Prabha Yadav

Pedicled anterolateral thigh flap: a versatile flap for difficult regional soft tissue reconstruction.

Reconstruction of extensive oncosurgical defects of lower trunk, perineum and upper thigh, without the complexity of microsurgery, is a reconstructive challenge. Pedicled anterolateral thigh (ALT) flap offers many advantages over other regional flaps for this purpose, such as the large skin and soft tissue availability, the remarkable pedicle length and the reliability. However, there is paucity of literature describing the utility of pedicled ALT flaps for reconstruction of these difficult soft tissue defects. We present our experience of pedicled ALT flaps for various post oncosurgical defects. From January 2005 to August 2008, 85 pedicled ALT flaps were done in 78 patients for post oncological excision defects of lower trunk, groin, perineum, and upper thigh. Majority of patients were males, with locally advanced inguinal disease, underwent wide skin excision and en bloc nodal resection. Age group ranged from 22 to 81 years. The flap size ranged from 10 × 5 cm (50 cm2) to 38 × 20 cm (760 cm2). The length of the pedicle ranged from 8 to 14 cm. Satisfactory coverage was achieved in all patients, except one, where the flap had to be discarded due to absent artery in the vascular pedicle. Clinically, no functional deficit of knee extensor mechanism was seen in any of these patients during routine activities. Present study has shown the wide arc of rotation, large skin replacement potential, and reliability of pedicled ALT flap.

Use of the submental island flap in orofacial reconstruction – a review of 20 cases

The submental flap, though not a widely used flap, is extremely useful in orofacial reconstruction. We present our experience with this flap particularly in the post oncological setting and describe its technique, complications and precautions adopted in its use. Between January 2001 and January 2007 we performed 20 submental flaps for primary reconstruction of post tumour excision defects in the intraoral and facial region. The procedure was successful in all cases without any complete flap loss. The complications encountered were partial flap loss in one case, haematoma in two cases and venous congestion in one case which was salvaged. Marginal mandibular nerve function was preserved in all cases.

Utility of Proximally Based Sural Artery Flap for Lower Thigh and Knee Defects

The proximally based sural artery flap presents distinct advantages in reconstruction of knee and lower thigh defects including thin sensate flap, reduced donor-site morbidity with good aesthetic outcome. However there are few reports in the literature regarding this flap. This study presents our experience with use of this flap in 37 patients. A retrospective study was performed over a 6-year period (from January 2003 to October 2008) using proximally based islanded sural artery flap for the lower thigh, knee, and upper leg defects following tumor excision defects. There were no complete failures in the series with only one flap requiring additional bipedicled flap for the necrosis of distal margin. All donor sites were closed with split thickness skin graft, with skin paddle sizes ranging up to 23 × 10.5 cm. All patients achieved a good final outcome. The authors found the proximally based islanded sural artery flap to be a simple and reproducible technique to perform and have greater reach up to the lower thigh. It provides thin pliable skin with minimal compromise to either appearance or function. The flap is suitable in the regional reconstruction around the knee as a pedicled flap.

Tongue flap revisited.

AIM To assess the usefulness of single-staged posteriorly based dorsal tongue flap in oral cavity reconstruction following ablative surgery, in terms of flap viability, functional outcome and donor site morbidity. MATERIALS AND METHODS A prospective database of patients who were reconstructed with dorsal tongue flap between July 2006 and November 2010 was used. RESULTS There were 27 patients who had tongue flap reconstruction in this period. Size of the defect following excision ranged from 3.5-5 cm in greatest dimension. Marginal mandibulectomy was done in thirteen patients and in twelve patients mucoperiosteal stripping was done. There was no partial or total flap loss in our series. Two patients had minor salivary leak which was managed conservatively. All the patients had adequate mouth opening, good swallowing and speech following surgery. CONCLUSION Dorsal tongue flap is a simple and reliable flap for intra oral reconstruction. It provides good functional results without much morbidity.

Implant-retained dental rehabilitation in head and neck cancer patients: an assessment of success and failure.

