Like rectus FFs, they can fill large defects. Als we je account op een ander apparaat herkennen, hoef je niet opnieuw de keuze te maken. Postoperative coronal CECT in a patient with T4bN0M0 basaloid carcinoma and recurrence after initial partial maxillectomy demonstrates the bulky rectus abdominis FF (block arrow) filling the left midface defect following orbital exenteration and total maxillectomy. Jejunal FF. Pedicled flaps shortly became the first-choice reconstructive flaps being easy and quick to harvest, as they do not require a multi-team for the preparation or dedicated instrumentation. Each free flap is designed and harvested at a spatially distinct site from the primary defect known as the donor or harvest site. In addition, it discusses microvascular techniques and explores different soft-tissue, perforator and bone flaps, including novel free tissue flaps, presented for the first time in the head and neck field. Je kunt je cookievoorkeuren altijd weer aanpassen. We do not capture any email address. Following laryngopharyngectomy, the intraoperative photograph (A) shows a segment of the jejunum (arrow) interposed between the oropharynx and esophagus, anastomosed end to end to allow patients to eat and swallow. Nodularity, a mass, or focal discrete enhancement is a characteristic imaging appearance of a recurrence (Fig 12). MR imaging may be useful for evaluation of perineural tumor, intracranial extension, cartilaginous involvement, and other troubleshooting. Additionally, fasciocutaneous FFs can be tubed/rolled to recreate epithelial-lined conduits (Fig 5).5,7,21 Two of the more commonly used fasciocutaneous FFs are the radial forearm and anterolateral thigh FFs. This article details our approach to this challenging and complex procedure. The interface of the flap and resection cavity, known as the recipient bed, is the most critical area to examine because this is the site of local disease recurrence. Local and Regional Flaps in Head & Neck Reconstruction: A Practical Approach provides comprehensive, step-by-step instruction for flap raising and insetting for the head and neck region. The CT or MR imaging appearance of the FF reconstruction reflects the flap components. Free flaps provide superior functional and aesthetic restoration with less donor-site morbidity. Radiologists will encounter cross-sectional imaging studies performed to evaluate postoperative complications in patients with FF. In addition, not every defect requires a free flap transfer to achieve good functional results. If you continue browsing the site, you agree to the use of cookies on this website. Because the ALT FF is harvested from the anterior and proximal aspect of the lower extremity, there is relatively little morbidity at the donor site and the patient's clothing typically covers any postoperative scarring.5,7. Fascia-containing FFs in H&N are nearly exclusively fasciocutaneous, including a skin paddle in addition to the fascia, vessels, and subcutaneous tissue. The osseous interface with native bone in the mandible, maxilla, or orbital walls should be assessed for bridging new bone (Fig 10). The ALT has a large, thin, pliable skin paddle with relatively little morbidity at the donor site. The radial forearm FF has a rich vascular supply and may be harvested in a variety of sizes. After 3 weeks of inset flap … While the 2 are distinct entities, it is not uncommon to hear them incorrectly used interchangeably. The tubular shape and thick cortical bone make the fibular FF particularly strong. Osseous-containing FFs are some of the most complex FFs. The mandible was fixed with external fixator before the resection and reconstructed with an AO 2.4-mm reconstruction plate. Osseous FF margins. 2 Full-thickness resection of the skin, floor of the mouth, and mandible. Conversely, the major graft vasculature is transected at the donor site and the tissue inset without vessel-to-vessel anastomosis. Hardware exposure. Both are blocks of transferred tissue, but flaps have their own blood supply while grafts depend on angiogenesis.5,7 Surgical flaps are transferred either with an intact vascular supply or the blood supply is re-established at the recipient site using microvascular techniques. An example of a regional flap is the pectoralis major myocutaneous flap, supplied by the pectoral branch of the thoracoacromial artery. Axial images are acquired from the frontal sinuses through the mediastinum at a 1.25-mm section thickness and are sent to the PACS. Fibular FF. A total of 45 cases of late free flap failure in the head and neck were identified. Dehiscence of FFs overlying surgical hardware can result in exposure of the surgical construct (Fig 15). Infection and fistulas can present with nonspecific imaging features, such as soft-tissue swelling and stranding, loss of fat planes, and collections of fluid and air. Latissimus dorsi FF. The recipient site margins (short arrow) have no nodularity. Volg je bestelling, Paper previously presented as an educational electronic exhibit at: Annual Meeting of the American Society of Head and Neck Radiology, September 7–11, 2016; Washington, DC. ALT FF intraoperative image (C) shows the harvested FF on the operating room back table with an elongated vascular pedicle (arrowhead). This ossification can be seen in up to 50% of patients as soon as 1 month after the operation and may present clinically as a palpable mass.36. Als we je account op een ander apparaat herkennen, hoef je niet opnieuw de keuze te maken. It has been used more extensively and for a wider variety of reconstructions than any other flap.5 This FF is particularly advantageous because the forearm skin is usually non-hair-bearing and the forearm is least influenced by obesity.7 Primary indications for use include reconstruction of skin or mucosal lining defects, partial/hemiglossectomy defects, and pharyngeal defects. Head and neck reconstruction surgery has considerably evolved over the past decades, along with the trend of using either a free or a pedicled flap for the reconstruction of oncologic defects. The initial baseline posttreatment PET/CECT is performed 10–12 weeks after the end of radiation treatment, or after the operation, to allow posttreatment changes to resolve. SUMMARY: Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Email mij eenmalig zodra dit artikel leverbaar is. These findings are especially important if the patient has new pain, dysphagia, or any symptom that would suggest recurrent malignancy. Flap Selection in Head and Neck Cancer Reconstruction AIJOC done in the triangle of infraclavicular fossa to divide the cutaneous branch of