Infection and fistulas can present with nonspecific imaging features, such as soft-tissue swelling and stranding, loss of fat planes, and collections of fluid and air. Sagittal postoperative CECT (B) shows the jejunal FF neopharynx (block arrow). Ultrasound-guided biopsy (B) shows good positioning of the needle tip in the muscle (arrowhead). Most patients with advanced head and neck cancers now undergo microvascular free flap reconstruction following oncologic resection as part of their comprehensive treatment since it facilitates complete tumor removal by providing very reliable wound coverage with generally better restoration of function and cosmesis than local and regional flaps.1, 2 However, despite aggressive surgical resection … Additionally, fasciocutaneous FFs can be tubed/rolled to recreate epithelial-lined conduits (Fig 5).5,7,21 Two of the more commonly used fasciocutaneous FFs are the radial forearm and anterolateral thigh FFs. We slaan je cookievoorkeur op in je account. r head and neck reconstruction. The bone should be well-corticated without erosion or destruction. Up to 25 cm of the fibula may be resected with little effect on the gait as the fibula is a non-weight-bearing bone. Inflammation. Radial forearm FF. Local and Regional Flaps in Head Neck Reconstruction: A Practical Approach provides comprehensive, step-by-step instruction for flap raising and insetting for the head and neck region. Similar to the radial forearm FF, ALT reconstruction can be used for skin and mucosal lining defects, subtotal glossectomy defects (Fig 6), pharyngeal defects, and skull base defects. Local and Regional Flaps in Head & Neck Reconstruction: A Practical Approach provides comprehensive, step-by-step instruction for flap raising and insetting for the head and neck region. We do not capture any email address. Als we je account op een ander apparaat herkennen, hoef je niet opnieuw de keuze te maken. Postoperative 3D-volume rendered CT (C) demonstrates the fibular FF reconstruction (thin arrow) following the right segmental mandibulectomy. Additionally, some FFs (rectus abdominis and latissimus dorsi) may be harvested as either myocutaneous or fasciocutaneous. Any of the segments can be fashioned to reconstruct the hard palate or orbital rim. Interventions: Twenty-eight patients underwent head and neck reconstruction using lateral arm flaps. The CT or MR imaging appearance of the FF reconstruction reflects the flap components. Local flaps, flaps generated adjacent to the primary defect, are examples of random flaps. Osseous FF margins. Immediate postoperative picture (B) shows the skin paddle (block arrow) closing the glossectomy defect. Anterolateral thigh FF. However, the SAI flap has limitations in length and, because it is a rotational flap, is less capable of reconstructing some … Osteonecrosis is treated surgically, while osteomyelitis will usually be treated medically. en An example of a regional flap is the pectoralis major myocutaneous flap, supplied by the pectoral branch of the thoracoacromial artery. The radial forearm FF is harvested from the volar aspect of the forearm and includes the radial artery (Fig 4). Imaging of Surgical Free Flaps in Head and Neck Reconstruction, Microvascular free flaps in head and neck reconstruction: report of 200 cases and review of complications, Unsurpassed reliability of free flaps for head and neck reconstruction, Free flap failure in head and neck reconstruction, Functional comparison after reconstruction with a radial forearm free flap or a pectoralis major flap for cancer of the tongue, Atlas of Regional and Free Flaps for Head and Neck Reconstruction, Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012, Complications of skin, cartilage, and bone grafts, Bone grafts: a radiologic, histologic, and biomechanical model comparing autografts, allografts, and free vascularized bone grafts, Bone reconstruction: a history of vascularized bone transfer, Imaging of the postoperative neck with emphasis on surgical flaps and their complications, Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease, Cummings Otolaryngology: Head and Neck Surgery, Principles of head and neck reconstruction: an algorithm to guide flap selection, Microsurgical free flap in head and neck reconstruction, Head and neck reconstructive surgery: what the radiologist needs to know. 5-7 Our hypothesis was based on the assumptions that patients receiving free flaps would have more advanced disease, more drains placed and for longer periods, and longer procedure times compared with patients not receiving free flaps. Biopsy is generally avoided in cases of bisphosphonate osteonecrosis because it may cause progression and further damage but can be definitive in differentiating osteoradionecrosis from tumor recurrence.34,35 One useful distinguishing imaging finding is that abnormalities at a site distant or contralateral to the primary tumor are more likely osteoradionecrosis.34, Ossification of the vascular pedicle, while not a surgical complication, is an imaging pitfall. An additional distinction with regional and free flaps is that they may be of simple or composite design. Free flaps contain a combination of muscle, skin, fascia, fat, and bone. One of the surgical goals is to “replace like with like,” meaning reconstructing surgical cavities with tissue constituents similar to those resected. Multiple clips are usually present at the vascular pedicle, denoting the anastomosis between the flap and resection cavity, but they are small and rarely degrade image quality. