Dual chimeric innervated vastus lateralis free flap for single stage blink and midface reanimation

Chong, Lauren; Tjahjono, Richard; Eviston, Timothy J.; Clark, Jonathan

doi:10.1002/hed.24795

Cited by 11 publications

(12 citation statements)

References 4 publications

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“…In patient 4, an ALT flap was anastomosed to the pedicle of a previous pectoralis flap to cover the oncological defect. Not only can this flap offer a reconstruction of the facial contour, but it can also serve as an NVFF for facial reanimation when the vastus lateralis muscle is transferred 25,26 . However, the pedicle of ALT was used years later as recipient vessels for a gracilis free flap.…”

Section: Discussionmentioning

confidence: 99%

“…Not only can this flap offer a reconstruction of the facial contour, but it can also serve as an NVFF for facial reanimation when the vastus lateralis muscle is transferred. 25,26 However, the pedicle of ALT was used years later as recipient vessels for a gracilis free flap. The resection of both the homolateral facial and masseteric nerves led to the use of the homolateral hypoglossal nerve.…”

Section: Discussionmentioning

confidence: 99%

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Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

Ibarra

Lasso

2022

Ann Plast Surg

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Background: Facial paralysis reconstruction can be difficult in extensive defects after complex facial or cranial base tumor resection and radiotherapy or when primary smile reanimation attempt has failed. The surgical challenge is more complicated when defects are associated with recipient vessels or nerves depletion. This scenario has not been well described in the literature, and the present article will address the alternatives that plastic surgeons may use in these circumstances. Methods: Seventy-five patients operated in the Hospital Gregorio Marañon between 2008 and 2020, for dynamic reconstruction of facial paralysis, were retrospectively evaluated, collecting data about previous facial nerve surgeries, radiotherapy, chemotherapy, recipient nerve for motor restoration and vessels used for free flaps, type of neurovascular free flap (NVFF), and functional score before and after the facial reanimation surgery. Patients presenting recipient vessel and/or nerve depletion after several facial surgeries requiring a variation from the common NVFF surgical protocol were included in this study. Results: Six cases (8%) with facial paralysis and absent recipient homolateral vessels or nerves after severe cranial base surgery, parotid malignancies, or schwannoma surgery were included. Two patients had an immediate functional reconstruction during the oncologic resection surgery, and 4 patients had a delayed reconstruction. Three patients had previous reconstruction with free flaps, and the vascular pedicles of previous flaps were used for the new NVFF. In the other 3 cases, interposition vein grafts to the contralateral recipient vessels were required to perform NVFF. Masseteric nerve in 4 cases, hypoglossal nerve and posterior branch of the deep temporal nerve in 1 case each, were used as recipient nerves. House-Brackmann score improved in all patients after surgery. Conclusions: Neurovascular free flap can be successfully performed to restore facial motion after depletion of homolateral recipient vessels or nerves after previous facial or cranial base surgeries. In these cases, interposition vascular grafts or the pedicle of previous flaps are essential to provide vascularization as well as an optimal orientation of flaps, to reach recipient nerves in a 1-step procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

Ibarra

Lasso

2022

Ann Plast Surg

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“…14 The muscle has a dense aponeurosis that can be used to provide reliable static suspension until muscle reinnervation is achieved. 14,18…”

Section: Discussionmentioning

confidence: 99%

“…The segmental innervation of the vastus lateralis muscle allows harvest of multiple muscle units on separate nerve supply. 14 In contrast to gracilis muscle harvest, the patient position is supine or lateral decubitus, whereas in gracilis harvest the patient is in lithotomy position or supine with a frog-leg position, which could pose more of a challenge in flap harvest and increase theatre operative time especially in patients with high body mass index. The vastus lateralis muscle is easily harvested, allows 2 team approaches, has a long pedicle with fairly constant anatomy, and only a small segment of the muscle is harvested.…”

Section: Discussionmentioning

confidence: 99%

The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction

Lelala

Pienaar

Hudson

2021

Journal of Craniofacial Surgery

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Background: Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle. Methods: This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome. Results: All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9months postoperative demonstrated successful reinnervation of the vastus lateralis muscle. Conclusions: This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip

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“…MVFTT donor sites such as the anterolateral thigh provide tremendous tissue volume in a variety of permutations including adipofascial, fasciocutaneous, and musculocutaneous arrangements . Additional benefits of the ALT are the readily available donor motor nerve grafts (nerves to the vastus lateralis) for facial nerve repair, tensor fascia lata for static facial slings, and even neurotization of chimeric muscle flaps for dynamic facial reconstruction . As such, MVFTT is ideally suited for large auricular and lateral skull base defects as it may provide adequate wound closure and healing, protection of vital structures including dura and neurovascular bundles, maximal restoration of facial contour, and maximal introduction of vascularized tissue necessary for mitigating possible radiation side effects in one operative session .…”

Section: Discussionmentioning

confidence: 99%

Microvascular free tissue transfer and cochlear implants: A case series and literature review

et al. 2019

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Objective: The use of microvascular free tissue transfer (MVFTT) for defects of the scalp and lateral temporal bone in patients with cochlear implants (CI) is uncommon. Herein, we report our experience with the utility, indications, and outcomes for MVFTT in patients with cochlear implants.Methods: A retrospective review of patients at our institution from September 2016 to December 2017 identified subjects with coexistent cochlear implant and ipsilateral MVFTT of the lateral temporal bone or scalp. Information including demographics, indication for MVFTT, timing of CI and MVFTT, donor site, and previous radiation to the head and neck was collected. To assess the current literature on MVFTT in CI patients, a MEDLINE search was performed using key search terms.Results: Two patients with cochlear implants and MVFTT of the ipsilateral temporal bone or scalp were identified. One patient underwent MVFTT for advanced device extrusion with stable audiometric parameters rather than locoregional reconstruction or device explantation. The second patient had primary cochlear implantation at oncologic lateral temporal bone resection (LTBR) and MVFTT for locally advanced squamous cell carcinoma and concurrent profound sensorineural hearing loss (SNHL). A literature review identifies MVFTT as an option for advanced device extrusion, treatment of osteoradionecrosis, and reconstruction after primary oncologic surgery.Conclusion: MVFTT is an important reconstructive tool for patients with functional, exposed cochlear implants. Cochlear implantation for severe to profound SNHL should be considered at the time of primary oncologic surgery and MVFTT of the lateral temporal bone or scalp.

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Dual chimeric innervated vastus lateralis free flap for single stage blink and midface reanimation

Cited by 11 publications

References 4 publications

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction

Microvascular free tissue transfer and cochlear implants: A case series and literature review

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