Reconstrucción microquirúrgica de lengua / Microsurgical tongue reconstruction

Malignant tumors of tongue are a common pathology with high morbidity and mortality. Treatment requires surgical oncology and systemic management, with the respective reconstruction in order to achieve an adequate quality of life, due to the primary function of the tongue during feeding, communication, social and labor interaction. That is why the choice of donor tissue for reconstruction depends heavily on its characteris-tics and the type of defect, essential to obtain favorable results in the patients. A review of the classification of resulting defects after tongue's tumors resection is performed, and management algorithm and microvascular free flaps more frequently used in this type of reconstruction.

Los tumores malignos de lengua son una patología frecuente con alto grado de morbilidad y mortalidad. Su tratamiento requiere manejo quirúrgico y sistémico oncológico, con la respectiva reconstrucción, para lograr así una adecuada calidad de vida, debido a la función primordial de la lengua durante la alimentación, la comunicación, la interacción social y laboral. Es por esto que la elección de los tejidos donantes para ello depende en gran medida de sus características y del tipo de defecto, aspecto fundamental para obtener resultados favorables en los pacientes. Se realiza una revisión de la clasificación de los defectos resultantes después de la resección de tumores de lengua, un algoritmo de manejo y los colgajos libres microvasculares más utilizados en este tipo de reconstrucción.

Ring Avulsion Injury Treated by Interpositioning Vessel Graft with a Proper Palmar Digital Artery: A Case Report

Because of extensive vascular injury, reconstruction of ring avulsion injury is classically believed to be challenging for a hand surgeon. We report a case of ring avulsion injury treated by debridement of the damaged artery and interpositioning vessel graft with a healthy proper palmar digital artery, which lead to successful functional recovery.

Advances in the practice of microsurgery: focusing on free anterolateral thigh perforator flap.

The purpose of this paper was to discuss an overview of the current clinical practice of microsurgery with a specific use of free anterolateral flap as one of the commonest flaps used in reconstructive surgery. A systematic review was performed through all English publication that goes to Pubmed during the period of 1997 to 2006 using keywords: “anterolateral thigh perforator flap.” The studies involved were retrospective case reviews on using microsurgical technique and involves free anterolateral thigh flap only without muscle involvement. Evaluation was done to search the indications, contraindications, area or organ to reconstruct, the cause of defects need reconstructive surgery, morbidities, functional and aesthetic results, techniques in regard of suture material, and instruments. Using 7th edition EndNote program, 230 abstracts were successfully retrieved in term of “anterolateral thigh perforator flap” of ANY FIELD and Boolean logic OR. Fifty six abstracts from many journals matched the criteria. Due to our limitation to get all of those articles, finally, 8 articles from Plastic and Reconstructive Surgery became the resources of this paper. The overall success rate in terms of flap viability is 98% (525 from 535 flaps) with partial necrosis is as low as 2.2% (12 from 535 flaps). Thinning procedure is commonly applied with regards of the thin flap needed. The recipient sites from 8 articles varies and can be any part of the body includes facial, neck, pharyngoesophagus, breast, upper and lower extremity. Four out of 8 papers mentioned functional evaluation and all stated satisfactory to excellent outcome. There are also 4 papers mentioning the aesthetic evaluation. Overall evaluation was mentioned as good to excellent. It is concluded that free anterolateral thigh perforator flap is a well established choice in most soft tissue reconstruction. It can be indicated to any area needed reconstruction especially head and neck, extremity, and go beyond conventional for breast reconstruction. It has also superior result in pharyngoesophageal reconstruction.