The serratus muscle (SAM) can be raised as an isolated muscular or osteomuscular flap on its nutrient vessels or in combination with a latissimus dorsi (LD) myocutaneous flap on the thoracodorsal pedicle for various reconstructive purposes. The aim of the present is to report on the results achieved after the use of the SAM alone (n = 7) and in combination with an LD (n = 3) after tumor resection or osteoradionecrosis (ORN) in ten patients with defects of the head and neck. One flap was lost due to venous thrombosis. The donor site morbidity was minimal. Emphasis is given on a new indication, namely ORN of the mandible. Short-term results show that the use of the SAM prevents a pathologic fracture in cases of a class IIIa osteoradionecrotic mandible. More extensive use of the SAM flap is advocated.

Adult↗

PubMedDate not supplied

[Pectoralis major myocutaneous island flap for cervicofacial reconstruction: a 9-year experience].

The Pectoralis major island flap for cervico-facial reconstructions: a nine year experience. The pectoralis major m.c. flap was used for the restoration of post-tumorectomy defects in 220 patients (n = 224). 181 flaps were used for internal and 43 for external reconstructions. The overall failure rate was 9% (2.7% partial failures and 6.4% total failures). The causes which led to partial or total necrosis of a flap are analyzed. The results are compared to those of the literature. It is concluded that the above mentioned is a versatile flap in cervico-facial reconstructive surgery with a high success rate provided certain basic principles are respected during dissection and during the early postoperative period.

Adult↗

PubMedDate not supplied

[Advances in maxillofacial surgery].

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Face↗

PubMedDate not supplied

[Are fixed cervical lymph node metastases always inoperable?].

Between 1977 and 1980 22 head and neck patients with large fixed lymph node metastases were operated 3 to 8 weeks after preoperative radiotherapy to 60 Gray. Six tumor-free survivals of more than 3 years prove that the fixation of lymph nodes, though serious, does not automatically mean inoperability. When the primary tumor is under control, it is always worth while to explore the neck. The actual reconstruction of the soft tissue cover is no longer a problem. And since the carotid artery can either be ligated (under EEG control) or by-passed, the real danger comes from deep loco-regional invasion into the base of the skull, the intervertebral foramina and the suprahyoid muscles. A specialized and if necessary a polydisciplinary approach is advocated to give these patients a reasonable chance of operability with a quantitatively and qualitatively decent survival.

Head and Neck Neoplasms↗

PubMedDate not supplied

Free flaps in head and neck surgery.

Free flaps in head and neck reconstruction offer a one step reconstructive procedure with a decreased patient morbidity and an 85% successrate in 60 free flaps, including twenty-eight intra-oral free flaps. Groinflaps were used in twenty-five patients and latissimus dorsi flaps in 34 patients. The indications included benign conditions in 10 patients, from which six has an atrofia of subcutaneous fattissue in the face. Carcinomas were treated in 50 patients. Forty squamous cell carcinomas involved 11 tumors of the floor of the mouth and 11 tongue carcinomas, five orbita and four nose reconstructions. The facial artery was the recipient vessel in 70% of the extra-oral and 68% of the intra-oral free flaps. The lingual artery was used in 12% of the cases, and the superior thyroid artery in 10% of the cases. Free flap procedures, do not increase the operation time substantially. The wound healing is excellent and the hospital stay shortened to 10 days. This quick recovery improves the quality of life for patients with often extensive cancer. Also major salvage procedure can be carried out after conventional methods have failed.

Cicatrix↗