thoracoacromial artery (Strategic Delay). Ook willen we cookies plaatsen om je bezoek aan bol.com makkelijker en persoonlijker te maken. When recognized and surgically treated promptly, compromised FFs have a salvage rate of 50%–75%.8 Management includes re-exploration of the site, with possible thrombectomy and anastomosis revision. Enter multiple addresses on separate lines or separate them with commas. Axial fat-saturated T1 postcontrast MR imaging (A) demonstrates the T4a left lateral oral tongue SCC (asterisk), which also involved the extrinsic tongue muscles and floor of mouth. One or 2 skin paddles can be obtained; unfortunately, they are often hair-bearing in male patients, resulting in an undesired postoperative cosmetic appearance if used in certain locations (ie, oral cavity mucosal reconstruction). Hiermee passen wij en derden onze website, app en advertenties aan jouw interesses aan. This richly illustrated atlas provides a clear and comprehensive step-by-step description of surgical techniques for raising and setting free flaps from different donor sites, to reconstruct damage to the head and neck caused by cancer and trauma. Patients undergo frequent inspection of tissue color, capillary refill, turgor, and temperature.12,30 Various other techniques, including Doppler monitoring and needle pricks, are also used in the immediate postoperative period. Probably the main impact of perforator flaps in the head and neck region is to increase the sophistication of our reconstructions as well as to provide us with more choices. One of the surgical goals is to “replace like with like,” meaning reconstructing surgical cavities with tissue constituents similar to those resected. Patient demographics, defect characteristics, adjuvant therapies, and postoperative complications were recorded. Multiplanar reformations are also sent to the PACS. 5-7 Our hypothesis was based on the assumptions that patients receiving free flaps would have more advanced disease, more drains placed and for longer periods, and longer procedure times compared with patients not receiving free flaps. To provide accurate and useful H&N imaging reports, radiologists should have a basic understanding of the surgical options, ranging from skin grafts to surgical flaps. Thank you for your interest in spreading the word on American Journal of Neuroradiology. Houd er rekening mee dat het artikel niet altijd weer terug op voorraad komt. However, not all patients are suitable candidates for free flap reconstruction. Hardware exposure and extrusion are the most commonly cited flap complications and occur in around 15% of patients.29,31 This complication is often seen in association with continued tobacco use. Interventions: Twenty-eight patients underwent head and neck reconstruction using lateral arm flaps. One drawback is that the thickness of the FF is particularly reflective of a patient's weight and may prove too bulky for some resection cavities in obese patients due to excessive subcutaneous fat.5 Rectus abdominis FFs can also be harvested as fasciocutaneous free flaps. Additionally, some FFs (rectus abdominis and latissimus dorsi) may be harvested as either myocutaneous or fasciocutaneous. Conclusions. MR imaging protocols vary depending on the location of the abnormality. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Grafts may be autograft (from the patient), allograft (from a donor, often cadaveric), or alloplastic (man-made). One or 2 skin paddles may be harvested; one usually recreates the oral mucosal surface as shown in the diagram. Tubed radial forearm FF. A fibular FF reconstruction was originally planned but abandoned due to severe peripheral vascular disease. Local flaps, flaps generated adjacent to the primary defect, are examples of random flaps. They conducted a retrospective review of all lateral forearm flap reconstructions performed between 2016 and 2018. Free tissue flaps are the most complex and technically challenging form of flap reconstruction. Then, the FF itself is evaluated. Thus, performing an accurate preoperative Allen test is of the utmost importance to ensure an adequate supply of the hand via the ulnar artery and to avoid catastrophic ischemia of the hand.5, The anterolateral thigh (ALT) FF has a large, thin, pliable skin paddle and a long vascular pedicle, up to 15 cm. verzendkosten Postoperative clinical picture (B) demonstrates the well-incorporated mature flap (double asterisks) following marginal mandibulectomy. The number of reports on its applications in the head and neck is limited. There are many techniques that can be used to reconstruct the head and neck. The radial forearm FF is harvested from the volar aspect of the forearm and includes the radial artery (Fig 4). Axial flaps are typically considered more reliable than random flaps on the basis of improved distal perfusion. In contrast, axial flaps are supplied by a specific arteriovenous system. Intraoperative photo (A) shows the radial artery (arrows) up to the skin paddle (asterisk) after Doppler mapping. However, some cases may be more obvious, with new rim-enhancing fluid collections or areas of frank dehiscence (Fig 14). If a plate and screws have been placed at the flap–native bone interface, there may be diastasis bridged by the plate, but the cut end bone margins should be smooth. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Preoperative imaging should always be reviewed when the posttreatment scan is interpreted as it helps to understand what anatomic structures were resected and where the primary tumor was located. Free flaps were first described in head and neck reconstruction in 1959 and has since become the gold standard for head and neck reconstruction. A free flap is a graft of human tissue which is taken together with its supplying blood vessels and placed in another part of the body where it … In addition, not every defect requires a free flap transfer to achieve good functional results. servicekosten. Each donor vascular pedicle is transected at the donor site, transferred along with the flap constituents to the primary defect, and inset at the primary defect. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications (including tumor recurrence) is crucial for the interpreting radiologist. Flap transfer to achieve good functional results frequency of free flap failure in the muscle ( )... Back ( Fig 4 ) hear them incorrectly used interchangeably neck resource intended for the.... Fat ( curved arrow ) following the right segmental mandibulectomy derde partijen jouw internetgedrag binnen en bol.com. 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