Abstract
Reconstructing extensive composite oromandibular defects is a difficult challenge. Many donor sites have been used including rib, second metatarsal, radius, scapula, iliac crest and fibula. Each of these flaps has advantages and disadvantages with regard to the donor defect, length of bone available, bone stock and reliability of the associated soft tissue. Additionally, a significant limitation in some patients is that the bone cannot be repositioned three-dimensionally with respect to the overlying skin island. The complex three-dimensional nature of composite resections may challenge the ability of any single osteocutaneous flap to adequately reconstruct all aspects of the resultant defect. To overcome this problem, the authors present a retrospective analysis of their experience with the flow-through sequentially linked free flaps concept for reconstruction of complex defects of head and neck in nine selected cases.
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References
Boyd JB, Gullane JP, Brown DH (1992) Classification of mandibular defects. Plast Reconstr Surg 92(7):1266–75
Blakwell KE, Buchinder D, Biller HF et al (1997) Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck 19:620–8
Wei FC, Demirkan F, Chen HC et al (1999) Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg 103:39–47
Wei FC, Celik N, Chen HC et al (2002) Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 109:45–47
Wei FC, Yazar S, Lin CH, Cheng MH, Tsao CK, Chiang YC (2005). Double free flaps in head and neck reconstruction. In clinics in plastic surgery—microsurgical reconstruction of the head and neck, vol 32 no. 3: 303–8.
Costa H, Guimarães I, Cardoso A, Malta A, Amarante J, Guimarães F (1991) One-staged coverage and revascularisation of traumatised limbs by a flow-through radial mid-forearm free flap. Br J Plast Surg 44:533–537
Costa H, Cunha C, Conde A, Barsdley A, McGrouther DA (1997) The flow-through free flap in replantation surgery: a new concept. Eur J Plast Surg 20:181–185
Sanger JR, Matloub HS, Yousif NJ (1990) Sequential connection flaps: a logical approach to customized mandibular reconstruction. Am J Surg 160:402–4
Urken ML, Weinberg H, Vickery C et al (1992) The combined sensate radial forearm and iliac crest free flaps for reconstruction of significant glossectomy–mandibulectomy defects. Laryngoscope 102:543–58
Wells MD, Luce EA, Edwards AL, Vasconez HC, Sadove RC, Bouzaglou S (1994). Sequentially linked free flaps in head and neck reconstruction. In Head and Neck Reconstruction. Clinics in Plastic Surgery. Saunders, Philadelphia, vol. 21, no.1, p 59–67
Koshima I, Hosoda S, Inagawa K et al (1998) Free combined anterolateral thigh flap and vascularized fibula for wide, through and through oromandibular defects. J Reconstr Microsurg 14:529–34
Bullocks J, Naik B, Lee E, Hollier L (2006) Flow-through flaps: a review of current knowledge and a novel classification system. Microsurgery 26:439–449
Chun JK, Sterry TP, Zhang WX, Wolfeld MB, Silver L, Teodorescu VJ, Marin ML (2003) Rat epigastric flow-through flap as a modulated arteriovenous fistula: model for the radial artery flow-through flap in distal arterial bypass. J Reconstr Microsurg 19:387–391
Gilbert A (1979) Vascularised transfer of the fibula shaft. Int J Microsurg 1:100
Zenha H, Azevedo L, Rios L, Pinto A, Barroso ML, Cunha C, Costa H (2010). The application of 3-D biomodeling technology in complex mandibular reconstruction—experience of 47 clinical cases. Published on-line 21/09/2010
McGregor IA, Morgan G (1973) Axial and random-pattern flaps. Br J Plast Surg 26:202
Mathes SJ, Nahai F (1982) Clinical applications for muscle and musculocutaneous flaps. Mosby, St. Louis
Cormack GC, Lamberty BGH (1984) A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Br J Plast Surg 37:80
Swartz WM, Banis JC, Newton ED et al (1986) The osteocutaneous scapular for mandibular and maxillary reconstruction. Plast Reconstr Surg 77:530–45
Soutar DS, Scheker LR, Tanner NSB, McGregor IA (1983) The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 36:1
Lamberty BGH, Cormack GC (1983) The antecubital fascio-cutaneous flap. Br J Plast Surg 36:428
Zhong-jia Yu (1986) Combined transplantation of free tissues. Plast Reconstr Surg 79(2):222–36
Chen H, Tang Y, Noordhoff MS (1987) Reconstruction of the entire esophagus with chain flaps in a patient with severe corrosive injury. Case report. Plast Reconstr Surg 79:222
Soutar DS (1993) Free flaps in intraoral reconstruction. In microvascular surgery and free tissue transfer. Edward Arnold, London, pp 168–181
Boyd JB (1993) Reconstruction of the mandible in microvascular surgery and free tissue transfer. Edward Arnold, London, pp 182–199
Ceulemans P, Hofer SO (2004) Flow-through anterolateral thigh flap for a free osteocutaneous fibula flap in secondary composite mandible reconstruction. Br J Plast Surg 57:358–61
Acknowledgements
Our sincere thanks go to Mrs. Fernanda Zenha, the author’s wife, for the drawing of the diagram of the anatomical and dynamic concept of the flow-through sequentially linked free flaps for head and neck reconstruction. We also thank Manuela Castanheira, the Unit secretary, for her help and support with the preparation of this paper.
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Costa, H., Zenha, H., Azevedo, L. et al. Flow-through sequentially linked free flaps in head and neck reconstruction. Eur J Plast Surg 35, 31–41 (2012). https://doi.org/10.1007/s00238-011-0575-0
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DOI: https://doi.org/10.1007/s00238-011-0575-0