Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Vessels ; injuries ; Child ; Child, Preschool ; Female ; Free Tissue Flaps ; blood supply ; Head ; surgery ; Humans ; Male ; Middle Aged ; Neck ; surgery ; Tissue Transplantation ; adverse effects ; methods ; Young Adult

Humans ; Lymph Nodes ; pathology ; surgery ; Neck Dissection ; methods ; Oropharyngeal Neoplasms ; pathology ; surgery

Objective To explore a new method in the treatment of odontoid pr ocess fracture with a self-designed screw and anterior percutaneous odontoid fix ation. Methods Computerized tomography (CT) was used to measure the coronal and sagittal external diameter of the base of odontoid process, the length of the od ontoid process, the total height of the axis and the angle between the axial lin e of the odontoid process and the vertical line of the anterosuperior border of the C3 vertebral body in 40 normal adults aged from 20 to 45 years. Ten odontoid process fractures were fixed with cannulated anterior odontoid screws and monit ored under fluoroscope. According to Anderson's classfication, there were 4 of t ype Ⅱand 6 of type Ⅲ. 4 had no any displacement of the dens, 3 had displacemen t less than 5 mm, and 3 had displacement of 5 mm or more. The fractures were fre sh in 8, and the other 2 were old. Each fracture was fixed by one screw, and ant erior bone-graft was performed in old fracture after screw fixation. Results The coronal external diameter of the base of odontoid process was (8.8?1.2) mm, wh ile the sagittal external diameter was (10.9?1.0) mm, the length of the odontoi d process was (14.2?1.2) mm, the total height of the axis was (38.2?1.8) mm an d the angle between the axial line of the odontoid process and the vertical line of the anterosuperior border of the C3 vertebral body was 23.1??1.4?. Satis factory results were achieved in all patients, and all screws were in good posit ion. No neurological deterioration occurred. After a mean follow-up of 19 months (range, 10 to 25 months), 8 cases showed radiographic union, while 2 nonunion. Neither clinical symptoms nor screw loosening or breakage occurred. Conclusion The direct anterior percutaneous screw fixation is practical for fractures of t he dens with appropriate instrumentation, as long as the surgeon is familiar wit h the topographic anatomy and makes sure the insertion point, the depth and the angle on percutaneous insertion of the screws, the satisfactory outcome will be obtained. There is no stiffening of the C1,2 and the motion limitation. The ant erior percutaneous procedure is surgically less traumatic than the conventional cervical approaches. One screw is optimal for this procedure.

Objective: To analyze the value and reliability of combined free fibula flap and radial forearm flap in the reconstruction of extensive composite oro-mandibular defects. Methods: Extensive composite oro-mandibular defects were reconstructed in 23 consecutive cases (averagely aged 52.9 years old) with combined free fibula flap and radial forearm flap from March 2000 to January 2002. Data concerning the operation, defect description and site, recipient vessel and complications were reviewed. Results: The overall flap survival rate was 100% (all of 46 flaps) without partial or total flap necrosis. The overall complication rate was 30.4%. The vessel thrombosis rate was 2.2%, and the flap salvage rate was 100%. Conclusion: In selected cases, combined free fibula flap and radial forearm flap method may provide satisfactory reconstruction for extensive oro-mandibular defect, and greatly improve the quality of life of patients.

Objective: To evaluate sensory recovery in noninnervated radial forearm free flap after tongue reconstruction. Methods: Sixty-five cases of tongue reconstruction by using free radial forearm flaps were analyzed. Flap sensations to touch, sharp vs dull, two-point discrimination and warmth vs cold was evaluated in each of these patients at 6 months and 12 months after treatment. Results:Twenty-nine flaps (44.6%) showed good sensory recovery, thirty-two flaps (50%) recovered partly, four flaps (6.1%) was anesthetic. Conclusion: Spontaneous recovery of flap sensation can be re-established after reconstruction. Delay or failure of sensory recovery in flap reconstruction could be caused by radiation therapy.

