Head and neck free flap survival when requiring interposition vein grafting: A multi-instiutional review

Seim, Nolan B.; Old, Matthew; Petrisor, Daniel; Thomas, William W.; Naik, Akash N.; Mowery, Alia; Kang, Stephen Y.; Li, Ryan; Wax, Mark K.

doi:10.1016/j.oraloncology.2019.104482

Cited by 28 publications

(45 citation statements)

References 10 publications

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“…Advances in tissue engineering have demonstrated that the successful regeneration of soft tissues helps to prevent exogenous infection, provide sufficient nutrients, and establish blood supply, as well as providing other benefits [5]. Moreover, a large number of clinical studies have identified that natural free flaps can be used to effectively achieve soft tissue regeneration, significantly improving the outcomes of craniofacial reconstruction [6]. It is well known that the vascular system is required for embryonic development and tissue regeneration, and adequate blood vessel formation enables supply of sufficient oxygen and nutrients and elimination of metabolic waste [7].…”

Section: Introductionmentioning

confidence: 99%

Exosomes derived from stem cells from apical papilla promote craniofacial soft tissue regeneration by enhancing Cdc42-mediated vascularization

Liu

XueYing

et al. 2021

Stem Cell Res Ther

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Background Reconstruction of complex critical-size defects (CSD) in the craniofacial region is a major challenge, and soft tissue regeneration is crucial in determining the therapeutic outcomes of craniofacial CSD. Stem cells from apical papilla (SCAP) are neural crest-derived mesenchymal stem cells (MSCs) that are homologous to cells in craniofacial tissue and represent a promising source for craniofacial tissue regeneration. Exosomes, which contain compound bioactive compounds, are the key factors in stem cell paracrine action. However, the roles of exosomes derived from SCAP (SCAP-Exo) in tissue regeneration are not fully understood. Here, we explored the effects and underlying mechanisms of SCAP-Exo on CSD in maxillofacial soft tissue. Methods SCAP-Exo were isolated and identified by transmission electron microscopy and nanoparticle tracking analysis. The effects of SCAP-Exo on wound healing and vascularization were detected by measuring the wound area and performing histological and immunofluorescence analysis on the palatal gingival CSD of mice. Real-time live-cell imaging and functional assays were used to assess the effects of SCAP-Exo on the biological functions of endothelial cells (ECs). Furthermore, the molecular mechanisms of SCAP-Exo-mediated EC angiogenesis in vitro were tested by immunofluorescence staining, Western blot, and pull-down assays. Finally, in vivo experiments were carried out to verify whether SCAP-Exo could affect vascularization and wound healing through cell division cycle 42 (Cdc42). Results We found that SCAP-Exo promoted tissue regeneration of palatal gingival CSD by enhancing vascularization in the early phase in vivo and that SCAP-Exo improved the angiogenic capacity of ECs in vitro. Mechanistically, SCAP-Exo elevated cell migration by improving cytoskeletal reorganization of ECs via Cdc42 signalling. Furthermore, we revealed that SCAP-Exo transferred Cdc42 into the cytoplasm of ECs and that the Cdc42 protein could be reused directly by recipient ECs, which resulted in the activation of Cdc42-dependent filopodium formation and elevation in cell migration of ECs. Conclusion This study demonstrated that SCAP-Exo had a superior effect on angiogenesis and effectively promoted craniofacial soft tissue regeneration. These data provide a new option for SCAP-Exo to be used in a cell-free approach to optimize tissue regeneration in the clinic.

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Section: Introductionmentioning

confidence: 99%

Exosomes derived from stem cells from apical papilla promote craniofacial soft tissue regeneration by enhancing Cdc42-mediated vascularization

Liu

XueYing

et al. 2021

Stem Cell Res Ther

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“…Prior studies have demonstrated comparable failure rates in head and neck reconstruction (15%). 13 In two pooled analyses of >2,000 and >3,000 head and neck free flap patients, vein grafts were associated with a 5-5.5 fold increased risk of flap failure. 14,15 Possible explanations for this include venous graft size mismatch affecting flow rate, issues with pedicle geometry, or poor quality target vessels in vessel depleted necks.…”

Section: Discussionmentioning

confidence: 97%

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

et al. 2021

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Objectives: Mid and upper face free flaps frequently are associated with challenges due to pedicle length. We sought to evaluate the frequency at which alternative pedicle maneuvers were required for these reconstructions and determine if there was any association with flap survival or postoperative complications.Study Design: Retrospective review at three tertiary care institutions. Methods: Database review.Results: Free flap reconstruction of the upper and midface was performed in 295 patients (108 bony, 187 soft tissue). In 82% of cases, the vessels reached the ipsilateral neck for anastomosis to traditional target vessels. Arterial grafts were required in 2% of reconstructions (4% bony and 1% soft tissue). Venous grafting was required in 7% of reconstructions (21% fibula, 16% scapula, and 3% soft tissue) and was associated with an increase in flap failure rate (19% vs 3%, P = .003). The most common recipient artery for revascularization was the cervical facial artery (78%). Alternate recipient vessels were selected in 13% of cases, including the superficial temporal vessels (7%), distal facial branches through a separate facial incision (4%), and angular vessels (2%). Vein grafting was associated with a higher flap failure rate. Alternative maneuvers did not affect need for intraoperative pedicle revision or complications.Conclusions: In upper and midface reconstruction, vascular grafting, targeting more distal branches of the facial system, or additional maneuvers to optimize pedicle orientation is often required to secure revascularization. Vein grafting is associated with a higher free flap failure rate. Scapular border flaps often require vascular grafting or atypical anastomotic locations.

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“…Typical recipient vessels may not be viable options in salvage cases, patients with recent infection, or in a vessel-depleted neck, in which use of the transverse cervical artery is often required. The dorsal scapular artery has also been described as a viable recipient vessel during free flap reconstruction in a vessel-depleted neck [64] . Interposition vein grafts may be required to lengthen the venous and/or arterial pedicle despite appropriate pre-operative planning and intra-operative efforts with overall success rates around 85% [65] .…”

Section: Recipient Vesselsmentioning

confidence: 99%

Anterior skull base reconstruction: a contemporary review

Naik¹,

Lancione²,

Parikh³

et al. 2021

PAR

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Anterior skull base (ASB) defects present a significant challenge in head and neck reconstructive surgery. The main goal of skull base reconstruction is to create a watertight separation between the intracranial cavity and aerodigestive tract. Successful reconstruction aims to prevent cerebrospinal fluid (CSF) leak, pneumocephalus, and a range of infectious manifestations. Functional outcomes and cosmesis are also critical considerations when developing a reconstructive plan. Advancements with endoscopic endonasal approaches have revolutionized skull base surgery but also have created new reconstructive challenges due to the narrow operative corridor, especially for extensive defects or salvage cases where microvascular free tissue transfer is required. Though a variety of techniques including local, regional, and free flaps have been described, ASB reconstruction remains a difficult undertaking due to the complex anatomy and high risk for post-operative complications. This review provides a comprehensive discussion of available reconstructive techniques that can be used after both open and endoscopic ASB resections to help determine the optimal reconstruction for a variety of defects.

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Head and neck free flap survival when requiring interposition vein grafting: A multi-instiutional review

Cited by 28 publications

References 10 publications

Exosomes derived from stem cells from apical papilla promote craniofacial soft tissue regeneration by enhancing Cdc42-mediated vascularization

Exosomes derived from stem cells from apical papilla promote craniofacial soft tissue regeneration by enhancing Cdc42-mediated vascularization

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

Anterior skull base reconstruction: a contemporary review

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