The midline central artery forehead flap: a valid alternative to supratrochlear-based forehead flaps.

Importance: This study clarifies the pedicle geometry and vascular supply of a midline forehead flap for nasal reconstruction. It reports on the vascular reliability of this flap and its ability to reduce hair transposition to the nose, a major complicating factor of previous forehead flap designs.

Objective: To compare the vascular reliability of 3 different pedicle designs of the forehead flap in nasal reconstruction (classic paramedian, glabellar paramedian, and central artery flap design) and evaluate hair transposition rates and aesthetic results.

Indications for reconstruction of mucosal defects in oropharyngeal cancer using a supraclavicular island flap.

The use of the supraclavicular island flap (SCIF) for the reconstruction of facial and neck skin defects is increasing. The value of this fasciocutaneous flap as a reconstructive modality for oropharyngeal defects in cancer patients is unclear. In the present study, a SCIF was used for reconstruction of mucosal defects following resection of the tumour in a group of four patients with T2 squamous cell carcinoma of the oropharynx and a clinical N0 neck.

Rare skin malignancies of the head and neck: a review.

The skin of the head and neck is a common location for skin cancers to develop. The majority of skin cancers of the head and neck are basal cell and squamous cell carcinomas, with melanoma also occurring at a significant incidence. However, there are many other histologies that occur and raise diagnostic and treatment challenges.

Microvascular free flap reconstruction of orbitocraniofacial defects.

Purpose: To examine the etiology, surgical extent and techniques, complications, and outcomes of microvascular free flaps (MFF) in the reconstruction of orbitocraniofacial defects.

Design: A retrospective, institutional review board approved study was performed of all patients undergoing MFF to repair orbitocraniofacial defects over 51 months.

Participants: Fifty-eight patients undergoing MFF to repair orbitocraniofacial defects were included.

Nonmelanoma skin cancer of the head and neck: current diagnosis and treatment.

An overview of where nonmelanoma cancers appear in the hierarchy of cancers is succinctly presented, as well as their incidence, etiology, and costs. The examination and treatment of these cancers are summarized.

Microvascular reconstruction of the mouth, jaws, and face: experience of an Australian oral and maxillofacial surgery unit.

Purpose: Microvascular reconstruction of oncologic surgical and traumatic defects has been globally practiced by plastic and orthopedic surgical disciplines since the early 1970s. During the past 20 years, reconstructive techniques have been progressively incorporated into the purview of oral and maxillofacial and otolaryngology-head and neck surgeons, particularly those practicing in Europe, the United Kingdom, and China. There has also been a steady increase in the adoption of these techniques in North America, South America, and Japan.

[Repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer].

Objective: To study the repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer, and to select the donor site of appropriate flap.

Methods: Between October 2000 and February 2010, 13 patients with advanced-stage tonsillar cancer were treated, including 5 cases of high differentiation squamous cell carcinomas and 8 cases of medium differentiation squamous cell carcinomas. There were 11 males and 2 females, with an average age of 53.

Mylohyoid advancement flap for closure of composite oral cavity defects.

Objectives/hypothesis: To describe a new surgical procedure in the reconstruction of composite oral cavity resections.

Study Design: Retrospective chart review for all patients who received mylohyoid pull through muscle flap for reconstruction of oral composite resection with marginal mandibulectomy by the senior author between 1999 and 2008.

Methods: Data gathered from the chart review included demographics, pathologic diagnosis, tumor margins, use of reconstruction plate, exposure to radiotherapy, need for gastrostomy tube, flap viability, and flap complications.

Initial Mohs surgery followed by planned surgical resection of massive cutaneous carcinomas of the head and neck.

Objective: To review our experience with Mohs excision of massive cutaneous carcinomas for peripheral margin control, followed by planned definitive resection of the deeply invasive component of the carcinoma.

Study Design: Retrospective review.

Methods: All cases of massive (at least 10 cm in dimension) cutaneous carcinomas treated by the technique outlined by Yadranko Ducic from 1998-2006.

MOC-PSSM CME article: Nonmelanoma facial skin malignancy.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify the environmental and genetic risk factors in developing nonmelanoma facial skin malignancy. 2.

Current concepts in cheek reconstruction.

For cutaneous cheek defects, the reconstructive surgeon should strive to optimize tissue match and scar camouflage while minimizing the distortion to neighboring facial landmarks. The surgeon must have an intimate understanding of the local anatomy and must be able to use the appropriate flap for the given characteristics of each defect and patient. Knowledge of several types of flaps and versatility in modifying these flaps from their "textbook" geometry are required.

The role of free tissue transfer in the reconstruction of massive neglected skin cancers of the head and neck.

Background: Most skin cancers involving the head and neck region are easily managed with surgical resection and local flap rotation. Occasional patients present with massive neglected skin cancers or skin cancers that have recurred after multiple treatments. Management of these massive tumors may involve craniofacial resection, maxillectomy, or mandibulectomy to obtain clear margins.

Osseous free tissue transfer in head and neck reconstruction.

Large palatomaxillary and oromandibular defects have a dramatic impact on speech, deglutition, mastication, and cosmesis. Traditional methods of reconstruction, such as locoregional flaps, free bone grafts, alloplastic materials, and prosthetic devices, have difficulty providing meaningful aesthetic and functional reconstruction of these defects. This article discusses current concepts in the reconstruction of large composite palatomaxillary and oromandibular defects with an emphasis on the role of free tissue transfer, including the factors to be evaluated when choosing a method of reconstruction, indications for specific donor sites, and recent technical refinements.

Mohs micrographic surgery for facial skin cancer.

Although it is well established that conventional treatment modalities generally result in high cure rates for non-melanoma skin cancer, it has been demonstrated over recent decades that the highest overall cure rates are achieved using Mohs micrographic surgery. The key to Mohs surgery is the excision and control of complete peripheral and deep resection margins in one plane, allowing orientation, mapping and re-excision of microscopic tumour extension. These extensions can be followed without sacrificing inappropriate amounts of normal tissue, yielding high cure rates and maximum preservation of tissue.

The optimum method for reconstruction of complex lateral oromandibular-cutaneous defects.

Background: Ablation of large intraoral cancers can create extensive through-and-through defects of the lateral face, resulting in loss of external facial skin, the lateral and anterior mandible, and the lateral mouth. Repair requires reconstruction of the lips, mandible, and full-thickness cheek defects. Ideal reconstruction with vascularized composite free flaps requires adequate bone and sufficiently large, yet versatile, skin flaps capable of resurfacing extensive intraoral and external defects.