Unsurpassed Reliability of Free Flaps for Head and Neck Reconstruction

Blackwell, Keith E.

doi:10.1001/archotol.125.3.295

Cited by 155 publications

(156 citation statements)

References 38 publications

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“…7 Microvascular free tissue transfer (of so-called flaps) enables reconstruction of major defects that were irreparable earlier, as well as markedly improving function and cosmesis. 8 Thus, surgeons can undertake aggressive surgical resections of large tumours, secure in the knowledge that the resulting tissue defect can be filled with healthy autologous flap tissue harvested from any appropriate part of the body. 9 Flap surgery involves transferring tissue from the immediate vicinity of the primary defect (local flaps) or from distant sites (distant flaps).…”

Section: Introductionmentioning

confidence: 99%

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

et al. 2008

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Transfer of healthy autologous tissue as a microvascular free flap facilitates reconstruction during ablative cancer surgery. In addition to filling surgical defects, free flaps might concentrate viral vectors at the tumour bed and mediate local therapeutic effects. We evaluated the magnitude, topography and duration of luciferase gene expression after plasmid and adenoviral delivery in rat superficial inferior epigastric (SIE) flaps. For plasmid delivery, luciferase expression was significantly increased by all transduction routes (topical, intraflap injection, intravascular) ( Po0.01) at day 1, but not at day 7. The spread of luciferase expression was significantly different between the 4 groups at 1 day ( P ¼ 0.026) and was greatest for flaps transduced by intravascular injection. For adenoviral transduction, total radiance was significantly different between the transduced groups at 1, 14 and 28 days (Po0.05 for all comparisons). The highest levels of radiance were seen in the intravascular group. There was a statistically significant difference in the spread of light emission between the 3 groups at 1 ( P ¼ 0.009) and 14 (P ¼ 0.013) days, but this was no longer evident at 28 days. Intravascular adenoviral delivery yields high-level, diffuse and durable gene expression in rat SIE flaps and is suitable for examination in therapeutic models.

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Section: Introductionmentioning

confidence: 99%

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

et al. 2008

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“…The use of microvascular free-flap reconstruction has been established as a reliable and effective means to reconstruct large ablative defects [8,9]. However, our institution's previous study is the only other study to examine the oncologic validity of recipient blood vessel preservation [3].…”

Section: Discussionmentioning

confidence: 99%

Oncologic Validity of Recipient Vessel Preservation in Microvascular Free-Flap Reconstruction

DeConde¹,

Thompson²,

Zaghi³

et al. 2014

ORL

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Objectives: The use of free-flap reconstruction requires a more limited neck dissection to allow for microvascular anastomosis. This study seeks to determine the oncologic validity of cervical vessel preservation. Materials and Methods: The current study is a prospective review of cervical vessel biopsies from patients undergoing resection of squamous cell carcinoma (SCCA) tumors of the head and neck with free tissue reconstruction. Results: From June 2010 to March 2012, 227 recipient vessel biopsies were performed on 100 patients. Three of these patients had grossly abnormal vessels, with malignancy confirmed by frozen section analysis. One patient had a vessel positive for malignancy that was grossly normal but found to have SCCA on the final pathology. Conclusions: When the recipient vessel appears grossly suspicious, a frozen section biopsy and re-resection should be considered. Recipient vessel trimmings should routinely be sent for permanent pathology since in rare cases, they can be involved by tumor, affecting the margin status, prognosis, and indications for adjuvant therapy.

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“…Mandibular reconstruction serves to provide oral competence, improve occlusion, and restore facial contour. 3,[5][6][7][8][9] Any disruption of mandibular continuity is associated with both the loss of an occlusal surface and the frequent creation of a soft-tissue defect. These anatomic changes can cause significant pain in the temporomandibular joint, restrict the patient to a soft or liquid diet, and cause catastrophic communication dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…These anatomic changes can cause significant pain in the temporomandibular joint, restrict the patient to a soft or liquid diet, and cause catastrophic communication dysfunction. [1][2][3]6 En bloc, composite mandibulectomies are often associated with a large soft-tissue defect. Today, there are several approaches that can provide bony reconstruction of the mandible itself, including cancellous marrow grafts and cranial bone grafts.…”

Section: Discussionmentioning

confidence: 99%

Composite Mandibulectomy: A Novel Animal Model

Sidell¹,

Bezouglaia²,

Tetradis³

et al. 2011

Otolaryngol.--head neck surg.

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Objectives-Segmental mandibular defects can result after the treatment of various pathologic processes, including osteoradionecrosis, tumor resection, or fracture nonunion with sequestration. The variety of etiologies and the frequency of occurrence make the reconstruction of segmental mandibular defects a topic of significant interest. Despite these incentives, a well-established small-animal model of the segmental mandibulectomy, including composite resection, does not exist. The objective of this study is the creation of a reliable animal model that can be used to study the reconstruction of en bloc mandibular defects. Surgical techniques and an array of reconstructive options are described. Study design-Description of an animal model.Setting-Animal laboratory at a quaternary care university medical center.Methods-We present an Animal Research Oversight Committee-approved prospective analysis of survival operations in the rat model. A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented. Postoperative management, early pitfalls, surgical complications, and future applications are discussed.Results-A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and 9 postoperative complications were recognized. There were 6 orocutaneous fistulas, 2 abscesses, and 1 seroma. There were 4 fatalities, which were attributed to anesthetic complications (2, intraoperative), hematoma formation (1, postoperative), and foreign-body aspiration (1, postoperative).

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Unsurpassed Reliability of Free Flaps for Head and Neck Reconstruction

Cited by 155 publications

References 38 publications

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

Oncologic Validity of Recipient Vessel Preservation in Microvascular Free-Flap Reconstruction

Composite Mandibulectomy: A Novel Animal Model

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