• Archives of Plastic Surgery
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• v.39 no.5
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• pp.522-527
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• 2012

Background A pectoralis major flap is one of the standard tools for the reconstruction of defects of the head and neck. Despite the technical advancement in free tissue transfer in head and neck reconstruction, the benefits of a pectoralis major flap should not be overlooked. The purpose of this study is to evaluate our 17 years of experience in reconstructing defects of the head and neck region using the pectoralis major flap. Methods We retrospectively reviewed the medical records of 112 patients (120 cases) who underwent pectoralis major flap operations for head and neck reconstruction during a period ranging from 1994 to 2010. Results In our series, no total necrosis of the flap occurred. Of the total cases, 30.8% presented with flap-related complications. Major complications occurred in 20% of all of the cases but were then all successfully treated. The male sex was correlated with the occurrence of overall complications (P=0.020) and major complications (P=0.007). Preoperative albumin levels of <3.8 g/dL were correlated with the formation of fistula (P=0.030). Defects of the hypopharynx were correlated with the occurrence of major complications (P=0.019) and the formation of fistula (P=0.012). Secondary reconstructions were correlated with the occurrence of overall complications (P=0.013) and the formation of fistula (P=0.030). Conclusions A pectoralis major flap is still considered to be a safe, versatile one-stage reconstruction procedure in the management of the defects of head and neck and the protection of the carotid artery.

• Korean Journal of Head & Neck Oncology
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• v.26 no.2
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• pp.198-203
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• 2010

Objectives : Getting full information from axial CT images needs experiences and knowledge. Sagittal and coronal images could give more information but we have to draw 3-dimensional images in mind with above informations. With aid of 3D reconstruction softwares, CT data are converted to visible 3D images. We tried to compare medical photographs of 15 surgical specimens from neck tumors with 3D reconstructed images of same patients. Material and Methods : Fifteen patients with neck tumors treated surgically were recruited. Medical photograph of the surgical specimens were collected for comparison. 3D reconstruction of neck CT from same patients with aid of 3D-doctor software gave 3D images of neck masses. Width and height of tumors of each photos and images from the same cases were calculated and compared statistically. Visual similarities were rated between photos and 3D images. Results : No statatistical difference were found in size between medical photos and 3D images. Visual similarity score were higher between 2 groups of images. Conclusion : 3D reconstructed images of neck mass looked alike the real photographs of excised neck mass with similar calculated sizes. It could give us reliable visual information about the mass.

• Korean Journal of Head & Neck Oncology
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• v.37 no.1
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• pp.63-66
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• 2021

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial circumferential tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft.

• Archives of Craniofacial Surgery
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• v.22 no.1
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• pp.38-44
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• 2021

Background: The free flap surgical method is useful for the reconstruction of head and neck defects. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 30 years. Methods: Between 1989 and 2018, a total of 866 free flap procedures were performed on 859 patients with head and neck defects, including 7 double free flaps. The causes of vascular crisis and salvage rate were analyzed, and the total flap survival rate calculated among these patients. Additionally, the survival and complication rates for each flap type were compared. Results: The 866 cases included 557 radial forearm flaps, 200 anterolateral thigh flaps, 39 fibular osteocutaneous flaps, and 70 of various other flaps. The incidence of the vascular crisis was 5.1%; its most common cause was venous thrombosis (52.3%). Salvage surgery was successful in 52.3% of patients, and the total flap survival rate was 97.6%. The success rate of the radial forearm flap was higher than of the anterolateral flap (p< 0.01), and the primary sites of malignancy were the tongue, tonsils, and hypopharynx, respectively. Conclusion: The free flap technique is the most reliable method for head and neck reconstruction; however, the radial forearm free flap showed the highest success rate (98.9%). In patients with malignancy, flap failure was more common in the anterolateral thigh (5.5%) and fibular (5.1%) flaps.

• Archives of Plastic Surgery
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• v.40 no.4
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• pp.353-358
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• 2013

Background Robots have allowed head and neck surgeons to extirpate oropharyngeal tumors safely without the need for lip-split incision or mandibulotomy. Using robots in oropharyngeal reconstruction is new but essential for oropharyngeal defects that result from robotic tumor excision. We report our experience with robotic free-flap reconstruction of head and neck defects to exemplify the necessity for robotic reconstruction. Methods We investigated head and neck cancer patients who underwent ablation surgery and free-flap reconstruction by robot. Between July 1, 2011 and March 31, 2012, 5 cases were performed and patient demographics, location of tumor, pathologic stage, reconstruction methods, flap size, recipient vessel, necessary pedicle length, and operation time were investigated. Results Among five free-flap reconstructions, four were radial forearm free flaps and one was an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and one flap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flap insetting and microanastomosis were achieved using a specially manufactured robotic instrument. The total operation time was 1,041.0 minutes (range, 814 to 1,132 minutes), and complications including flap necrosis, hematoma, and wound dehiscence did not occur. Conclusions This study demonstrates the clinically applicable use of robots in oropharyngeal reconstruction, especially using a free flap. A robot can assist the operator in insetting the flap at a deep portion of the oropharynx without the need to perform a traditional mandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methods and is accepted as the most up-to-date method.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.134-137
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• 2007

