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The Head and Neck
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Buccal mucosa lesions are mainly epidermoid carcinomas and can present clinically as exophytic or ulcerative lesions. The overall 5-year survival is 40%. It is estimated that 50% of the patients will develop lymph node metastases. Local recurrence and metastases to the cervical lymph nodes are poor prognostic signs. The 5-year survival of those with local recurrence is 24%, and for those with cervical lymph node metastases is 35%. Small lesions must be surgically excised with 2-cm margins and including the underlying muscle. The skin of the cheek may be preserved. Larger or more invasive tumors require wider resections and the sacrifice of the skin of the cheek, radical neck dissection, and cheek reconstruction with skin flaps and postoperative irradiation.23 Verrucous lesions of the buccal mucosa are considered well-differentiated squamous cell carcinomas. These rarely metastasize and are resistant to irradiation. Surgical excision is the only effective method of treatment.
Unfavorable outcomes in microsurgery: possibilities for improvement
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Paolo Cariati, Almudena Cabello Serrano, Fernando Monsalve Iglesias, Maria Roman Ramos, Jose Fernandez Solis, Ildefonso Martinez Lara
The rate of flap failure was 22.6% in Group 1 (12/53) and 5.5% in Group 2 (1/18). Specifically, six radial flaps (6/12; 50%); two fibula flaps (2/12; 16.6%), two scapular osteoucutaneous flaps (lateral edge) (2/12; 16.6%), one cubital flap (1/12; 8.3%), and one ALT flap (1/12; 8.3%) failed in Group 1. The average failure rate was 50% (2/4) for scapular osteoucutaneous flaps (lateral edge), 50% for cubital flaps (1/2), 21.4% (6/28) for radial flaps, 13.3% (2/15) for fibula flaps, and 25% for ALT flaps (1/4). Moreover, three radial flaps showed partial necrosis of the skin paddle in Group 1 (3/53; 5.6%). One of these flaps was used for cheek reconstruction while the other two were used for tongue and floor of the mouth reconstruction, respectively. On the other hand, only a tip scapula flap used for maxillary reconstruction failed in Group 2. Analysis of this data revealed a flap survival rate of 71.7% in Group 1 (38/53) and 94.4% in Group 2 (17/18) (p < 0.05).
Use of cervicothoracic rotation flap and osteocutaneous radial forearm free flap for a complex multilayered cheek defect reconstruction
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Ashley Tankersley, Ignacio Velasco Martinez, Abelardo Medina
In general, cervicofacial and cervicothoracic flaps are technically easy to dissect and reliable. They can reach numerous defects within well-known boundaries namely supraorbital margin (superiorly), midline (medially) and retroauricular region (posteriorly). They are also indicated in anterolateral defects of the neck [19]. Inside this area, they also cover anatomical structures such as major blood vessels, facial nerve and exposed bones, among others [13]. The use of cervicofacial and cervicothoracic flaps for cheek reconstruction results in excellent color and texture match, adequate thickness, good scar location and concealment and acceptable sensory recovery and morbidity at the donor site [11].
Cross cheek dumbbell-shaped radial forearm free flap for bilateral trismus release
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Touqeer Hussain, Hasan Tahir, Obaid U. R. Rahman, Mirza Shehab Afzal Beg
RFFF for bilateral cheek reconstruction, with skin paddle being accommodated in the lower gingivo labial sulcus has been described as causing the lower lip prolapse [17]. Bi-paddled RFFF from a single forearm was described in the journal of Oral Maxillofacial Surgery in 2007 by Lee JT et al. [19] skeletonized ‘bridge pedicle’ was placed under the anterior vestibule mucosa, predisposed to pedicle compression especially in cases with sub-mucous fibrosis while in our case a narrow skin paddle is used connecting both dumbbells for coverage of bridging pedicle providing supple tissue over connecting pedicle as well.