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History. Early 1900's Alexis Carrel1950's Jacobsen and Suarez-- first anastomoses in animal1957 Som and Seidenberg first free tissue transfer in humans1972 Daniels and Taylor free flap". History. 1974 Baker and Panje first free flap in for head and neck cancer reconstruction1980's osteocuta
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1. Revascularized Tissue Transfers of the Head and Neck Russell D. Briggs, M.D.
Karen H. Calhoun, M.D.
2. History Early 1900’s Alexis Carrel
1950’s Jacobsen and Suarez-- first anastomoses in animal
1957 Som and Seidenberg– first free tissue transfer in humans
1972 Daniels and Taylor– “free flap”
3. History 1974 Baker and Panje– first free flap in for head and neck cancer reconstruction
1980’s osteocutaneous flaps popularized
1987 osseointegrated implants popularized
1990 sensate flaps popularized
4. Advantages of Free Tissue Transfer Wide variety of available tissue types
Large amount of composite tissue
Tailored to match defect
Wide range of skin characteristics
More efficient use of harvested tissue
Immediate reconstruction
5. Advantages of Free Tissue Transfer Two team approach
Improved vascularity and wound healing
Low rate of resorption
Defect size little consequence
Potential for sensory and motor innervation
Permits use of osseointegrated implants
6. Disadvantages of Free Tissue Transfer Technically demanding
Increased operating room time
Increased flap failure rate
Functional disability at donor site
7. Preoperative Planning Patient selection
Age
Diabetes
Arteriosclerosis
Tobacco use
Collagen vascular disease
Coagulopathies
Hypercoagulable states
8. Preoperative Planning Donor site selection
Functional and aesthetic needs
Degree of bulk
Need for carotid coverage
Surface area of defect
External vs. internal lining
Need for bone
History of donor site abuse
9. Intraoperative Management Operating microscope, instruments, sutures
Irrigation supplies
Anticoagulants and volume expanders
No pressors
Patency assessment (15-20 minutes)
Pulsation
Doppler
10. Postoperative Management Skilled nursing important
No pressure on pedicle (no ties on neck)
Eliminate cooling of flap
Keep head in neutral position
No pressors– keep BP stable
Hematocrit important
Frequent inspections and doppler pedicle
11. Postoperative Management
Inspection and prick test
Arterial vs. venous insufficiency
Pharmacotherapy
Heparin, dextran, aspirin
12. Postoperative Management Temperature measurements
SPECT scanning
Infrared spectroscopy
Transcutaneous and intravascular devices
Technicium scanning
13. Reconstructive Planning Must consider all options for particular defect and patient
Options
Secondary intent
Primary closure
Skin grafts
Local flaps
Myocutaneous flaps
Free flaps
14. Oral Cavity and Oropharynx Reconstruction Thin pliable mucosa
Possibilities
Radial Forearm
Scapular/Parascapular
Lateral Arm
Gastric Mucosa
15. Radial Forearm Free Flap Venous Source
Deep venous commitantes and/or cephalic vein
Arterial source
Radial artery
16. Radial Forearm Free Flap Advantages
Thin skin with long, large pedicle
Easy positioning
Potential for sensate flap
Potential for unusual shapes
Potential for vascularized bone
Ease of preoperative evaluation Disadvantages
Loss of hand
Poorly aesthetic donor site
Requires skin graft
Potential for pathologic fractures
Loss of hand function
17. Radial Forearm Free Flap