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 of reconstructive freedom, allowing this flap to be useful for a multitude of body sites. Although the arterial anatomy is straightforward, the venous outflow of the flap is generally through a circuit utilizing a superficial, deep, and united venous system.

Trapezius Myocutaneous Flap Reconstruction for the Head and Neck.

Introduction: The trapezius myocutaneous flap is a valuable option for reconstructing defects in the head and neck region requiring a sizeable skin paddle. This study assessed surgical outcomes of the trapezius myocutaneous flap in head and neck reconstruction, specifically focusing on defects of the lateral temporal bone, lateral neck, and scalp or posterior midline neck.

Methods: This retrospective study analyzed patients grouped by site of defect within the head and neck.

Open Treatment of Mandible Angle Fractures and the Role for Maxillomandibular Fixation.

Background: Maxillomandibular fixation (MMF) remains a mainstay in the treatment algorithm of bony injuries involving the lower facial skeleton to help restore premorbid occlusion.

Purpose: To compare postoperative open reduction and internal fixation outcomes in dentate patients with noncomminuted, isolated angle fractures of the mandible between patients that underwent postoperative MMF and those who did not.

Methods: Retrospective review of 224 patients treated for isolated, noncomminuted mandible angle fractures between January 1997 and December 2023.

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-institutional cohort of FTFs used for head and neck reconstruction were reviewed. For comparison, FTF outcomes were compared to free flaps that required vein grafts (VG) to reach distant recipient vessels.

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 population is not new and the success rates are comparable to those in adults, there is still a lack of information about its applications in children. This study aims to review the indications for use and discuss the anatomic considerations that may influence surgical complexity and long-term outcomes in the developing craniofacial skeleton.

Interpreting Lower Trapezius Musculocutaneous Flap Skin Paddle Perfusion with Indocyanine Green Angiography.

The lower trapezius myocutaneous flap (LTF) is a pedicled flap with clinically significant variability of distal skin flap perfusion. To compare the incidence of partial flap necrosis before and after the institution of routine intraoperative laser-assisted indocyanine green (ICG) angiography. This is a retrospective review of all LTF performed between November 2021 and July 2022.

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 smoking on donor site complications in this population.

Methods: Multi-institution retrospective study of 103 patients (50 active smokers, 28 former and 25 never smoked).

Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients.

Background: The utilization of an arteriovenous loop is an underreported technique that affords the creation of reliable vascular options. Understanding the efficacy and impacting variables of microvascular reconstruction with an arteriovenous loop can be critical to its use.

Methods: Multi-institutional study of 36 patients who underwent vein grafting or AV loop with free tissue transfer.

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 initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects.

Does Bulky Adenopathy in Human Papilloma Virus-Positive Oropharyngeal Squamous Cell Carcinoma Require a Planned Post-Treatment Neck Dissection for Occult Residual Disease?

Purpose: A planned neck dissection was traditionally considered for a large nodal disease after definitive chemoradiation, yet controversy exists for the human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV OPSCC). We aimed to measure the frequency of persistent occult neck disease in planned neck dissection for HPV OPSCC presenting with a large (≥3.0 cm) nodal burden.

Surgical Management of Necrotizing Fasciitis of the Head and Neck.

Objective: The purpose of this study was to highlight risk factors and surgeries for necrotizing fasciitis (NF) of the head and neck in the literature. NF is rare but can rapidly progress.

Materials And Methods: A literature search was done using PubMed and SCOPUS.

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 revascularization attempt for compromised free flaps.

Cranioplasty.

Calvarial defects are commonly encountered after neurosurgical procedures, trauma, and ablative procedures of advanced head neck cancers. The goals of cranioplasty are to provide a protective barrier for the intracranial contents, to restore form, and prevent syndrome of the trephined. Autologous and alloplastic techniques are available, each with their advantages and drawbacks.

Bony Orbital Surgery for Graves' Ophthalmopathy.

The majority of Graves' ophthalmopathy, or thyroid eye disease, can be managed medically; however, in refractory or severe cases, surgical intervention with orbital decompression may be necessary. The majority of the published literature is retrospective in nature, and there is no standardized approach to orbital decompression. The purpose of this review is to evaluate the various surgical approaches and techniques for orbital decompression.

Jaw in a Day: Immediate Dental Rehabilitation during Fibula Reconstruction of the Mandible.

Reconstructing mandibular defects presents challenges to dental rehabilitation related to altered bone and soft tissue anatomy. Dental implants are the most reliable method to restore the lost dentition. Immediate dental implants have been placed for many years but with unacceptably low rates of dental/prosthetic success.

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 distributed to head and neck microvascular reconstructive surgeons.

Maxillofacial Bony Considerations in Facial Transplantation.

Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer.

Reconstruction of the Mandibular Condyle.

The mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward.

Pilot Study of External Beam Radiotherapy for Recurrent Unremitting Tracheal Stenosis.

Objective: Tracheal stenosis can have a variety of presentations, severities, causes, and be a difficult condition to treat. Some patients demonstrate recurrent stenosis after multiple endoscopic treatments and are either poor candidates for open procedures or do not desire open surgery. We sought to evaluate low-dose postoperative external beam radiotherapy (EBRT) as a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies.