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Modified Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap for Salvage of Mandibular Reconstruction.

ABSTRACT: The modified pedicled internal mammary osteomyocutaneous chimeric flap is a powerful option for head and neck reconstruction in patients not suitable for free tissue transfer. In this article, the senior author's (K.C.) technique for flap elevation is described in the context of a patient with mandibular osteoradionecrosis resulting in severe crossbite and trismus after multiple failed attempts at reconstruction with free tissue transfer. The modified pedicled internal mammary osteomyocutaneous chimeric flap was chosen as it offered intraoral lining, extraoral soft tissue, and vascularized bone for mandibular reconstruction without requiring free tissue transfer. The flap dissection as well as the risks, benefits, and indications for this flap are described herein. The modified pedicled internal mammary osteomyocutaneous chimeric flap is a technically complex reconstructive option reserved for situations in which conventional methods have been exhausted. It offers an eloquent solution for patients who otherwise may have no options.

SUBMITTER: Morin SD

PROVIDER: S-EPMC10718360 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Modified Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap for Salvage of Mandibular Reconstruction.

Morin Samantha D SD Gowda Arvind U AU Chaiyasate Kongkrit K

Plastic and reconstructive surgery. Global open 20231213 12

The modified pedicled internal mammary osteomyocutaneous chimeric flap is a powerful option for head and neck reconstruction in patients not suitable for free tissue transfer. In this article, the senior author's (K.C.) technique for flap elevation is described in the context of a patient with mandibular osteoradionecrosis resulting in severe crossbite and trismus after multiple failed attempts at reconstruction with free tissue transfer. The modified pedicled internal mammary osteomyocutaneous ...[more]

PMID: 38093724

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Project description:Pedicled temporoparietal fascial flaps (TPFF), which are flexible, thin, and highly vascularized, have been tried for the moyamoya angiopathy (MMA) treatment. To reduce postoperative complications and improve prognosis, we performed surgical modification and followed up to observe the efficacy. From February 2018 and June 2022, the clinical data of 31 adult MMA patients who underwent the modified TPFF combined revascularization were collected. The clinical outcomes and complications of the patients were recorded until the cut-off date of follow-up. The primary endpoints were the magnetic resonance perfusion (MRP), modified Rankin Scale (mRS) scores, and Matsushima Grade; the secondary endpoints were the clinical symptom outcome and Postoperative complications. Descriptive statistics and rank sum test to assess the therapeutic effect of the modified TPFF combined revascularization for adult MMA treatment. The clinical symptoms of MMA were alleviated in 26 patients and disappeared in five. In all patients, MRP showed improvement in cerebral perfusion on the operated side, and no deterioration or new cerebral infarction occurred during follow-up. Postoperative digital subtraction angiography (DSA) showed that the anastomotic site was patent, and the MMA collateral was decreased in all patients. Only 1 case (3%) of Matsushima grade C showed poor collateral compensation. The admission mRS score (1.54±0.66) of the ischemic MMA was significantly reduced compared with ≥6 months postoperatively (0.54±0.72, P<0.01). The admission mRS score (0.57±0.53) of the hemorrhagic MMA was reduced compared with ≥6 months postoperatively (0, P<0.05). Postoperative complications included epileptic seizures in 2 cases, a cerebral hyper-perfusion syndrome in 2 cases, intracranial rebleeding in 2 cases, skin necrosis in 1 case, and skin maceration in 1 case. Modified TPFF combined revascularization might be a feasible and safe surgical technique for MMA, but it is still necessary to increase the sample size and extend the follow-up time to evaluate its efficacy. Ischemic MMA may have a more significant prognostic benefit than hemorrhagic MMA by this surgery.

Dataset Information

Modified Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap for Salvage of Mandibular Reconstruction.

Publications

Modified Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap for Salvage of Mandibular Reconstruction.

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