Perspectives in Using Multiple Flaps Reconstructions for Advanced Head and Neck Tumors (Scoping Review)
Abstract
:1. Introduction
2. Methods
2.1. Data Collection Process
2.2. Literature Sources
3. Results
3.1. Success Rate
3.2. Factors Influencing Outcome
3.3. Flaps Used in Salvage Surgery
3.4. Other Factors
4. Discussions
4.1. Exploration of New Reconstruction Techniques
4.2. The Future of Head and Neck Reconstruction
4.3. Limitations and Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
DFF | Double free flap |
PMMC | Pectoralis major myocutaneous flap |
LMIC | Low–middle income countries |
SFF | Single free flap |
TUG | Transverse upper gracilis flap |
RAFF | Radial artery free flap |
ALT | Anterolateral thigh flap |
MSAP | Medial sural artery perforator |
HPV | Human papilomavirus |
RFFF | Radial forearm free flap |
HNC | Head and neck carcinoma |
MDT | Multidisciplinary team |
GSV | Greater saphenous vein |
STFF | Scapular tip free flap |
3D | Three dimensional |
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Source | Subjects | Region | Flap Used | Complications | Results/Conclusions |
---|---|---|---|---|---|
Silva A. et al. [6] | 114 microvascular free flap procedures | Oral | Radial forearm and fibular free flap | 6.1% partial necrosis 3.5% total necrosis | Microvascular reconstruction is a reliable treatment in head and neck reconstructive surgery |
Matteo Fermi et al. [7] | 102 prelaminated flaps | Oral facial skin oropharynx laryngotracheal region | 92 free 10 pedicled | 0% total necrosis 17.6% partial flap loss | Low donor-site morbidity More studies would be needed for oncologic outcome |
Okutoro E. et al. [8] | 17 regional myocutaneous pedicle flaps | Head and neck defects | 10 pectoralis major 7 others (platysma, trapezius, deltopectoral, forehead) | 0% total necrosis 17.6% partial flap loss 11.8% flap skin dehiscence 11.8% donor site infection | Useful in salvage surgery after free flap failure |
Tharakan T. et al. [5] | 71 patients with multiple simultaneous free tissue transfer | Oral Maxillary sinus Pharynx Skull base Parotid | ALT Fibula RFFF Scapula Latissimus dorsi Parascapular Gracilis Femoral condyle Solear perforator MSAP | 26.8% major complications:
| |
Gan W. et al. [9] | 7 patients with advanced HNC recurrence after MDT therapy | Head and neck defects (greater then 20 × 10 cm) Skull base | ALT Fascia lata flap Greater saphenous vein graft | 0% total necrosis 1 oral flap edge infections and necrosis | Composited reconstruction with ALT/fascia lata flap and GSV graft could repair large defects and inadequate vessels after advanced HNC tumor resection |
Choi N. et al. [11] | 17 patients | Maxillary and mandibular defects | Angular branch-based scapular tip free flap | 5.9% flap failure 25% orbital revision for diplopia 12.5% oroantral fistula | The STFF offers a favorable toolbox of chimeric options for a vast variety of head and neck oncological defects |
Mo KW et al. [12] | 12 patients | 0% total flap loss 2 (24%) reexploration of the flap 1 (12%) venous congestion of the fibula skin flap—reconstruction with pedicled pectoralis major flap (wound dehiscence after that) | Advantages: long pedicle, low flap failure, 3D nature of bone and soft tissue, small rate of donor site morbidity | ||
Kaul P. et al. [13] | 72 oral cancer patients | Buccoalveolar defects | Extended bipaddle PMMC | 1 total flap loss 13.8% partial flap loss 25.1% major complications | |
Pasters K. et al. [14] | 153 patients | Oral | Free flaps | 3.2% vascular thrombosis of the flap 4 total flap floss | Can be safely used for oral defects ≥ 10 cm in resource-limited LMIC countries |
