patients were treated using a free ALT musculocutaneous flap. Reconstructed areas included tongue, oropharynx, mandible, maxilla, hypopharynx, cheek, and skull base. Flap survival rate was 97.8%. Donor site morbidity consisted in two cases of partial necrosis of the skin graft used its closure with a final donor site complication rate of 2.2%. Overall results showed an 89% of patients returned to a normal or a soft diet. Speech was good or intelligible in 88% and cosmesis resulted good or acceptable in 89% of cases. The free ALT musculocutaneous flap offers unique advantages in head and neck reconstructions including adequate bulk when needed, obliteration of dead space, support for the soft tissues of the face, low donor-site morbidity, and harvesting without needing for perforators dissection, allowing for optimal patient outcome. Excessive bulky and thickness of subcutaneous tissue, especially in occidental population, have to be considered as the main disadvantages of this technique, finally the high incidence of hairy skin in thigh area in male patients and donor site scars associated with the use of skin grafts have to be considered as supplementary minor drawbacks. Copyright © 2012 Wiley Periodicals, Inc.

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Author and article information

Journal

Journal ID (nlm-ta): Acta Otorhinolaryngol Ital

Journal ID (iso-abbrev): Acta Otorhinolaryngol Ital

Journal ID (publisher-id): Pacini

Title: Acta Otorhinolaryngologica Italica

Publisher: Pacini Editore SRL

ISSN (Print): 0392-100X

ISSN (Electronic): 1827-675X

Publication date (Print): August 2016

Volume: 36

Issue: 4

Pages: 321-325

Affiliations

[1 ] Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy;

[2 ] Department Organs of Sense, ENT Section, University of Rome "La Sapienza", Rome, Italy

Author notes

Address for correspondence: Armando De Virgilio, Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy. Tel. +39 06 52665065. Fax +39 06 52665066. E-mail: armando.devirgilio@ 123456gmail.com

Article

Publisher ID: Pacini

DOI: 10.14639/0392-100X-1031

PMC ID: 5066469

PubMed ID: 27734986

SO-VID: 5f5d5850-08eb-4f2c-9a42-e729b1307a9a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/

History

Date received : 10 January 2016

Date accepted : 04 March 2016

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Vastus lateralis myofascial free flap in tongue reconstruction Translated title: Lembo miofasciale di vasto laterale nella ricostruzione della lingua

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Most cited references 5

A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients.

Step-by-step mandibular reconstruction with free fibula flap modelling

The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon's experience in 92 cases.

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