Background and Objectives: The goals of laryngeal reconstruction have been prevention of aspiration, production of a functional voice, and maintenance of an adequate airway for decannulation. It is generally believed that the reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve laryngeal function. The objective of this study is to evaluate of voice function after VPL with mucosal flap and fat graft reconstruction. Materials and Methods: From 1994 to 2006, 13 patients, who had been treated with VPL with mucosal flap and fat graft reconstruction. The voice characteristics, acoustic, aerodynamic parameter were measured in 13 patients after vertical partial laryngectomy with mucosal flap and fat graft reconstruction. Acoustic analysis was carried out using Computerized Speech Lab (CSL) and aerodynamic analysis were carried out using Aerophon II,3 months and 12 months after surgery. Results: The GRBAS scale, jitter, shimmer, NHR were improved as time goes on after surgery. But, maximum phonation time was shortened after surgery and there is no significant differences between before and after surgery in mean flow rate. Conclusion: The voice function of the mucosal flap and fat graft reconstruction after VPL were satisfactory. This can be an excellent reconstruction method after vertical partial laryngectomy.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.12-16
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• 2011

Background and Objectives : The pectoralis major myocutaneous flap(PMMCF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Even with the worldwide use of free flaps, the PMMCF is still considered the mainstay in head and neck reconstruction. The aim of the study is to evaluate the application and reliability of the PMMCF in selected cases of head and neck complication. Materials and Methods : We conducted a retrospective review of 14 patients who underwent the surgical reconstruction using the PMMCF due to the complications after head and neck ablative surgery between 1997 and 2007. Outcome measures included the indications of PMMCF, complications and post-operative functional result. Results : PMMCFs were used to reconstruct defects in the following series; wound dehiscence(7 patients), flap failure(4 patients), pharyngocutaneous fistula(3 patients). Flap survival was 100 percent and mean flap size was $67.2cm^2$. Five patients had complications such as pharyngocutaneous fistula, marginal necrosis, carotid blowout. Conclusions : The PMMCF is a safe and convenient method for reconstruction of the surgical complications after resection of advanced tumors and can be still used as a salvage procedure after free flaps failure.

• Archives of Plastic Surgery
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• v.50 no.3
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• pp.264-273
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• 2023

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular reconstructions of the head and neck. The aim is to conduct a high-quality Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)- and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2)-compliant systematic review comparing the use of the MSAP flap to other microvascular free flaps in the head and neck. Medline, Embase, and Web of Science databases were searched to identify all original comparative studies comparing patients undergoing head and neck reconstruction with an MSAP flap to the radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap from inception to February 2021. Outcome studied were the recipient-site and donor-site morbidities as well as speech and swallow function. A total of 473 articles were identified from title and abstract review. Four studies met the inclusion criteria. Compared with the RFFF and the ALT flaps, the MSAP flap had more recipient-site complications (6.0 vs 10.4%) but less donor-site complications (20.2 vs 7.8%). The MSAP flap demonstrated better overall donor-site appearance and function than the RFFF and ALT flaps (p = 0.0006) but no statistical difference in speech and swallowing function following reconstruction (p = 0.28). Although higher quality studies reviewing the use of the MSAP flap to other free flaps are needed, the MSAP flap provides a viable and effective reconstructive option and should be strongly considered for reconstruction of head and neck defects.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.190-193
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• 2001

Background and Objectives: Reliable and versatile free flap has become a mainstay in reconstruction of the head and neck. But until now pectoralis major myocutaneous flap (PMMCF) as workhorse is useful and has some advantages such as good viability, one-stage reconstruction and carotid protection. The objective of this study was to review the role and indication of PMMCF in this era of potent free flaps for head and neck reconstruction. Patients and Methods: Sixty one PMMCF and one hundred forty six free flaps used for head and neck reconstruction between 1991 and 2001 were reviewed retrospectively. We compared the applied sites of flap, the flap failure rate and complications. Results: Contrary to the free flap, use of PMMCF has gradually decreased after the middle of 1990s. PMMCF were mainly used for mucosal defect(33cases, 54.1%) and cervical skin defect(22cases, 36.1%) and free flap were mainly used for mucosal defect(129cases, 88.4%). In point of use of PMMCF according to years, from 1991 to 1997, 30cases(70%) are used to reconstruct mucosal defect and 12cases(29%) are used to reconstruct skin defect. But from 1998 to 2001, only 2cases(10.5%) are used to reconstruct mucosal defect and 13cases(68.4%) are used to reconstruct neck skin defect. In case of free flap, from 1991 to 1997, 41cases (87%) are used to reconstruct mucosal defect and from 1998 to 2001 88cases(89%) are used as same purpose. Three major necrosis (more than 50%) deveolped in 61 PMMCF (4.9%) and three major necrosis developed in 146 free flaps(2.1%). Conclusion: PMMCF is no longer flap of choice for primary reconstruction but it is a still one of a good tool in some head and neck reconstruction such as covering single wide defect of face or neck skin, back-up procedure of free flap, postoperative status, treatment of pharyngocutaneous fistula and covering vital structure.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.47-51
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• 2003

Background and Objectives: Oro-and pharyngocutaneous fistula after irradiation can lead to extensive wound necrosis and fetal complication such as carotid rutpure. So, there is a need to clean and cover the wound rapidly in these compromised patients. Pectoralis major myocutaneous (PMMC) flap has been presented for reconstruction of complex defects in these irradiated patients. We applied the double paddle PMMC flap for the simultaneous reconstruction of above complex defects and evaluated the it's clinical efficacy. Material and Methods: Retrospective chart review of three cases of simultaneous head and neck reconstruction after irradiation with double paddle PMMC. All patients received prior radiotherpy before development of complications. The double paddle PMMC flap was used for mucosal lining of the oral cavity and epithelial lining of external skin in 2 cases, for mucosal lining of the pharynx and epithelial lining of external skin in 1 case. Results: Considerable complications such as major flap necrosis or fistula did not occur in any of the cases, and simultaneous reconstruction was achieved in all cases without reoperations. Conclusion: Many extended defects such as oro-and pharyngocutaneous fistula involving cover and lining about the head and neck after irradiation can be rehabilitated by the double paddle pectoralis major myocutaneous flap.