Objective To investigate the clinical application of free submental flap for defects reconstruction after oral cancer ablation.Methods Eleven cases of free submental flaps for defects reconstruction after oral cancer ablation from April,2013 to May,2014 were reviewed.The primary disease,defect type,flap side,flap size and flap survival rate were recorded.The follow-up data of tumor recurrence,lymph node metastasis,as well as postoperative facial appearance and function of marginal mandibular branch of facial nerve were collected.Results Primary disease of all 11 cases was oral squamous cell carcinoma.No flap failure was reported and the overall flap survived.The follow-up period was 6-18 months with the average of 9 months.There was no tumor recurrence and metastasis of lymph node.Postoperative facial appearance was satisfactory and there was no nerve injury of marginal mandibular branch which showed normal and symmetrical expression motion.Conclusion Free submental flap owns many ad vantages including constant anatomy,long vascular pedicle,wide range of indications and low donor-site morbidity.Contralater submental flap may avoid potential lymph node metastasis.Free submentai flaps is an ideal choice for reconstruction of oral and maxillofacial defects after cancer ablation.

Carcinoma, Squamous Cell ; secondary ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mouth Neoplasms ; pathology ; Prognosis

OBJECTIVEThe paper reviewed the effectiveness and reliability of skin paddles of free fibula flaps in the reconstruction of maxillofacial defects.

METHODSFifty-five consecutive free fibula osteocutaneous flap transfers performed from June 21, 1999 to October 31, 2000 were reviewed. The skin paddles of each flap were analyzed in terms of surgical design, blood supply, size, reconstruction location, and survival.

RESULTSFifty-seven skin paddles were used for the 55 free fibula flaps (double skin paddles for 2 flaps), 37 were nurtured by one perforator, 18 by two and two by 3 perforators. Twenty-eight skin paddles were used for intraoral reconstruction, 7 for extraoral reconstruction, 1 for both intraoral and extraoral reconstruction, 2 for soft tissue augmentation, and the remaining 19 were simply used as window for monitoring the blood flow of fibula flap. One free fibula flap with one skin paddle was lost because of venous thrombosis, and the other 54 flaps survived completely, with 100% survival of 56 skin paddles.

CONCLUSIONThe skin paddle of free fibula flap is safe and reliable. It can be used for all kinds of soft tissue reconstruction, as well as window for monitoring the blood flow of fibula flap after operation.

Adolescent ; Adult ; Aged ; Child ; Female ; Fibula ; Humans ; Male ; Mandible ; surgery ; Mandibular Neoplasms ; pathology ; surgery ; Microsurgery ; Middle Aged ; Mouth Neoplasms ; pathology ; surgery ; Oral Surgical Procedures ; methods ; Postoperative Complications ; surgery ; Reconstructive Surgical Procedures ; methods ; Reoperation ; Skin Transplantation ; Surgical Flaps ; blood supply ; Tissue and Organ Harvesting ; methods

[ABSTRACT]OBJETIVETo analyze the reliability and safety of our simplified microsurgical techniques in head and neck reconstruction.METHODSA total of 3045 consecutive cases of free flap transferred in the head and neck region from May 1999 to May 2015 were reviewed. Data concerning the operation included the date of surgery, defect description and site, stage and histology of tumor, type of free flap, recipient vessel and complications.RESULTSOf the 3045 cases, 1856 were males, and 1189 were females. The age ranged from 5 to 86 years, with the average of 47.8 years. Among the 3045 cases, 2868 were tumor-related defects reconstructions, and 2653 were one stage reconstructions. The overall success rate of free flap was 98.5%. The vessel thrombosis rate was 2.9%, and the flap salvage rate was 48.9%.CONCLUSIONOur microsurgery technique greatly simplified traditional microsurgical technique. Head and neck reconstruction using this technique is very safe and reliable, and needs further clinical applications.

Objective To study the method and effect of lateral arm free flap in reconstruction of severe atresic eye socket.Methods Forteen cases of severe atresic eye socket,from June,2011 to June,2013,were repaired by lateral arm free flap.The flaps were designed and harvested as drop shape with size about 6 cm × 10 cm and then were removed epidermis except distal 6 cm × 6 cm area which were transferred to orbit for eye socket reconstruction.The remaining fascia and dermis were filled to augment temporal defect.Superficial temporal artery was anastomosed with posterior branch of radial collateral artery in 14 cases and superficial temporal vein was anstomosed with radial collateral vein in 11 cases,with middle temporal vein in 3 cases.Results All 14 cases lateral arm free flaps survived with no donor site morbidity.Followed up for 1 year to 3 years,artificial eye could be fitted satisfactorily and temporal contour improved.Conclusion Lateral arm free flap is a recommendable option for severe atresic eye socket reconstruction because of concealed donor site scar,proper volume,matched vascular caliber and minor donor site morbidity.