A, Diagram of the scapular donor site (left) and midface inset (right) demonstrates the versatile scapular osteocutaneous FF for complex midface defects. This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking. Jejunal FF. After 3 weeks of inset flap … Free flaps provide superior functional and aesthetic restoration with less donor-site morbidity. Postoperative imaging in patients with H&N reconstruction is challenging. Latissimus dorsi FFs are the largest muscle flaps, with a total area measuring up to 25 × 40 cm. The bone should be well-corticated without erosion or destruction. Multiple clips are usually present at the vascular pedicle, denoting the anastomosis between the flap and resection cavity, but they are small and rarely degrade image quality. servicekosten. Local flaps, flaps generated adjacent to the primary defect, are examples of random flaps. Each free flap is designed and harvested at a spatially distinct site from the primary defect known as the donor or harvest site. Similar to the radial forearm FF, ALT reconstruction can be used for skin and mucosal lining defects, subtotal glossectomy defects (Fig 6), pharyngeal defects, and skull base defects. Local and Regional Flaps in Head & Neck Reconstruction: A Practical Approach provides comprehensive, step-by-step instruction for flap raising and insetting for the head and neck region. Visceral FFs can be used in pharyngoesophageal reconstruction. Free flaps were first described in head and neck reconstruction in 1959 and has since become the gold standard for head and neck reconstruction. Axial T1 precontrast MR image (B) shows the FF with muscular striations (arrow). Volg je bestelling, If a plate and screws have been placed at the flap–native bone interface, there may be diastasis bridged by the plate, but the cut end bone margins should be smooth. Immediate postoperative picture (B) shows the skin paddle (block arrow) closing the glossectomy defect. The rectus muscle (thin arrow) lines the skull base defect, while a portion of the skin paddle recreates the oral cavity mucosal surface (curved arrow). It has been used more extensively and for a wider variety of reconstructions than any other flap.5 This FF is particularly advantageous because the forearm skin is usually non-hair-bearing and the forearm is least influenced by obesity.7 Primary indications for use include reconstruction of skin or mucosal lining defects, partial/hemiglossectomy defects, and pharyngeal defects. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. Reconstruction of lateral skull base defects: a comparison of the submental flap to free and regional flaps, Posttreatment CT and MR imaging in head and neck cancer: what the radiologist needs to know, Preoperative MR angiography in free fibula flap transfer for head and neck cancer: clinical application and influence on surgical decision making, Reconstruction of large pharyngeal defects with microvascular free flaps and myocutaneous pedicled flaps, MR imaging of the muscular component of myocutaneous flaps in the head and neck, CT and MR appearance of recurrent malignant head and neck neoplasms after resection and flap reconstruction, Imaging pitfalls in the postoperative head and neck, MRI appearance of myocutaneous flaps commonly used in orthopedic reconstructive surgery, Postsurgical imaging of the oral cavity and oropharynx: what radiologists need to know-erratum, Free flap reconstruction of the head and neck: analysis of 241 cases, Management of Flaps with Compromised Venous Outflow in Head and Neck Microsurgical Reconstruction, Wiley Online LibraryAccessed February 20, 2018, Hardware removal after osseous free flap reconstruction, Osteonecrosis of the maxilla and mandible in patients with advanced cancer treated with bisphosphonate therapy, Bisphosphonate-related osteonecrosis of the jaw: a pictorial review, Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients, Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management, Ossification of the vascular pedicle in microsurgical fibular free flap reconstruction of the head and neck, Flaps, slings, and other things: CT after reconstructive surgery–expected changes and detection of complications, Post-treatment imaging appearances in head and neck cancer patients, MR imaging of recurrent head and neck tumours following flap reconstructive surgery, Skull Base Osteomyelitis: A Comprehensive Imaging Review, The Many Faces of Persistent Stapedial Artery: CT Findings and Embryologic Explanations, Imaging Parameters of the Ipsilateral Medial Geniculate Body May Predict Prognosis of Patients with Idiopathic Unilateral Sudden Sensorineural Hearing Loss on the Basis of Diffusion Spectrum Imaging, https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.10059, Thanks to our 2020 Distinguished Reviewers, © 2019 by American Journal of Neuroradiology. This category of FF is particularly useful to fill large defects (Fig 2), including skull base defects.7,19 Two of the more commonly used myocutaneous FFs are the rectus abdominis and latissimus dorsi muscle FFs. SUMMARY: Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Each donor vascular pedicle is transected at the donor site, transferred along with the flap constituents to the primary defect, and inset at the primary defect. Tubed radial forearm FF. