Neuropathy is nerve damage that affects the nerves and is complicated by microvascular damage. Microvascular free flap reconstruction of the head and neck has become a successful and reliable procedure important in the treatment of head and neck cancer. Managing the microvascular and macrovascular complications of. In the maxillomandibular area the size of soft tissue as well as bone defect, the underlying etiology cancer, trauma, and infection, anatomic location, aesthetic visibility, associated functional disabilities and the availability of a local and or distant donor site. Postoperative monitoring and salvage of microvascular free flaps. Of the 240 flaps, return to the operating room was necessary for 20 8. Objective to evaluate and discuss the free flap reconstructive options for patients with partial and total maxillectomy defects.
Microvascular surgery general considerations iowa head and. Free muscle flaps have even proved to be effective in preserving infected autogenous vein grafts after radical surgical debridement 175. However, reliable assessment of perfusion can be difficult, so we prospectively evaluated it in 4 types of microvascular free flaps in the oral cavity n 196 and assessed differences in blood flow by noninvasive monitoring with a laser doppler flowmetry unit. Of the 240 flaps, return to the operating room was necessary.
Microvascular health solutions improve glycocalyx health. Raising of microvascular flaps a systematic approach klaus. Raising microvascular flaps, a systematic approach is an excellent operative manual and should be an asset to the armamentarium of all reconstructive. Indications as the ease of performance of microsurgery has increased over the past 10 years, the number of clinical situations suitable for these procedures has increased as well.
Revisiting radial forearm free flap for successful venous drainage. Microvascular free flaps for softtissue defects mayo clinic. To be effective, changes in perfusion need to be recognized quickly to correct any treatable problems. A systematic approach this book provides all who are involved in microsurgical tissue transfer, including plastic. Wolff kd, holzle f 2011 raising of microvascular flaps. The systematic approach of this operative manual is based on photographs of perfect quality showing cadaver preparations alongside with explanatory colour. This is done by transferring tissue from one part of your body donor site to the area that needs to be reconstructed or repaired recipient site. The new third edition continues with the didactic principle of splitting. Free flaps can provide considerable skin, bone, fat, and muscle.
Microvascular research is dedicated to the dissemination of fundamental information related to the microvascular field. Examples of surgeries with the use of flaps are hand reconstruction or replantation surgery after traumatic amputation, fractures with bone loss, burns, head and neck neoplastic surgery, and breast reconstructive surgery. A full exploration of microvascular reconstruction of the oral cavity is beyond the scope of this article. The fibula free flap in maxillary reconstruction atlas oral maxillofacial surg clin n am 14 2006 185189. Microvascular free flap surgery has become a successful and reliable method of reconstruction following head and neck cancer resection.
Basics of microvascular reconstruction of maxillomandibular. Postoperative monitoring and salvage of microvascular free. Maxillary reconstruction using microvascular free flaps. Today this aim can be achieved through the use of microvascular free flaps that have replaced classical local and regional flaps to ensure oncologic radicality on one hand, better functional and aesthetic results on the other 3. Impact of microvascular free flap reconstruction in oral. Oromandibular reconstruction using microvascular composite. Raising microvascular flaps, a systematic approach is an excellent operative manual and should be an asset to the armamentarium of all reconstructive plastic surgeons. Changes of perfusion of microvascular free flaps in the. In the present study, the proportion of patients receiving implants in free flaps containing bone followed by prosthetic rehabilitation was 35. Microvascular surgery protocols general considerations.
The microvascular technique of free flap and its artery. Microvascular flaps for reconstruction in head and neck cancer. N2 included in this discussion of microvascular free flaps for softtissue defects is an examination of the oral and pharyngeal lining, the epithelial line conduit between the oropharynx and esophagus, skullbase defects, total glossectomy defect, facial augmentation. Disruption of perfusion to a flap or replant can result in partial or complete tissue loss.
The anastomosis is done using a microscope or a loupe, hence it is termed microsurgery the free flap is sutured to the defect, while it is monitored to. The cause of failure of the flaps was not always clearly related to a single factor. Microvascular reconstruction surgery using tissue transfer is a surgery done to repair the space left in your body. The skin flaps discussed in this article are primarily random flaps. This book provides all who are involved in microsurgical tissue transfer, including plastic surgeons, ent surgeons, trauma surgeons, and oral and maxillofacial surgeons, with all the knowledge they will need in daily practice. Course language english location institute of anatomy uniklinik rwth aachen wendlingweg 2 52074 aachen, germany course fee 1. Evaluation of blood flow in free microvascular flaps article pdf available in journal of reconstructive microsurgery 173.
Examples of flaps include the forearm radial and ulnar, latissimus dorsi, and rectus abdominis 6. Delivering optimum care for cancer in the community is a major challenge and outcomes can be variable. It is a composite flap and comprises muscle, overlying fascia and skin. Microvascular free flaps offer an incredible amount of tissue. The scar is difficult to merge into natural crease lines. Raising of microvascular flaps provides all those who deal with microsurgical tissue transfer, i. The anterolateral thigh flap in mandibular reconstruction atlas oral maxillofacial. Microvascular definition of microvascular by medical. Outcome of microvascular free flaps in a highvolume training. Read pdf raising of microvascular flaps kindle books available. Drainage methods include combining both systems or using one alone. In 1970 tamai 1 transplanted the biceps brachii and rectus femoris muscles from the hind limb to the contralateral hind limb in a dog along with an artery, vein, and motor nerve repair. After studying medicine and dentistry at fu berlin, professor wolff completed his phd in both subjects in 1987 and acquired his postdoctoral teaching qualification habilitation in 1994.
