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.

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.

Thoracodorsal Artery Perforator and Superior Epigastric Artery Perforator Flaps for Volume Replacement Oncoplastic Breast Surgery.

 Breast conservation therapy (BCT) and oncoplastic breast surgery (OBS) are now established modalities of treatment for breast cancer, with proven oncological safety. Traditionally, latissimus dorsi (LD) flaps have been the one-stop solution workhorse when volume replacement is needed. We present our experience with thoracodorsal artery perforator (TDAP) and superior epigastric artery perforator (SEAP) flaps.

Free fibula flap for lower limb salvage after tumour resection.

Context: Post-tumour resection lower limb salvage.

Aim/introduction: Resection of tumours of the femur and tibia around the knee and ankle joints results in large bony defects. Often arthrodesis is an alternative; in case, adequate functional motors cannot be preserved or due to economic constraints.

Anterolateral Thigh Twin Free Flaps from a Single Donor Site-a Modification Based on the Oblique Branch of the Lateral Circumflex Femoral Artery.

The pedicle of the anterolateral thigh flap is formed by the descending branch of the lateral circumflex femoral artery. Recently, an oblique branch of lateral circumflex femoral artery was described by Wei et al., which can also be used as an alternative to the descending branch.

Implant-retained dental rehabilitation in head and neck cancer patients: an assessment of success and failure.

Background: This study aimed to evaluate the rate of osseointegration (ROI) and overall success rate (OSR) of implants placed in native and grafted jaws with or without radiotherapy at a 5-year follow-up in Indian head and neck cancer patients.

Material And Methods: Thirty head and neck cancer patients from various socioeconomic strata were accrued. Eighty-five implants were inserted in 17 native and 13 grafted jaws.

Anthropomorphic and perforator analysis of anterolateral thigh flap in Indian population.

Background: Anterolateral thigh (ALT) flap is one of the most common flaps in the reconstruction armamentarium of plastic surgeons, but there is no published data about the flap characteristics in the Indian population. The aim of this study is to analyse the anthropomorphic characteristics of the ALT flap and the perforator details in Indian population.

Materials And Methods: ALT flap details were studied in 65 patients of Indian origin comprising 45 males and 20 females.

Cephalic vein: Saviour in the microsurgical reconstruction of breast and head and neck cancers.

Background: Reconstruction with microvascular free flaps is considered the reconstructive option of choice in cancer of the head and neck regions and breast. Rarely, there is paucity of vessels, especially the veins, at the recipient site. The cephalic vein with its good caliber and constant anatomy is a reliable recipient vein available in such situations.

Two in one: Double free flap from a single free fibula osteocutaneous unit.

In the past two decades, the advancement in the microsurgical techniques has revolutionised the reconstruction of post-oncological head and neck defects. Free fibula osteocutaneous flap (FFOCF) has been considered as the treatment of choice by many for mandible reconstruction. The improvement in the surgical resection and adjuvant treatment has improved the survival rates even in patients with advanced cancer.

Skin paddle vascularity of free fibula flap - A study of 386 cases and a classification based on contribution from axial vessels of the leg.

Objective: The skin paddle of the free fibula flap receives its vascular supply from septocutaneous perforators, musculocutaneous perforators or from both, and these perforators might originate from the peroneal or posterior tibial vessels or from both. The objective of this study was to classify the skin paddles based on the dominance of vascular contribution by these axial vessels through their different perforator systems.

Materials And Methods: A retrospective analysis of 5-year data of 386 free fibula flaps used in oro-mandibular reconstruction was done and the skin paddle vascularity was studied.

Free anterolateral thigh flap for reconstruction of complex craniofacial defects after resection of tumors of the fronto-orbitomaxillary complex.

Tumors of the fronto-orbitomaxillary segment are complex and pose a significant challenge for radical resection and subsequent reconstruction. With evolution in surgical reconstructive techniques, better reconstruction of these complex defects is now possible and facilitates more aggressive surgical management. The anterolateral thigh (ALT) flap has features particularly suited for this reconstruction.

Reconstruction of oncological oro-mandibular defects with double skin paddled-free fibula flap: a prudent alternative to double flaps in resource-constrained centres.

Objective: The free fibula flap is the choice flap for mandibular reconstruction following extensive tumor resections. While large defects are managed with a second flap [free or pedicle] in advanced centres, a free fibula flap with a large skin paddle that can be de-epithelised to provide outer skin and inner lining is the best alternative in resource- constrained centres.

Materials And Methods: From January 2005 to December 2009 a total of 386 free fibula flaps were used of which 307 flaps had de-epithelised double skin paddle in reconstructing complex oral and mandibular defects after tumor ablative surgeries.

Chimeric superficial temporal artery based skin and temporal fascia flap plus temporalis muscle flap - An alternative to free flap for suprastructure maxillectomy with external skin defect.

Flaps from temporal region have been used for mid face, orbital and peri-orbital reconstruction. The knowledge of the vascular anatomy of the region helps to dissect and harvest the muscle/fascia/skin/combined tissue flaps from that region depending upon the requirement. Suprastructure maxillectomy defects are usually covered with free flaps to fill the cavity.

Assessment of quality of life after implant-retained prosthetically reconstructed maxillae and mandibles postcancer treatments.

Purpose: The aim of this prospective study was to assess treatment outcome and impact on quality of life with implant-retained prosthesis in reconstructed jaws in head and neck cancer patients.

Materials And Methods: Twelve patients were rehabilitated with implant-retained dental prosthesis following free fibular graft after segmental resection. These subjects were evaluated by standardized questionnaires European Organization for Research and Treatment of Cancer QLQ-C30 (version 3) and clinical assessment for quality of life.

There is no donor side specificity of fibula free flap for complex oromandibular reconstruction.

Background: The objective of this study was to prove that there is no significance to the donor side (right or left) of the free fibula osteocutaneous flap (FFOCF) in the reconstruction of complex oromandibular defects (COMD) and proper flap planning, designing and tailoring are important in reconstructing different types of COMD after tumour-ablative surgery.

Materials And Methods: Three hundred and eighty-six consecutive patients who where reconstructed with FFOCF for COMD from Jan 2005 to Dec 2009 over a period of 5 years were studied. Except in seven patients, all fibula flaps were harvested from the left leg as per convenience and to facilitate a simultaneous, two-team approach.

Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap.

Background: The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage.

Materials And Methods: From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied.

Pedicle transfer in oral cavity reconstruction.

In head and neck reconstructions when a free flap is used intra orally to provide the lining its vascular pedicle has to be transferred to the neck for anastomosis. This has to be performed in such a way that the pedicle does not get kinked or twisted. The pedicle is enrolled in a split open glove from its point of entry into the flap till its proximal most part.

A simple and cost effective template for central segment reconstruction of mandible with free fibula flap.

Purpose: A variety of templates are being used for mandible reconstruction with free flaps. We describe a simple and cost effective method using a 'K' wire template for the central segment reconstruction of the mandible with free fibula flap.

Materials And Methods: Over a period of 5 years from January 2005 to December 2009, there were a total of 386 mandible reconstructions with free fibula flaps of which 262 were central segment reconstructions.

Successful management of free osteocutaneous fibula flap with anomalous vascularity of the skin paddle.

The free osteocutaneous fibula flap is an established method of reconstruction of maxillary and mandibular defects. The vascularity of the skeletal and the cutaneous components is provided by the peroneal artery via the nutrient artery and the septo- and musculocutaneous perforators. In rare situations, these perforators may arise from other major leg arteries.