The Rectus Abdominis Free Flap in Head and Neck Reconstruction

Urken, Mark L.; Turk, Jon B.; Weinberg, Hubert; Vickery, Carlin; Biller, Hugh F.

doi:10.1001/archotol.1991.01870210103021

Cited by 41 publications

(16 citation statements)

References 31 publications

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“…16 Although it was first employed in breast reconstruction, 14,[18][19][20] today this is the best free flap for the complex reconstruction of the cranial base 21 and other less complex head and neck reconstructions. 22,23 Among other advantages, it is not necessary to move the patient when the flap is being prepared and elevated. In addition, it is possible to close the donor site directly by simply detaching the underlying tissues.…”

Section: Discussionmentioning

confidence: 99%

“…The rich vascularization of the abdominal skin allows flexibility in the design of the skin paddle, making it easier for the surgeon to decide the thickness and design of the flap. 23 There are some disadvantages in relation to the donor site. Occasionally, it may be necessary to transpose or change the place of insertion of the navel so that the abdominal wall is symmetrical.…”

Section: Discussionmentioning

confidence: 99%

“…Direct approximation suture can also be performed. 23 An exceptional case of the ileum has been published. 22 Complications that can occur in the recipient site are related to the myocutaneous flap paddle, which in some patients may be too bulky.…”

Section: Discussionmentioning

confidence: 99%

“…Another justificationreason for the use of myocutaneous rectus abdominis free flap is when the patient underwentthe employment of radiation therapy before treating the responsible tumor. 23 The morbidity of the donor site is more evident aesthetically when the radial flap is used because forearm grafting is necessary. Since there is the possibility of abdominal hernia, the weakness and elevation of the abdominal wall should be avoided, making direct absorbable sutures in the muscle and subcutaneous tissue and silk sutures in the skin.…”

mentioning

confidence: 99%

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Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions

Camacho‐Martínez¹,

Rollón

Salazar

et al. 2011

An. Bras. Dermatol.

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BACKGROUND: Dermatologic surgeons routinely harvest pedicled flaps at distance with an axial or random pattern to repair facial defects. These types of skin flaps are time-consuming and have high economic, social and personal costs. These drawbacks could be avoided with the introduction of a single-step transfer of free flaps to the recipient site, with microvascular anastomosis. OBJECTIVE: To demonstrate that better results are obtained with myocutaneous or fasciocutaneous free flaps and which one is more suitable in surgical dermatology. MATERIAL AND METHODS: We selected two patients of opposite sexes and similar ages who had undergone Mohs surgery to remove recurrent malignant tumors that were located in the upper cheek bordering the zygomatic zone. The woman was treated with a fasciocutaneous radial free flap and the man with a rectus abdominis free flap. RESULTS: Both patients had excellent immediate postoperative outcomes. Complications observed in the male patient were related to a previous pulmonary alteration. The fasciocutaneous radial free flap reconstruction was easier to perform than the rectus abdominis free flap; nevertheless, the radial free flap is very thin and, although the palmaris longus tendon is used, it does not yield enough volume, requiring later use of implants. In contrast, the rectus abdominis free flap transfers a wide flap with enough fat tissue to expand in the future. As for the cosmetic results regarding the donor site, the rectus abdominis free flap produces better-looking scars, since secondary defects of the palmar surface cannot be directly closed and usually require grafting -a situation that some patients do not accept. CONCLUSIONS: In surgical dermatology, each case, once the tumor has been extirpated, requires its own reconstructive technique. The radial free flap is suitable for thin patients who are willing to cover their arm with a shirt. The rectus abdominis free flap is best suited for obese patients with deep and voluminous defects, although it is necessary to dislocate the navel from its original position. Keywords: Mohs surgery; Muscle development; Surgical flaps Resumo: FUNDAMENTOS: Os cirurgiões dermatológicos habitualmente realizam retalhos pediculados cutâneos à distância, de padrão axial ou ao acaso, para reparar os defeitos faciais. Estes tipos de retalhos cutâneos requerem muito tempo para realizar-se e têm elevadas despesas econômicas, sociais e pessoais. Com a introdução da transferência em uma única etapa de retalhos livres ao local receptor, com anastomose microvascular, estes inconvenientes poderiam ser evitados. OBJETIVO: Demonstrar que se obtêm melhores resultados com retalhos livres fasciocutâneos ou miocutâneos e qual deles é mais adequado em Dermatologia cirúrgica. MATERIAL E MÉTODOS: Selecionamos dois pacientes, de sexos diferentes e idades similares, que haviam sido tratados com cirurgia de Mohs, para eliminar os tumores malignos recidivantes que se localizavam na parte superior das bochechas contatando com a zona zigomática. A mulher...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions

Camacho‐Martínez¹,

Rollón

Salazar

et al. 2011

An. Bras. Dermatol.

