Role of Microsurgery in Organ-Preserving Surgeries in Uro-oncology.

Organ preservation surgery is the need of the hour in cancer management whenever it is feasible. Vascular continuity is a must for organ preservation. We found such same in this article.

Utility of Microvascular Reconstruction in Gastrointestinal Cancer Surgery During Complex Resections and Emergency Salvage.

Major gastrointestinal surgical resections and subsequent reconstruction can occasionally need arterial or venous resection, can encounter variant anatomy, or may lead to injury to vessels. These can lead to arterial and/or venous insufficiency of viscera like the stomach, liver, colon, or spleen. Left unaddressed, these can lead to, partial or total, organ ischemia or necrosis.

Flow-Through Radial Artery Forearm Flap for Tongue Revascularization After Excision of Base of Tongue Malignancies.

Tongue cancers are common in the spectrum of oral malignancies. In base of tongue cancers, tumour excision might lead to injury of ipsilateral or both lingual arteries, leading to ischemia of residual, native tongue. Free radial artery forearm flap is commonly used for tongue reconstruction.

Long-Term Outcomes of Recurrent Laryngeal Nerve Repair/Reconstruction in Oncological Settings.

Vocal cord paralysis results from involvement of the recurrent laryngeal nerve (RLN), either before the surgery or following excision. Coaptation of the resected edges utilising microsurgical techniques is the most promising therapeutic strategy available for RLN excision. The RLN can be repaired by direct epineural coaptation or using nerve grafts adhering to recommended microsurgical techniques.

Comparison of Reconstruction of Maxilloalveolar Resections in Head and Neck Cancers with Chimeric Anterolateral Thigh Flap (ALT) versus Standard ALT Flap.

 Oral malignancy that presents at a locally advanced stage needs complex surgical resections in which the maxillary cavity is usually left open. The constant maxillary secretions lead to problems like poor healing, fistula formation, and flap necrosis, causing longer hospital stays, delayed adjuvant therapy, and additional surgeries. Several methods have been tried to ameliorate this, each faced with its own difficulties.

TFL Perforator Flap Complementing and Completing the ALT-AMT Flap Axis.

 Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility.

Division versus de-epithelialization of fibula osteocutaneous flap for composite oromandibular defects: A propensity score-matched analysis.

Background: Different fibula osteocutaneous free flap (FOCFF) configurations have been described with a double-skin paddle (DSP) to address composite through-and-through oromandibular defects: division of the skin paddle using different perforators (div-FOCFF) or a de-epithelialized DSP FOCFF (deEpi-FOCFF). This study aimed to compare the surgical outcomes using these two methods (deEpi-FOCFF/div-FOCFF).

Methods: Patients who underwent segmental mandibulectomy and reconstruction with a DSP FOCFF between 2011 and 2014 were included.

DIEP Flap for Head and Neck Reconstruction: An Underutilized Option!

 The deep inferior epigastric artery perforator (DIEP) flap is a workhorse flap for breast reconstruction. Its use for head and neck (HN) reconstruction is rare. Abdomen provides a donor site abundant in skin and subcutaneous tissue, amenable to primary closure; sizeable, robust, and consistent perforators and a long, sizeable pedicle for comfortable microvascular anastomosis.

Patient reported outcomes after multivisceral resection for advanced rectal cancers in female patients.

Introduction: Multivisceral resections for rectal cancer can lead to long-term functional disturbances. This study aims to evaluate the quality-of-life outcomes in female patients who underwent multivisceral resection for rectal cancer, specifically focusing on urinary and sexual functions.

Methods: A cross-sectional study was conducted on female patients who underwent multivisceral rectal resections.

Delayed Partial Venous Insufficiency of Free Flap: To Intervene or Not?

Delayed venous congestion of a free flap poses a dilemma for clinicians, as the optimal management strategy is often uncertain. This case report presents a successful outcome achieved through a strategy of watchful waiting for a delayed presentation of a partially congested free flap. This approach enabled the avoidance of unnecessary surgical interventions and minimized potential complications associated with flap exploration.

Gastric salvage after venous congestion during major pancreatic resections: A series of three cases.

Pancreatic resections, depending on the location of the tumor, usually require division of the vasculature of either the distal or proximal part of the stomach. In certain situations, such as total pancreatectomy and/or with splenic vein occlusion, viability of the stomach may be threatened due to inadequate venous drainage. We discuss three cases of complex pancreatic surgeries performed for carcinoma of the pancreas at a tertiary care center in India, wherein the stomach was salvaged by reimplanting the veins in two patients and preserving the only draining collateral in one case after the gastric venous drainage was compromised.

Free Thoracodorsal Artery Perforator Flap for Head and Neck Reconstruction: An Indian Experience.

 We describe our experience with use of free thoracodorsal artery perforator (TDAP) flap for head and neck (H&N) cancer reconstruction, with respect to the patient and disease profile, suitable defect characteristics, the reconstructive technique, and complications.  Consecutive patients (  = 26) undergoing free TDAP flap for H&N onco-reconstruction, in a single center, were included from January 2015 to December 2018 and the data were analyzed.  Perforator(s) were reliably predicted preoperatively, using handheld Doppler.

Comparison of Functional Outcomes of Intestinal Flaps Vs Tubed Fasciocutaneous Flaps for Circumferential Pharyngoesophageal Defects-an Indian Perspective.

