RESUMEN
The reconstruction of large soft tissue defects in the orbital and maxillomalar region is a difficult task. A good functional and aesthetic result has to be achieved. The cervicopectoral rotation flap has many advantages; it is easy, rapid and safe to harvest, compatible with cervical dissection and radiotherapy. It is an anatomical unit, with skin properties similar to the rest of the facial skin. This is our pedicle flap of choice for large soft tissue defects in the midface, specially in elderly patients. We use it in association with the temporalis myofascial flap in cases of orbital exenteration. In large defects, the alternatives to these flaps are microsurgical free flaps or other pedicled flaps. These flaps require more complex techniques, are time consuming surgically, have greater morbidity and equal or worse functional and aesthetic results. In this paper we present our experience. Twenty-two patients with large soft tissue defects in the maxillomalar and orbital regions have had reconstructions with these flaps (facio-cervico-pectoral rotation flap and temporalis myofascial flap) in the last 8 years.
Asunto(s)
Cara/cirugía , Músculo Esquelético/trasplante , Trasplante de Piel/métodos , Colgajos Quirúrgicos/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estética , Músculos Faciales/trasplante , Fascia/trasplante , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/rehabilitación , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Escisión del Ganglio Linfático , Masculino , Maxilar/cirugía , Microcirugia , Persona de Mediana Edad , Músculos del Cuello/trasplante , Órbita/cirugía , Evisceración Orbitaria , Músculos Pectorales/trasplante , Músculo Temporal/trasplante , Cigoma/cirugíaRESUMEN
The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.
Asunto(s)
Trasplante Óseo , Implantes Dentales , Estética , Neoplasias de la Boca/cirugía , Músculo Esquelético/trasplante , Trasplante de Piel , Colgajos Quirúrgicos/métodos , Acromion/anatomía & histología , Trasplante Óseo/efectos adversos , Trasplante Óseo/patología , Carcinoma de Células Escamosas/cirugía , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático , Mandíbula/cirugía , Microcirugia , Músculo Esquelético/anatomía & histología , Cuello/cirugía , Modalidades de Fisioterapia , Escápula/anatomía & histología , Hombro , Trasplante de Piel/efectos adversos , Colgajos Quirúrgicos/efectos adversos , Colgajos Quirúrgicos/patología , Procedimientos Quirúrgicos Vasculares , Cicatrización de HeridasRESUMEN
Microvascular reconstructions in the head and neck are usually long operating time procedures. Mechanical anastomotic devices help to reduce operating time and can reduce anastomotic failures avoiding foreign bodies in the lumen of the vessel. One of these systems is the 3M/Precise microvascular anastomotic device, it is a non-absorbable device, however, criticisms of this system have been directed to the fact that pulsation of the vessel wall against a rigid structure could lead to thinning of the vessel wall and aneurysm formation. No aneurysms have been found previously in other experimental models. Our experimental study on the aorta and vena cava of the rat comprises 25 arterial and 25 venous anastomoses. In the arteries, four proximal aneurysms were found, two of these were failures. In the venous anastomoses, no failures were found nor aneurysm formation. The system is very useful for performing clinical end to end venous anastomosis helping to reduce anastomotic failures. Aneurysms have been found in arteries although four different ring sizes were available. The device is less easy to use in them than in veins and sometimes can be difficult to apply, making manual suturing a better choice for clinical arterial anastomosis.