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“…A number of options exist for the reconstruction of full-thickness cheek defects, such as folded forehead flap [10], folded trapezius flap [11], bipaddle PM myocutaneous flap [12], rectus abdominis free flap [13], distal forearm flaps, anterolateral thigh flap, and double flaps [14].…”

Section: Discussionmentioning

confidence: 99%

Carcinoma buccal cavity: Late presentation and salvage, experience from a North Indian center

Tripathy

Yaseen²,

Bariar³

et al. 2010

Indian J Otolaryngol Head Neck Surg

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Carcinoma buccal cavity, the most common oral cavity cancer was seen in our set up in more than 50% cases. Forty patients of carcinoma buccal cavity were studied at JN Medical College, Aligarh Muslim University, and Aligarh over a period of last 5 years (2003)(2004)(2005)(2006)(2007)(2008). Mean age at presentation 36.5 years (30-55) years. Male: Female, 27:13.Most common association was with smoking and chewing tobacco and pan over a mean long period of 15 years (8-22 years). Most common location was lateral wall of buccal cavity over cheek area related to their typical chewing habit of keeping the tobacco over that area over a prolonged period. Most of them, more than 90% (36 cases) presented late involving both mucosa and skin and in 25% cases also involving the alveolus and mandible. Wide excision and modified radical neck dissection with or without mandibulectomy (marginal, partial or hemimandibulectomy) done in all cases. Reconstruction was done by pedicled pectoralis major (PM) and deltopectoral (DP), the workhorse flaps for head and neck reconstruction for mucosal lining and skin cover respectively in 25 cases. Five cases needed only lining done by PM flap. Ten cases were salvaged by pedicled forehead flap for both lining and cover. All the cases healed properly with acceptable results and good functional recovery. Two cases reported recurrence treated with postoperative radiotherapy. Poor socioeconomic status, smoking and chewing habit, poor oral hygiene, malnutrition and moreover lack of awareness led to late presentation. However, an attempt was made for salvage at our center.

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Muscle Tissue Engineering for Partial Glossectomy Defects

Kim

Hadlock

Cheney

et al. 2003

Arch Facial Plast Surg

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Background: Tongue reconstruction represents a difficult reconstructive problem, based on the tongue's complex multimodality function. Existing methods of tongue reconstruction often result in significant deficits in speech and deglutition. A functional neotongue requires adequate soft tissue bulk and restoration of coordinated muscle function. Tissue engineering, a scientific approach that allows introduction of isolated cell populations of interest within 3-dimensional polymer scaffolds to create new tissue, may allow the generation of more highly functional tissue in tongue reconstruction. Objectives: To apply muscle-tissue engineering techniques in the reconstruction of partial glossectomy defects in rats, and to compare the gross and histological nature of tissue found after reconstruction of the hemiglossectomy defect with acellular vs tissue-engineered composite material. Materials and Methods: Thirty mature Lewis rats underwent a left-sided mucosa-sparing partial glossectomy. The defects were then filled with 1 of the following 3 substances: isotonic sodium chloride solution, a collagen-rich hydrogel, or hydrogel containing a suspension of neonatal myoblasts from syngeneic rats. The animals were killed after 6 weeks and the tongues were harvested. The control and operated-on tongue halves were evaluated for weight differences and histological features. Results: The group receiving the hydrogel-myoblast composite injections demonstrated a statistically significant increase in tongue weight of the operated-on side compared with the control side. In contrast, the isotonic sodium chloride solution and hydrogel groups demonstrated loss of tongue weight. These findings correlated with the results of the histological evaluation. Hemitongues from the composite group demonstrated formation of new tissue with areas of musclelike tissue extending from islands of residual hydrogel, and we found evidence of neovascularization and possible neurotization. In contrast, the isotonic sodium chloride solution group exhibited dense fibrous scar with loss of muscle architecture and dramatic loss of tongue volume. The hydrogel group demonstrated preservation of tongue volume with persistent islands of gel, but no clear evidence of new tissue formation.

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The Rectus Abdominis Free Flap in Head and Neck Reconstruction

Cited by 41 publications

References 31 publications

Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions

Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions

Carcinoma buccal cavity: Late presentation and salvage, experience from a North Indian center

Muscle Tissue Engineering for Partial Glossectomy Defects

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