Pharyngolaryngoesophageal (PLO) reconstruction is a complex and technically demanding procedure. The reconstructive surgeon's concerns include avoiding fistula and stricture formation, as well as restoring normal speech and swallowing. A retrospective observational study with circumferential pharyngo-laryngo-oesophagal defects with aims and objectives of evaluation and comparison of the long-term functional outcomes like speech and swallowing along with the complications of fistula and stricture in two groups of JFF and FC flaps from the data is collected from electronic medical records of Tata Memorial Hospital, Mumbai, from January 2011 to May 2020.

Safety of free fibula flap harvest in IIIA and IIIB tibio-peroneal trunk variations.

Introduction: In head and neck cancer malignancies, free fibula flap is the gold standard for reconstruction of segmental bone defects owing to its predictable anatomy, long bone length, and feasibility for multiple osteotomies. However, sometimes because of variations in anatomy of tibio-peroneal trunk, it is a dilemma for the surgeons to use free fibula flap for reconstruction. This case series aimed to evaluate the safety of harvest of fibula in such cases in terms of acute and chronic donor-site complications.

In-Situ 'Divide' and 'Deliver': A Simple Technique to Preserve Nerves in Chimeric Anterolateral Thigh Flap Harvest.

Anterolateral thigh (ALT) flap is the workhorse for reconstruction in head and neck post cancer excision. Chimeric multi-paddle flaps are useful for composite defects involving skin, mucosa, and soft tissue. The nerve to vastus lateralis (VL) runs along the pedicle, frequently interdigitating with it or the perforators.

Management of Through-and-Through Oromandibular Defects after Segmental Mandibulectomy with Fibula Osteocutaneous Flap.

Background:  Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF) for through-and-through oromandibular defects by comparing the surgical outcomes and complications of different techniques to close the external skin defect.

Methods:  A retrospective analysis was conducted of patients who underwent reconstruction of through-and-through oromandibular defects after oncologic segmental mandibulectomy between January 2011 and December 2014.

Opportunistic use of naturally expanded neck skin for a buccal mucosa defect.

A 77-year-old female presented with an ulceroproliferative lesion of the left buccal mucosa extending to the commissure, diagnosed with squamous cell carcinoma on biopsy. She also had a large thyroid swelling, with expanded skin, diagnosed with a multinodular goiter. The patient underwent buccal mucosa wide local excision with left-sided selective neck dissection and total thyroidectomy.

Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle.

 The aim of this study is to assess the results of retrograde flow of internal mammary artery and vein (IMA/V) as a donor vessel for free flap microvascular anastomosis (MVA). This need arises with bipedicle deep inferior epigastric perforator (DIEP) flaps, when all four zones with extra fat need to be harvested for unilateral breast reconstruction coupled with poor midline crossover of circulation naturally or because of midline scar. Large anterolateral thigh flaps for chest wall cover, with multiple perforators from separate pedicles, also need supercharging.

Outcome Analysis of Advanced Oral Cancers Requiring Large Composite Fibular Osteocutaneous Flap Reconstruction: Experience From a Tertiary Care Cancer Hospital.

Background: Advanced oral cancer entailing extensive resection of large parts of the mucosa, bone, and skin require reconstructions with composite free flaps. Our aim was to analyze the outcomes of those oral squamous cell carcinomas requiring fibular osteocutaneous free flaps with large skin defects.

Methods: Perioperative course and histopathological and survival outcomes of 246 consecutive patients warranting composite fibular flaps from January 2010 to June 2015 at Tata Memorial Hospital, Mumbai, India, were retrospectively analyzed.

Reduction Mammoplasty Approach to Oncoplasty-Zone-Wise Planning in Indian Patients.

This article is an attempt to formulate certain guidelines for planning of zone-wise reconstruction after breast conservation surgery. The planning involves applying reduction mammoplasty principles with certain modifications to address the defect. This is a retrospective study of 61 patients with breast cancer who underwent breast conservation surgery and reconstruction of partial breast defects with oncoplastic techniques between January 2014 to March 2019.

Chimeric ALT Plus TFL Perforator Flap for Breast Reconstruction Post Radical Mastectomy with Large Skin Defect.

A 17-year-old girl with large malignant phyllodes tumor of left breast underwent a radical mastectomy with large skin excision resulting in defect of 20 cm × 18 cm. Postoperative radiation therapy necessitated robust cover with flap. The challenge was compounded by her body habitus.

Microvascular Flap Reconstruction for Head and Neck Cancers in Previously Operated and/or Radiated Neck: Is It Safe?

Background: Microvascular reconstruction after oncologic resection with curative intent in recurrent or second primary cancer cases is challenging not only because of the complexity of the defect but also due to difficulty in finding suitable donor vessels in the neck that has already been subjected to surgery and subsequent adjuvant treatment. In our present study, we evaluated the success of free flaps, reexplorations, and factors associated with reexploration and with flap failures in previously operated and/or radiated neck.

Methods: In this retrospective study, we analyzed patients who underwent microvascular reconstruction from January 2016 to December 2018 in patients with previous surgery and/or radiation, considered as "already treated neck" (ATN).

Awareness and Acceptability of Breast Reconstruction Among Women With Breast Cancer: A Prospective Survey.

Purpose: Quality of life has become an integral aspect of the management of breast cancer. Many women still need to undergo a modified radical mastectomy (MRM). Factors affecting the choice a woman makes to undergo breast reconstruction (BR) are unclear and are hypothesized to be influenced by socioeconomic factors.