The clinical applications of free have been extended tremendously in head and neck reconstruction. In a nine-year period, 92 microvascular free flaps were performed to repair the defects following major head and neck ablative surgery. Twenty-one transverse rectus abdominis myocutaneous flaps, 18 radial foream flaps, 15 latissimus dorsi muscle flaps, 12 jejunal flaps, 8 fibular osteocutaneous flaps, 6 rectus abdominis muscle flaps, 6 iliac osteomyocutaneous flaps, 2 groin fasciocutaneous flaps, 1 scapular fasciocutaneous flap, 1 parascapular osteocutaneous flap, 1 tensor fascia lata muscle flap and 1 serratus anterior muscle flap were used for reconstruction. Twenty-five maxillary defects including the orbit or skull base, 16 pharyngoesophageal defects, 15 intraoral defects, 15 mandibular defects, 13 scalp defects, 1 cervical region and 7 other facial region were covered with various free flaps. The overall success rate of the flaps was 95.6%. The complications included total flap loss (3 cases), partial flap loss (1 case), recurrence of primary tumors (15 cases), cerebrospinal fluid leakage (3 cases), fistula formation (3 cases) and infection (5 cases). Superficial temporal artery, facial artery, superior thyroidal artery, lingual artery, occipital artery, transverse cervical artery were commonly used recipient arteries and 7 cases of vein grafts were used if indicated. End to end anastomosis was performed in 84 cases and end to side anastomosis in 8 cases. The average follow-up period was 42 months, ranging from 6 months to 8 years. One patent died during postoperative intensive care due to sepsis and 19 patients died because of recurrence of tumors and underlying medical diseases during the follow-up period. Although free flaps may appear to be riskier than traditional forms of reconstruction, they offer the surgeon a greater spectrum of reconstructive options. Free flap reconstruction also improves the quality of life and minimizes the loss of function. Limitations of the use of free flaps result only from a lack of technical skills and specialized equipment.
Arteries ; Cerebrospinal Fluid ; Fascia Lata ; Fistula ; Follow-Up Studies ; Free Tissue Flaps* ; Groin ; Head* ; Humans ; Critical Care ; Myocutaneous Flap ; Neck* ; Orbit ; Quality of Life ; Rectus Abdominis ; Recurrence ; Scalp ; Sepsis ; Skull Base ; Superficial Back Muscles ; Temporal Arteries ; Thyroid Gland ; Transplants ; Veins

No abstract available.
Peripheral Nerves* ; Regeneration*

The chest wall plays a role to protect vital organs in the trunk such as heart and lung, and to facilitate a semi-rigid structure for breathing. When a defect occurs in a chest wall for such reasons as trauma, tumor, infection, inflammation, post-radiation necrosis, congenital anomaly, and so forth, not only anatomical, but also functional aspects should be considered in reconstruction process. It is, generally speaking, difficult to reconstruct a chest wall defect, since these patients tend to be old aged and have underlying disease with chronic and heavily contaminated wounds which had experienced irradiation or operation. In chest wall reconstruction, the authors utilized muscle flaps in trunk to secure a semi-rigid structure, because muscle flaps in trunk are easily accessible, and have reliable blood vessels. We have conducted 42 cases of chest wall reconstruction between Feb, 1996 and Jan, 2003. Except one case, we succeeded in gaining satisfactory results in functional and anatomical aspects. Based on these experiences, we would like to clarify the principles of chest wall reconstruction as below, helping to choose a proper method in the operations. The principles are appropriate debridement, skeletal reconstruction when indicated, coverage of soft tissue with muscle flap and removal of dead spaces.
Blood Vessels ; Debridement ; Heart ; Humans ; Inflammation ; Lung ; Necrosis ; Respiration ; Thoracic Wall* ; Thorax* ; Wounds and Injuries

No abstract available.
Herpes Simplex ; Herpes Zoster ; Humans ; Methylmethacrylates ; Polystyrenes