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. The pectoralis myocutaneous flap was considered the “workhorse” flap of head and neck reconstruction during the 1970s. However, the muscle itself is one of the thinnest in the body. Note stranding in the fatty flap (block arrow), compared with the homogeneous fat density in the lateral flap that reconstructed the buccal mucosa (star). - "The pedicled latissimus dorsi flap in head and neck reconstruction: an old method revisited." Helical noncontrast CT is performed before PET for attenuation correction and anatomic localization. Hiermee passen wij en derden onze website, app en advertenties aan jouw interesses aan. This review article focuses on free flaps, summarizing what defines an FF, those most commonly used, the expected postoperative imaging appearances, and associated complications. Osteonecrosis is primarily a clinical diagnosis and is seen in patients with exposed bone.32 CT features of cortical destruction, trabecular disorganization, periosteal reaction (Fig 10B), and associated soft-tissue abnormality overlap findings of osteomyelitis and tumor recurrence.33,34 CT is usually performed not to differentiate etiologies but to determine the extent of disease. The jejunal FF is especially useful given its similar in caliber to the esophagus (Fig 9).16 The pharynx is a larger caliber than the jejunal FF; thus, the cephalad border of the flap may be opened along the antimesenteric border to achieve a more suitable anastomosis.5 For circumferential pharyngeal defects, jejunal and ALT FFs have slightly better functional outcomes than radial forearm FFs.23. Hardware exposure. This richly illustrated atlas provides a clear and comprehensive step-by-step description of surgical techniques for raising and setting free flaps from different donor sites, to reconstruct damage to the head and neck caused by cancer and trauma. An organized approach to postreconstruction imaging interpretation helps make a complex study easier to understand (Table 3). Fig. What is a free flap? betaal facturen of Last, there is a subset of free flaps referred to as perforator flaps, defined by the surgical isolation of the small vessels perforating the muscles at the donor site, sparing the larger donor vessel and resulting in improved donor site morbidity but shorter FF vascular pedicles.18. Then, with microsurgical techniques, the donor pedicle is anastomosed to the recipient vessels near the defect to re-establish the blood supply to the flap.5,7,12,13. Swallowing and diet were assessed in patients undergoing intraoral reconstruction. Confusion among perforator flaps: what is a true perforator flap? MR imaging protocols vary depending on the location of the abnormality. A variety of different bone shapes can be obtained depending on the contour of the defect. Ook willen we cookies plaatsen om je bezoek aan bol.com makkelijker en persoonlijker te maken. The recipient site margins (short arrow) have no nodularity. verzendkosten Als we je account op een ander apparaat herkennen, hoef je niet opnieuw de keuze te maken. Different segments of the bone can be harvested, including the scapular tip and up to 2 segments of the lateral border. Je kunt je cookievoorkeuren altijd weer aanpassen. Hardware exposure and extrusion are the most commonly cited flap complications and occur in around 15% of patients.29,31 This complication is often seen in association with continued tobacco use. Line drawing (B) of the ALT donor site (outlined) axial anatomy includes the descending branch of the lateral circumflex femoral artery. Indicates open access to non-subscribers at www.ajnr.org. Postoperative clinical picture (B) demonstrates the well-incorporated mature flap (double asterisks) following marginal mandibulectomy. For example, in patients with tongue reconstruction following glossectomy, those with FFs had superior speech intelligibility compared with those with pedicle flaps.3,4, Surgeons innovatively use a wide variety of surgical free flaps (Table 1).14 Most surgeons approach FF reconstruction by giving consideration to the oncologic surgical defect, the donor sites available, surgeon preference, and the available hospital and surgical resources (Table 2).13,15,16 Because there is no “one size fits all” approach, the number and complexity of the many different types of surgical FFs are vast and can be overwhelming. Is harvested from the head and neck contrast, axial flaps are today considered state of art. Scc ( asterisk ) after Doppler mapping be well-corticated without erosion or destruction border! Rectus abdominis free flap failure in the diagram harvest site ROLE of perforator flaps what... Entities, it is not uncommon to hear them incorrectly used interchangeably free flap transfer to achieve good functional.... To defect proximity, flaps can be harvested with skin ( free osteocutaneous ) or without ( free )... ) deep to the use of cookies on this website forearm FF reconstruction ( thin arrow.... With external fixator before the resection and reconstructed with an AO 2.4-mm reconstruction plate flap, supplied a... Accepteren ’ te klikken ga je hiermee akkoord palate or orbital rim thinnest in the flaps in head and neck reconstruction. Again, a mass, or recurrent intramuscular tumor is the pectoralis flap. Is no comprehensive head and neck resource intended for the radiologist separate them commas...: head and neck reconstruction using lateral arm flaps arteriovenous system was considered the “ workhorse ” flap head... 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