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Etiology and Management of Intraoperative Free Flap Failure.
[BACKGROUND] Intraoperative free flap failure necessitates prompt intraoperative decision-making on alternative reconstructive strategies. In this study, we investigate the etiology and management of intraoperative flap loss. [METHODS] Ret…
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Salvage Laryngectomy With Primary Pharyngeal Closure and Flap Onlay Technique.
[OBJECTIVE] Salvage laryngectomy is associated with significant reconstructive challenges related to pharyngocutaneous fistula (PCF) formation and need for secondary reconstruction. This retrospective study evaluates these surgical outcomes…
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Pediatric Free Flaps: Indications, Considerations, and Follow-up.
Free tissue transfer is a very effective reconstructive technique for challenging defects of the head and neck and in many cases the gold standard for congenital facial paralyses and composite defects. Although its use in the pediatric popu…
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Flow-Through Flaps as a Robust Method for Advanced Free Flap Reconstruction in the Head and Neck: A Multi-Institutional Experience.
[BACKGROUND] Flow-through flaps (FTFs) are an advanced technique in which a free flap is anastomosed to the pedicle of another free flap to reconstruct extensive head and neck defects when recipient vessels are scarce. [METHODS] A multi-in…
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Vein Selection for Optimal Flap Outcomes in the Radial Forearm Free Flap: A Systematic Review and Meta-Regression.
[BACKGROUND] Radial forearm free flaps represent a workhorse reconstructive modality in microsurgical rehabilitation. The reliable anatomy, availability of thin, pliable tissue, and a long pedicle afford the surgeon a significant latitude o…
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Hyperbaric Oxygen Effects on Surgical Outcomes in Mandibular Osteoradionecrosis Requiring Segmental Resection and Free Tissue Transfer.
Treatment of head and neck cancer with radiation can cause osteoradionecrosis of the mandible (MORN), requiring removal of nonviable bone and free flap reconstruction. To compare surgical outcomes in patients with MORN treated with free ti…
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Secondary Free Flap Reconstruction of the Maxilla Following Obturator Failure.
[BACKGROUND] In patients with acquired maxillary defects, obturators are often effective, but some fail, necessitating further surgery, typically via free flap reconstruction. Long-term functional outcomes in these cases are underreported. …
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Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19.
[INTRODUCTION] Coronavirus disease 2019 (COVID-19) affects the vascular system, subjecting patients to a hypercoagulable state. This is of particular concern for the success of microvascular free flap reconstruction. This study aims to repo…
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Post-operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps.
[EDUCATIONAL OBJECTIVE] Assess outcomes of pediatric facial reconstruction with fibula free flaps. [OBJECTIVES] Free flap reconstruction of complex maxillofacial defects in pediatric patients is rare. Post-operative complications, donor si…
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Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy.
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after init…
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Impact of smoking on donor site following rectus flap harvest for head and neck reconstruction.
[OBJECTIVES] The rectus abdominis myocutaneous free flap has been widely used as a reconstructive option in head and neck reconstruction with great success. Challenging the popular assumption, this study sought to examine the effects of smo…
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Clinical outcomes following intraoperative pedicle disruption in fibula free flaps.
[OBJECTIVES] Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following acciden…
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Nonsurgical Rejuvenation of the Neck.
Nonsurgical skin tightening in the neck is an area of significant growth with seemingly countless devices. Optimal treatment choice depends on the patient's concerns, anatomy, and lifestyle. Patients with minimal skin laxity, but dynamic pl…
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Implantable Doppler Removal After Free Flap Monitoring Among Head and Neck Microvascular Surgeons.
[OBJECTIVE] Investigate current practice patterns of head and neck microvascular reconstructive surgeons when removing an implantable Doppler after free flap surgery. [STUDY DESIGN] Cross-sectional survey study. [METHODS] Survey distribut…
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Success and Outcomes Following a Second Salvage Attempt for Free Flap Compromise in Patients Undergoing Head and Neck Reconstruction.
[IMPORTANCE] Incidence of perioperative free flap compromise is low, with successful salvage in up to 70%. When the flap is compromised a second time, the value of intervening is unknown. [OBJECTIVE] To assess the outcomes of a second reva…
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Nonsurgical Rejuvenation of the Neck.
Nonsurgical skin tightening in the neck is an area of significant growth with seemingly countless devices. Optimal treatment choice depends on the patient's concerns, anatomy, and lifestyle. Patients with minimal skin laxity, but dynamic pl…
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Safety of fibula free flap in patients following total knee replacement.
[BACKGROUND] Fibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total kn…
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Reconstructive Options During Nonfunctional Laryngectomy.
[OBJECTIVE] A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study evaluating the method of closure on postoperative fistula rate and …
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Considerations in Free Flap Reconstruction of the Midface.
Midface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is require…
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Genioplasty and Mandibular Implants.
Genioplasty is a useful technique employed for both aesthetic and, in the case of obstructive sleep apnea, functional purposes. Mandibular implants similarly represent a powerful tool in the facial surgeons armamentarium. Herein, we review …
- Skeletal Facial Plastic Surgery.
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Osteoradionecrosis of the Maxilla: Conservative Management and Reconstructive Considerations.
The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this benefit comes at the potential expense of the tissue surrounding the primar…
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Osteoradionecrosis of the Midface and Mandible: Pathogenesis and Management.
Radiation therapy is an important and commonly used treatment modality for head and neck cancers. Osteoradionecrosis (ORN) is a potential debilitating complication of treatment, which most commonly affects the mandible. Management strategie…
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Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies.
Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontier…
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Fistula Management in Head and Neck Cancer.
Fistulas in head and neck cancer patients are a common and challenging issue. Despite their commonality, there is little consensus regarding optimal treatment strategies or in preventative measures that might be taken preoperatively. A gene…
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Flap Failure and Salvage in Head and Neck Reconstruction.
With advanced head and neck ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional and aesthetic outcomes. Contemporary microvascular reconstructive surgery with free tissue transfer has be…
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Modern Management of Facial Nerve Disorders.
Facial paralysis is a devastating condition, encompassing a spectrum of disorders, with resultant psychosocial, functional, and aesthetic sequelae. With this in mind, an individualized treatment approach based on the cause, pattern, and dur…
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Surgical Techniques to Improve the Soft Tissue Triangle in Rhinoplasty: A Systematic Review.
In this systematic review we aim to (1) describe the anatomy and function of the soft tissue triangle, (2) identify the existing rhinoplasty literature that discusses the role of the soft tissue triangle, (3) provide a summary of the outcom…
- Erratum: Surgical Techniques to Improve the Soft Tissue Triangle in Rhinoplasty: A Systematic Review.
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Premaxillary Deficiency: Techniques in Augmentation and Reconstruction.
Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communiti…