The free microvascular tissue transfer overcomes many of the limitations of previous types of musculocutaneous flaps. Advancement flaps advancement flaps involve raising a skin paddle in a subdermal plane and moving its leading edge into the defect. Functional microvascular muscle flaps microsurgeon. Free implies that the tissue is completely detached from its blood supply at the original location donor site and then transferred to another. This study analyzed the surgical outcome and complications of microvascular free flaps performed at the authors institution in germany, between 1987 and 2010. Oromandibular reconstruction using microvascular composite flaps. Pdf evaluation of blood flow in free microvascular flaps. Wolff holzle raising of microvascular flaps 3rd ed. The safety and success of micro vascular transfer have been well documented in the general population, but its positive results achieved in elderly patients have. N2 we believe that it is essential to closely monitor the viability of any free flap in order to decrease potential morbidity to the patient. Microvascular free flap reconstruction for head and neck.
Raising of microvascular flaps raising of microvascular flaps. Vessel selection and free flap monitoring in head and neck. The glycocalyx is an antiaging microthin protective gel layer that lines the inside of all blood vessels throughout your body, including your vital organs. The thiel embalming technique provided flap raising procedures to be performed under realistic conditions similar to the living body. The specific flaps used were the free tram n 176, diep n 58, and sgap n 6 flaps. Wolff holzle, raising of microvascular flaps, 3rd ed. Microvascular complications affect smaller blood vessels and can lead to damage in the kidneys nephropathy and eyes retinopathy.
Raising of microvascular flapsprovides all those dealing with microsurgical tissue transfer, i. The occurrence of each factor is based on the total number of flaps. Regionallyarranged atlas features drawings of surgical approaches with accompanying descriptive text. Designing and developing quality surgical instruments and surgical instrumentation for various medical and surgical disciplines. As noted above, in all but the first of the 30 patients who underwent this surgery, the microvascular anastomoses for the 2 flaps were performed to separate recipient vessels.
Flap and replant perfusion monitoring microsurgeon. Among the free flap failures, five were related to anastomoses within the zone of injury. A systematic approach klausdietrich wolff, frank holzle this book provides all who are involved in microsurgical tissue transfer, including plastic surgeons, ent surgeons, trauma surgeons, and oral and maxillofacial surgeons, with all the knowledge they will need in daily practice. Microvascular antiaging supplement regenerates glycocalyx. Reconstruction with a free flap is routine in head and neck surgery. This book provides all who are involved in microsurgical tissue transfer, including plastic surgeons, ent surgeons, trauma surgeons, and oral and maxillofacial surgeons, with all the knowledge they wi.
The safety and success of micro vascular transfer have been well documented in the general population, but its positive results achieved in elderly patients have received less. Some flaps can be also raised while the resection is still in progress, and the donor. Microvascular surgery is used to reattach severed fingers, hands, arms, and. The robust circulation and high reliability of free flaps represent an important advantage of this type of reconstruction 4,5. The terms free flap, free autologous tissue transfer and microvascular free tissue transfer are synonymous terms used to describe the transplantation of tissue from one site of the body to another, in order to reconstruct an existing defect. The effectiveness of free flap reconstruction has increased with improved surgical technique as well as technological refinement in vessel selection and flap monitoring. Each defect is individualized according to the missing component. For each flap, an anatomically based system of stepbystep procedures is proposed that best combines simplicity, safety, and reliability for successful flap harvesting. Raising of microvascular flaps a systematic approach. Patients fiftyone patients had partial or total maxillectomy defects resulting from. Advancement flaps involve raising a skin paddle in a subdermal plane and moving its. Skin that is transposed from the trunk and limbs is of a much lighter, paleyellow colour especially caucasians compared to the face, whereas regional. Mariam awada, european journal of plastic surgery, vol.
Photographs of each step are accompanied by schematic color drawings to enhance understanding of the anatomy. T1 microvascular free flaps for softtissue defects. Candidate factors to be associated with anastomotic failure are listed in table i. Vessels and nerves could be exposed and dissected up to a diameter of 1 mm and allowed for microvascular suturing even after weeks like fresh specimens. T1 postoperative monitoring and salvage of microvascular free flaps. Osteocutaneous free flaps for mandibular reconstruction.
Changes of perfusion of microvascular free flaps in the head. With the increase in life expectancy, the incidence of head and neck cancer has grown in the elderly population. The free flap is brought up to the defect area, and the vein and artery from the flap vascular pedicle are anastomosed reconnected to the vein and artery identified in the wound. Free microvascular tissue transfer for the reconstruction of. Today this aim can be achieved through the use of microvascular free flaps that have replaced classical local and regional flaps to ensure oncologic radicality on. It is primary, if microvascular angina is the unique cause of symptoms, and secondary, if it occurs in the setting of a specific disease 3. Monitoring circulation of flaps and replants postoperatively is critical to success in microvascular surgery. Fulllength articles presenting the results of original research and brief communications are featured. About your microvascular reconstruction surgery using free. Microvascular free tissue transfer consists of raising a donor flap from a site distant to the defect, isolating the vascular pedicle of the flap. Principles of local, regional and microvascular flaps. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. The secret to antiaging is regenerating glycocalyx function.
Indeed, microvascular dysfunction causes microvascular angina. The free kindle book listings include a full description of the book as well as a photo of the cover. Free microvascular tissue transfer for the reconstruction. Outcome of microvascular free flaps in a highvolume. Textbook and dvdrom raising of microvascular flaps, 2nd ed. Careful consideration of the donor site, strategies for vessel selection, and intra and postoperative flap monitoring protocols and procedures are crucial for successful free tissue transfer. These complications can be divided into 2 major categories.
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