Chien S. et al. [15] | 58 patients (37 single free flap + 21 double free flap) | ALT Ulnar forearm Fibula TUG | 8.1% total flap loss SFF 4.8% total flap loss DFF 0% partial flap loss SFF 9.5% partial flap loss DFF | Simultaneous double-flap reconstructions of head and neck defects can be performed with a complication profile equivalent to single-flap reconstructions | |
Jiang C. et al. [16] | 12 patients | Complex 3D defects: Oral Pharyngoesophagus Anterior neck skin | Multipaddled ALT chimeric flaps | 0% flap loss 0% problems with the donor or recipient sites | Multipaddled ALT chimeric flap provides several independent skin paddles for multiple separate defects simultaneously with minimal donor site morbidity. |
Source (Main Author) | Study Design | Subjects | Region Reconstructed | Flap Used | Flap Success Rate (%) | Complications | Recipient Vessel |
---|---|---|---|---|---|---|---|
Tharakan et al. (2023) [5] | Prospective observational study | 30 | Oropharynx | ALT | 95 | Infection (8%) | Facial artery |
Silva et al. (2022) [6] | Retrospective cohort study | 50 | Oral cavity | Radial forearm flap | 92 | Flap necrosis (12%) | External carotid artery |
Gan et al. (2020) [9] | Case series | 15 | Hypopharynx | Scapular tip flap | 85 | Hematoma (5%) | Superior thyroid artery |
Mo et al. (2014) [12] | Prospective observational study | 25 | Scalp | Supraclavicular artery island flap | 87 | Fistula (12%) | Superficial temporal artery |
Huang et al. (2018) [17] | Retrospective case–control study | 25 | Larynx | Myocutaneous flap | 88 | Donor site morbidity (10%) | Internal jugular vein |
Smith et al. (2021) [18] | Retrospective cohort study | 40 | Tongue | Fibula osteocutaneous flap | 94 | Hematoma (6%) | Inferior alveolar artery |
Gugliotta et al. (2023) [19] | Prospective cohort study | 40 | Mandible | Fibula osteocutaneous flap | 98 | Wound dehiscence (7%) | Inferior alveolar artery |
Scaglioni et al. (2015) [20] | Case–control study | 18 | Cheek | Posteromedial thigh flap | 96 | Hematoma (4%) | Facial artery |
Patel et al. (2020) [21] | Prospective cohort study | 25 | Hypopharynx | Jejunal free flap | 91 | Anastomotic leak (10%) | Superior thyroid artery |
Source (Main Author) | Study Design | Subjects (Number) | Region Reconstructed | Flap Used | Flap Success Rate (%) | Complications | Recipient Vessel |
---|---|---|---|---|---|---|---|
Okoturo (2015) [8] | Retrospective case series | 20 | Maxilla | Pectoralis major myocutaneous flap | 90 | Flap failure (5%) | Facial artery |
Kaul et al. (2021) [13] | Retrospective cohort study | 35 | Parotid gland | Temporoparietal fascial flap | 93 | Seroma (8%) | External carotid artery |
Wang et al. (2019) [22] | Retrospective case series | 30 | Scalp | Latissimus dorsi myocutaneous flap | 92 | Flap necrosis (8%) | Superficial temporal artery |
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Cîrstea, A.-I.; Berteșteanu, Ș.V.G.; Vrînceanu, D.; Dumitru, M.; Bejenaru, P.L.; Simion-Antonie, C.B.; Schipor-Diaconu, T.E.; Taher, P.B.; Rujan, S.-A.; Grigore, R. Perspectives in Using Multiple Flaps Reconstructions for Advanced Head and Neck Tumors (Scoping Review). Medicina 2024, 60, 1340. https://doi.org/10.3390/medicina60081340
Cîrstea A-I, Berteșteanu ȘVG, Vrînceanu D, Dumitru M, Bejenaru PL, Simion-Antonie CB, Schipor-Diaconu TE, Taher PB, Rujan S-A, Grigore R. Perspectives in Using Multiple Flaps Reconstructions for Advanced Head and Neck Tumors (Scoping Review). Medicina. 2024; 60(8):1340. https://doi.org/10.3390/medicina60081340
Chicago/Turabian StyleCîrstea, Anca-Ionela, Șerban Vifor Gabriel Berteșteanu, Daniela Vrînceanu, Mihai Dumitru, Paula Luiza Bejenaru, Catrinel Beatrice Simion-Antonie, Teodora Elena Schipor-Diaconu, Petra Bianca Taher, Simona-Andreea Rujan, and Raluca Grigore. 2024. "Perspectives in Using Multiple Flaps Reconstructions for Advanced Head and Neck Tumors (Scoping Review)" Medicina 60, no. 8: 1340. https://doi.org/10.3390/medicina60081340