Oral and Maxillofacial Surgery Clinics of North America最新文献

Head and neck reconstruction has evolved to a more accurate replacement of the missing tissues for aesthetic and functional benefits, besides a concern with the morbidity caused in the donor site. This has led us to the use of perforator flaps. Deep inferior epigastric perforator flap allows the harvest of a large well-vascularized skin paddle with adequate bulk for large and voluminous defects reconstruction. Its main uses described in the literature are: tongue reconstruction, orbitomaxillary reconstruction, and scalp reconstruction. Thoracodorsal artery perforator flap is derived from the subscapular system and allows the harvest of a large array of chimeric flaps.

The authors aim to provide a comprehensive overview of the advancements in head and neck reconstructive surgery using thinned perforator flaps. The article categorizes these flaps based on thickness and discusses the importance of standardized terminology. Critical aspects like flap vascularity, pre-operative planning, and imaging technologies for perforator mapping are examined with practical considerations. The article then delves into various thinning techniques and their applications in head and neck reconstructions, highlighting challenges and concerns. In conclusion, significant progress in reconstructive surgery using thinned perforator flaps has brought advancements in improving surgical precision and patient outcomes in head and neck reconstructions.

The integration of imaging technologies such as computed tomography angiography and color Doppler ultrasonography are transforming soft tissue free flap reconstruction. The search for thinner and more refined flaps has expanded indications for flaps harvested from donor sites that were not commonly used in head and neck reconstruction. This article explores how these tools and techniques facilitate precise flap selection, thickness, and design customization based on detailed patient preoperative perforator anatomy and vascular configuration mapping. Optimizing outcomes with tailored flap designs improves surgical accuracy and patient-specific results in soft tissue reconstruction.

A perforator is a vessel that travels through muscle and perfuses the skin. Perforator flaps require intramuscular dissection and can be used as pedicled or free flap. With improved understanding of microvasculature, they can be tailored to have multiple skin paddles, multiple components, or shaped to conform to any defect. Reliable perforator flap-based reconstruction is a meticulous microvascular technique, ultimately allowing the surgeon to harvest any flap in a freestyle fashion and transplant to any recipient vessel. New technologies improve the safety and reproducibility of this type of reconstruction.

Head and neck cancer (HNC) is the sixth most common cancer across the world. Despite a general reduction in tobacco consumption and therefore reduction in risk exposure there has been an increasing incidence of oropharyngeal squamous cell carcinoma. Progress made in the past decades in free tissue transfer reconstruction and robotic surgery have merged into transoral robotic reconstruction with free perforator flaps for head and neck. We reviewed and discussed indications and contraindications for this type of procedure, as well as potential limits refinements.

This article illustrates the use of locoregional perforator and pedicled flaps from the 2 main vascular systems of the head and neck area. The 2 authors combine their experiences and research findings to highlight clinical scenarios for these useful refined reconstructions and discuss their pros and cons.

The anterolateral thigh (ALT) free flap has become a workhorse for head and neck reconstruction. This paper offers a thorough introduction to the ALT flap, covering its anatomy, surgical technique, adaptable designs, and use in a range of clinical settings along with case studies. With its long vascular pedicle and tissue versatility, the ALT flap is well-suited for matching varied defects. Still, understanding possible anatomic variances and managing complications are critical to its success. With this paper as a comprehensive guidance, surgeons can apply the ALT flap for difficult head and neck reconstructions and achieve the best possible results.