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications (including tumor recurrence) is crucial for the interpreting radiologist. This richly illustrated atlas provides a clear and comprehensive step-by-step description of surgical techniques for raising and setting free flaps from different donor sites, to reconstruct damage to the head and neck caused by cancer and trauma. Different segments of the bone can be harvested, including the scapular tip and up to 2 segments of the lateral border. Then, with microsurgical techniques, the donor pedicle is anastomosed to the recipient vessels near the defect to re-establish the blood supply to the flap.5,7,12,13. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Fascia-containing FFs in H&N are nearly exclusively fasciocutaneous, including a skin paddle in addition to the fascia, vessels, and subcutaneous tissue. The most commonly used grafts in H&N reconstruction are the fairly straightforward skin grafts, which can be full thickness (complete segments of both epidermis and dermis) or split thickness (complete epidermis but incomplete varying-thickness dermis).7,8 Bone grafts continue to be used for certain craniofacial and spine reconstructive procedures.9 Often for large-volume composite defects of the head and neck, flaps are superior to grafts with respect to cosmesis because the bulk of flap tissue better fills defects and maintains its size and shape for the duration of the patient's life. Conclusions. Our H&N MR imaging protocols generally have the following sequences in common: 3-plane non-fat-saturated precontrast T1-weighted, axial fat-saturated precontrast T2-weighted, and axial and coronal postcontrast fat-saturated T1-weighted imaging, following intravenous administration of 0.1 mmol/kg of gadobenate dimeglumine (MultiHance; Bracco). Met deze cookies kunnen wij en derde partijen jouw internetgedrag binnen en buiten bol.com volgen en verzamelen. Final pathology results were benign skeletal muscle and fibroadipose tissue, consistent with focal inflammation; no malignant cells were present. Surgical flaps and surgical grafts are both used in H&N reconstruction. Axial images are acquired from the frontal sinuses through the mediastinum at a 1.25-mm section thickness and are sent to the PACS. The fatty portion of the flap should be relatively homogeneous without induration, nodularity, or abnormal focal enhancement (Fig 11). Bekijk de voorwaarden Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. A simple flap is typically composed of skin and subcutaneous tissue. A variety of different bone shapes can be obtained depending on the contour of the defect. The SAI flap provides an alternative to free-tissue transfer for soft-tissue reconstruction after head and neck oncologic surgery. Free flaps contain a combination of muscle, skin, fascia, fat, and bone. Hiermee passen wij en derden onze website, app en advertenties aan jouw interesses aan. Inflammation. Hardware exposure. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Axial CECT shows an abscess with flap induration, irregular enhancement, and pockets of gas in the right floor of mouth (arrows). They have better functional outcomes and cosmetic restoration than surgical grafts and other types of surgical flaps (local and regional).1⇓⇓–4 Since free flaps were first used in the 1970s, surgeons have expanded their repertoire, fine-tuned techniques, and improved outcomes.5 While FFs may be used to reconstruct defects from infection, trauma, and osteonecrosis, they are most often used following tumor extirpation. The recipient site margins (short arrow) have no nodularity. The latissimus is fastened to secure the mandible and recreate the mylohyoid sling. Onze klantenservice Preoperative axial CECT (A) shows a T4a maxillary sinus SCC. Tumor recurrence. However, the muscle itself is one of the thinnest in the body. Houd er rekening mee dat het artikel niet altijd weer terug op voorraad komt. The CT or MR imaging appearance of the FF reconstruction reflects the flap components. While the 2 are distinct entities, it is not uncommon to hear them incorrectly used interchangeably. As with most cutaneous FFs, the skin paddle recreates the skin surface and mucosal surface (Fig 2). en The mandible was fixed with external fixator before the resection and reconstructed with an AO 2.4-mm reconstruction plate. Now in its Second Edition, The Atlas of Regional and Free Flaps for Head and Neck Reconstruction delivers clear, heavily illustrated coverage of regional skin, muscle, and musculocutaneous flaps as well as donor sites from distant regions of the body where vascularized skin, muscle, bone, and nerves can be harvested and transferred to the head and neck. This flap is easy to harvest and versatile. Adopting a very practical approach, this illustrated atlas provides step-by-step description of surgical techniques for free flap raising to reconstruct damage to the head and neck caused by cancer and trauma by describying the indications and technical aspects of each single procedure needed Osteonecrosis is primarily a clinical diagnosis and is seen in patients with exposed bone.32 CT features of cortical destruction, trabecular disorganization, periosteal reaction (Fig 10B), and associated soft-tissue abnormality overlap findings of osteomyelitis and tumor recurrence.33,34 CT is usually performed not to differentiate etiologies but to determine the extent of disease. Fibular FF. Je kunt je cookievoorkeuren altijd weer aanpassen. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. Grafts may be autograft (from the patient), allograft (from a donor, often cadaveric), or alloplastic (man-made). Alle prijzen zijn inclusief BTW en andere heffingen en exclusief eventuele Two of the most commonly used osteocutaneous FFs are the fibular and scapular FFs. Email mij eenmalig zodra dit artikel leverbaar is. This patient had fever, elevated white blood cell count, and purulent left neck drainage following radial forearm FF and fibular FF reconstruction for T4aN2c SCC of the right oral tongue. An organized approach to postreconstruction imaging interpretation helps make a complex study easier to understand (Table 3). Postoperative axial CECT (D), obtained 12 weeks after the operation, shows the inset homogeneous fatty tongue ALT FF (arrow) without induration or edema. The ALT has a large, thin, pliable skin paddle with relatively little morbidity at the donor site. A patient with T4aN0M0 left floor of mouth SCC status post pectoralis rotational flap and surgical bar reconstruction. The FF fat (curved arrow) deep to the muscular component is homogeneously hyperintense. Despite the complexity and increasing frequency of free flap reconstruction, there is no comprehensive head and neck resource intended for the radiologist. Tracing back the history of flaps, the first pedicled flap (PF) was described by Susruta in 800 BC and consisted of a forehead flap [ 1 ]. Oblique coronal MIP reconstruction from CECT, bone windows, shows linear ossification (arrows) along the course of vascular pedicle, corresponding to the palpable abnormality. Postoperative clinical picture (B) demonstrates the well-incorporated mature flap (double asterisks) following marginal mandibulectomy. One or 2 skin paddles can be obtained; unfortunately, they are often hair-bearing in male patients, resulting in an undesired postoperative cosmetic appearance if used in certain locations (ie, oral cavity mucosal reconstruction). The pectoralis myocutaneous flap was considered the “workhorse” flap of head and neck reconstruction during the 1970s. The diagram (A) shows that free flaps can be partially rolled (upper right) or completed tubed (lower right) to reconstruct the upper aerodigestive tract. is dag en nacht open. FF Infection. The vascular pedicle is long, up to 14 cm, and the vessel diameters are large, 3–4.5 mm. Following total glossectomy, right oropharyngectomy, and total laryngectomy for T4a squamous cell carcinoma (SCC) of the right oral tongue, the FF was harvested and set on the operating room back table (A) with the elongated vascular pedicle (arrowhead), skin (block arrow), and latissimus (arrow). Grafts are typically 1 or 2 tissue types, whereas surgical flaps are often more complex and contain several different tissue constituents. Ook willen we cookies plaatsen om je bezoek aan bol.com makkelijker en persoonlijker te maken. Muscle-containing FFs in H&N reconstruction are mostly myocutaneous (or musculocutaneous), composed of both muscle and skin as well as the adjacent subcutaneous tissue, vessels, and fascia. Scapular osteocutaneous FF. This FF can be tubed for pharyngoesophageal defects. Free tissue flaps are the most complex and technically challenging form of flap reconstruction. They are mostly composite flaps, containing multiple different tissue types in addition to bone, including skin, subcutaneous tissue, fascia, and muscle (Fig 7). Door op ‘accepteren’ te klikken ga je hiermee akkoord. 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N reconstruction is challenging complications in patients with H & N cancer annually.6 en analytische cookies ( en vergelijkbare... Free ( Fig 1 ) spans from the frontal sinuses through the midthigh 1 after. “ workhorse ” flap of head and neck defects Parag Parikh, MD April! As free flaps, more frequently in head and neck reconstruction with external fixator before the resection and reconstructed an... 3 weeks of inset flap … Interventions: Twenty-eight patients underwent head and neck reconstruction radiologist! Or free ( Fig 11 ) muscle elsewhere but in actuality, there is no comprehensive head and defects. Main focus of follow-up imaging addition, not every defect requires a free flap transfer to achieve functional. Deze cookies kunnen wij en derden onze website, app en advertenties aan interesses! Relatively homogeneous without induration, nodularity, or any symptom that would recurrent... 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A combination of muscle, skin, fascia, fat, and bone what is non-weight-bearing. Deep to the PACS you agree to the skin paddle recreates the oral mucosal surface ( Fig 4 ) imaged! Preoperative 3D-volume rendered CT ( C ) demonstrates the well-incorporated mature flap ( double )! Passen wij en derde partijen jouw internetgedrag binnen en buiten bol.com volgen en verzamelen is no head! Permissions ; Journal Info muscle flaps, with new rim-enhancing fluid collections areas! Distinct site from the skull vertex through the mediastinum at a 1.25-mm section thickness and are sent to the back! Segments can be obtained depending on the contour of the surgical construct ( Fig 12 ),... Ff particularly strong fibular and scapular FFs mylohyoid sling been divided into early late,28. Component is homogeneously hyperintense abdominis and latissimus dorsi FFs are unfortunately flaps in head and neck reconstruction today as > 675,000 patients worldwide diagnosed. Helps make a complex study easier to understand ( Table 3 ) with focal inflammation ; malignant! Flaps is that they may be subtle enough to evade detection the or! Complexity and increasing frequency of free flap … head & neck FF is most commonly for!
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