Free flaps have become the main alternative for intraoral reconstruction in current practice. However, controversy exists on pros and cons of different free flap options for this challenging area. Although there are various studies focusing on different free flap options, comparative studies are very few and there is not a single study comparing all 4 thin free flap options for intraoral reconstruction. Between 2018 and 2021, 30 patients underwent intraoral reconstruction. Four pliable and thin flaps, medial sural artery perforator flap, superficial circumflex iliac artery perforator flap, radial forearm free flap, and superthin anterolateral thigh flap were used for reconstructions and compared per functionality and patients’ quality of life. One medial sural artery perforator flap and 1 superficial circumflex iliac artery perforator flap failed because of perfusion problems, and the remaining flaps survived. Harvest time and donor site closure were with significant difference (P<0.05) between groups. Quality of life results were similar except one of the disease-specific questions. In authors’ opinion, anterolateral thigh flap is the best option in normal-weight individuals because of its reliability, pliability, and constant reliable vascular structure. Although other options may be considered in overweighted patients, thinly elevated anterolateral thigh flap still seems to be the most reliable option.

Background Free intestinal flaps for pharyngolaryngoesophagus reconstruction may require revision operations, including free flap re‐inset for functional improvement. This report aimed to present our experience on vascular pedicle division at the secondary procedure of free flap re‐inset for functional improvement in pharyngoesophageal reconstruction. Patients and Methods Eight male and seven female patients, with a mean age of 52 years old (range: 28–78 years), underwent pharyngoesophageal stricture (n = 7) and hypopharynx carcinoma reconstruction (n = 8) with three free jejunal and 12 free ileocolonic flaps. During revision procedure to shorten the flap for functional improvement, which was performed at 3 months after the initial operation, there were 11 venous and 4 arterial pedicle division cases. The intestinal flap circulation signs, such as presence of normoperistalsis, pink color, moderate secretion, and bleeding at puncture site, were observed for 1 hr. Results No venous pedicle divisions required reanastomosis. However, all arterial pedicle division cases required immediate restoration with a vein graft because of immediate intestinal changes. No postoperative complications were seen, excluding a patient with anterior wall reconstruction who had arterial division and reanastomosis. Patients were followed up for a median duration of 28 months. Conclusion For revision operations involving free intestinal flaps, the arterial pedicle must be protected or repaired if transected, whereas the venous pedicle does not necessitate such a maneuver.

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Introduction: Nasal musculature anatomy is a topic that plastic surgeons pay attention to. However, the presence and role of the myrtiformis muscle (MM) remain controversial. To elucidate these aspects, an anatomy-based study was conducted.Materials and methods: Seven midsagittally split and two total cadaver head's nasal bases, embalmed with modified Larssen solution (MLS), were dissected for MM anatomy. The features of this muscle were photographed, and a video of its function was recorded.Results: It was found that MM originates from the maxillary alveolar process and continues as two heads, one reaching the alar base with spicular fibrotendinous endings and the other extending to depressor septi nasi fibers. Owing to its bi-vectoral muscle fibers, MM is found to constrict the nares by simultaneously forcing the alar base and lowering the columella. It was also found that left-sided muscles were larger than right-sided muscles.Conclusions: The MM is found to be a constrictor muscle of the nares in this study, contrary to recent observations.

Background/Aim: The power of free flaps for lower extremity injury reconstruction is no longer a matter of debate; however, contrasting views remain regarding the timing of reconstruction. The mainstay article of Godina reported that reconstruction within the first three days after injury was more advantageous than surgery at later times, but different views about the best day for reconstruction have also been described in the literature. With developments in the field of microsurgery, plastic surgeons have become more experienced, shortened the times needed for surgery, and achieved flap success. We have also become more experienced with surgical times, and reconstruction on the day of injury has been performed as an emergency reconstruction (ER) procedure since 2018. However, despite the disadvantages of a delayed wait period, patients still experience delayed reconstruction (DR) due to their pre-operative conditions and dispatches from peripheral centers over delayed time periods. This study aimed to present our experiences with lower extremity reconstruction in emergency situations and after delayed periods with descriptions of technical tips for each situation. Methods: Between 2018 and 2021, patients who underwent lower extremity reconstructions were examined as retrospective case-control study. Twenty-four patients (17 male and seven female) underwent lower extremity reconstructions with microsurgical free flap coverage. Patients’ ages ranged from 6 to 75 years old. Ten patients underwent ERs (on the day of injury), and 14 patients underwent DRs. Twenty anterolateral thigh, two medial sural artery perforator, one latissimus dorsi, and one radial forearm flaps were chosen for reconstructions. Flaps were chosen for one-third of the distal lower extremity reconstructions (n=11) and Gustilo type 3B injuries (n=11), Gustilo type 3C injuries (n=1), and one-third for middle lower extremity soft tissue reconstructions (n=1). Infections, length of hospital stays, time spent during the reconstructive surgery, vascular complications, and additional debridement necessity counts were recorded and compared with previous statistical analyses. Results: One venous thrombosis in the emergency group and three venous and one arterial thrombosis in the delayed group were reported. The patients were taken to the operating room immediately after which re-anastomoses were performed successfully, and all flaps survived. The hospital stay was between 4 and 60 days in the emergency group and 20 and 99 days in delayed group. Infections (P=0.03), vascular complications (P=0.04), and hospital stays (P=0.01) were statistically significantly lower in the emergency group than in the delayed group. Conclusion: ER has many advantages, such as preventing time consuming surgeries and providing short hospital stays and low complication rates, over DR. However, DR is inevitable for some reasons, and despite its more complicated nature, meticulous flap follow-up and salvage procedures may provide the same flap success as found with ERs.