Background: This study aimed to evaluate the rate of osseointegration (ROI) and overall success rate (OSR) of implants placed in native and grafted jaws with or without radiotherapy at a 5-year follow-up in Indian head and neck cancer patients. Material and Methods: Thirty head and neck cancer patients from various socioeconomic strata were accrued. Eighty-five implants were inserted in 17 native and 13 grafted jaws. Nineteen patients received radiation therapy. A 5-year follow-up ROI and OSR of implants were reported. Results: The 5-year ROI and OSR were 88% and 77%, respectively. ROI was 93% for grafted, 85% for native, 83% for irradiated, and 100% for nonirradiated jaws. OSR was 73% for grafted, 80% for native, 71% for irradiated, and 89% for nonirradiated jaws. Patients from higher socioeconomic strata had higher OSR (92%) as compared with those belonging to lower socioeconomic strata (65%). Conclusion: The failure rate observed in this study was 24% for implants placed in head and neck cancer patients at a 5-year follow-up.

Reconstruction of oncological oro-mandibular defects with double skin paddled-free fibula flap: A prudent alternative to double flaps in resource-constrained centres

OBJECTIVE The free fibula flap is the choice flap for mandibular reconstruction following extensive tumor resections. While large defects are managed with a second flap [free or pedicle] in advanced centres, a free fibula flap with a large skin paddle that can be de-epithelised to provide outer skin and inner lining is the best alternative in resource- constrained centres. MATERIALS AND METHODS From January 2005 to December 2009 a total of 386 free fibula flaps were used of which 307 flaps had de-epithelised double skin paddle in reconstructing complex oral and mandibular defects after tumor ablative surgeries. RESULTS Complete flap survival was seen in 282/307 patients. Complete flap loss was seen in 9/307 patients. Partial flap loss was seen in 16 patients. Re - exploration was done in 30 patients and the flap was salvaged in 21 patients. CONCLUSION The vascular supply of the free fibula osteo myocutaneous flap is reliable and a flap with a large skin paddle can be used to provide both inner lining and outer cover in resource-constrained centres.

Primary non-metastatic Ewing sarcoma of the jaw in children: results of surgical resection and primary reconstruction.

The rarity of Ewing sarcoma (ES) of the jaw coupled with the technical challenge of resection and associated functional and cosmetic impairment has resulted in deficient data on surgical management of these tumors. The purpose of this study is to describe the results of surgical excision and reconstruction of primary non‐metastatic ES of the mandible and maxilla in children.

Managing Venous Discrepancy: Simple Method

Microvascular anastomosis is an essential technique for free flap transfer and replantation surgery. Size discrepancy in microvascular anastomosis is a common issue in free flap transfer. Different methods are used by microvascular surgeons to solve the problem of vascular discrepancies. We describe a simple technique using Ligaclips (TM) that effectively narrows the wider vein in such discrepancy.

Successful management of free osteocutaneous fibula flap with anomalous vascularity of the skin paddle

The free osteocutaneous fibula flap is an established method of reconstruction of maxillary and mandibular defects. The vascularity of the skeletal and the cutaneous components is provided by the peroneal artery via the nutrient artery and the septo- and musculocutaneous perforators. In rare situations, these perforators may arise from other major leg arteries. In such circumstances, the procedure has to be either abandoned or modified so that neither the vascularity of the flap nor the donor limb is compromised. We present a case of an anomalous musculocutaneous perforator, which originated from the proximal part of the posterior tibial artery, passed through the soleus muscle and supplied the skin paddle. The flap was elevated as a single composite unit and was managed by two separate vascular anastomosis at the recipient site, one for the peroneal vessels and the other for the anomalous perforator.

Successful reconstruction of large oropharyngeal defect with pectoralis major myocutaneous flap in a four-year-old boy with recurrent fibromatosis.

BackgroundPectoralis major myocutaneous (PMMC) flap continues to be the workhorse in head and neck reconstruction. Although free tissue transfer has revolutionized the reconstruction in cancers of the oral region, PMMC is still considered a readily accessible source of vascularized soft tissue available to the reconstructive surgeon and especially in most developing nations where due to the cost, time, expertise, or infrastructural constraints free flaps cannot be generally offered. Although commonly used in adults, it has been hardly described for reconstruction in children.Case presentationWe present a 4-year-old child with recurrent fibromatosis of the oropharyngeal region where the PMMC was used for reconstruction of the surgical defect and to the best of our knowledge is the youngest patient undergoing reconstruction with PMMC for neoplastic lesion of the head and neck.ConclusionThe PMMC flap is justifiably a popular flap that continues to command an important place in the head and neck surgeons reconstructive armamentarium.