Novel V-shaped kiss flap harvest technique for the forearm free flap in soft tissue reconstruction.

INTRODUCTION: Radial forearm flap (RFF) is widely used in oral reconstruction. However, the donor-site defect remains the main limit. In this paper, V-shaped kiss RFF (VRFF) is described as a novel technique to improve aesthetics and function of it. A retrospective study was conducted to introduce VRFF and evaluate its effect and safety. METHODS: A total of 21 patients who underwent VRFF for oral reconstruction, and 23 patients who underwent conventional RFF from February 2016 to April 2018 were included in this study. Direct comparisons were made on patient's subjective evaluation of postoperative hand function and degree of scarring and objective donor-site function assessment including range of wrist movements and grip strength before and after surgery between the two groups. RESULTS: No skin grafts were used in the VRFF group, and 20 of 21 patients achieved primary healing at donor site, while all patients from the RFF group had skin grafts. And 18 of 23 patients achieved primary healing. The postoperative scar score of donor site in the VRFF group was significantly higher than that in the RFF group (3.4 vs 2.8, P = 0.035). There were no significant differences in other subjective evaluation and donor-site morbidity and hand function assessment. CONCLUSION: VRFF is able to provide a new and simple method to close donor-site defect and realize a better healing in donor site.

Clinical Outcomes After Primary Implantation into Modified One-and-a-Half-Barrel Fibula Free Flap Reconstructed Mandible.

PURPOSE: The aim of this study was to introduce and evaluate a modified one-and-a-half-barrel fibular technique guided by occlusion for functionally reconstructing mandibular defects. MATERIALS AND METHODS: Fifteen patients underwent mandibular reconstruction with the modified one-and-a-half-barrel technique and simultaneous insertion of dental implants. A vascularized fibular segment was used to reconstruct the alveolar ridge of the neomandible with dental implants loaded simultaneously. The inferior border was reconstructed with a nonvascularized segment. Panoramic radiographs were taken 1 week, 6 months, and 12 months after the surgery to measure the vertical height of the fibular segment, calculate the bone resorption rate at different time points, and observe the implant marginal bone loss and crown-to-implant ratio. The OHIP-14 questionnaire was employed to evaluate the perceived outcomes of oral rehabilitation. RESULTS: The vertical height of the vascularized and nonvascularized fibular segments 1 week, 6 months, and 12 months after the surgery was 14.51 ± 1.93, 14.19 ± 1.88, and 13.81 ± 1.78 mm; and 8.65 ± 0.98, 7.72 ± 0.94, and 7.25 ± 0.93 mm, respectively. The bone resorption rate of vascularized and nonvascularized fibular segments was 2.20% ± 1.04% and 10.69% ± 5.73%, respectively, in the first 6 months, and 2.67% ± 1.44% and 6.16% ± 2.75%, respectively, in the latter 6 months, showing a significantly higher resorption rate in the nonvascularized segment (P < .05). The implant marginal bone loss after functional loading was significantly greater than that before dental rehabilitation (P = .001). The OHIP-14 total scores were 20.07 ± 10.24, 19.00 ± 7.82, and 3.93 ± 1.87 before surgery, at 6 months, and at 12 months after surgery, respectively (P = .000). CONCLUSION: The proposed technique not only guarantees the esthetic appearance of patients but also achieves a suitable vertical height to facilitate the placement of the implant at the same time.

The effect of external jugular vein's preservation on the prognosis of sternocleidomastoid myocutaneous flap.

OBJECTIVE: As a supplementary and significant pedicle flap,the sternocleidomastoid (SCM) myocutaneous flap has been be flexiblely used in the reconstruction of oral soft tissue defect. The problem of venous stagnation after its transposition limited its clinical application.To improve its application, we raised a modified SCM flap for oral softtissue defect reconstruction. METHOD: We carried out a continuous retrospective study of 43 patients who had tissue defects because of oral carcinomas resection and underwent reconstruction with modified SCM flap from April 2014 to January 2017. RESULTS: 3 of 43 cases had partial flap necrosis and there were primary healing in the rest 40 cases. During the follow-up,4 patients were lost, 2 patients recurred in situ and 2 patients had neck recurrence. The remaining patients were satisfied with their appearance, and had normal oral function. CONCLUSION: Modified SCM flap is simple to harvest. It can improve the venous return and has a high survival rate. It has active effect in the recovery of the function of oral and maxillofacial region and elevates quality of life of patients.

Digital navigation and 3D model technology in mandibular reconstruction with fibular free flap: A comparative study.

OBJECTIVE: The low accuracy limits the use of fibular free flap (FFF). We apply digital navigation and 3D printing model technology in mandibular reconstruction to improve FFF's accuracy. METHODS: 34 patients who underwent with FFF to repair mandibular defects were divided into Navigation Group (13 cases, using digital navigation and 3D printing model) and Control Group (21 cases, only 3D printing model). We retrospectively reviewed patients' hospitalization information and evaluated patients by subjective and objective items, such as UW-Qol scale, CT data. RESULTS: The operation time of Navigation Group was higher significantly than Control Group (10.36 ± 1.87vs9.00 ± 1.34 h).There were no significant differences in early postoperative complications. The Qol score of appearance, motion, anxiety were higher significantly in Navigation Group. The CT results showed that mandibular angle deviation and chin deflection of Navigation Group were better significantly than Control Group (1.72 ± 1.29° vs 3.69 ± 1.67°, 2.45 ± 1.39 vs 5.19 ± 2.13 mm). CONCLUSIONS: The digital navigation can improve FFF's accuracy in mandibular reconstruction. It doesn't significantly increase complications. The digital navigation's installation and operation methods should be simplified to shorter operation time and expand its application.

Assessment of fibula flap with flexor hallucis longus's effect on head & neck tumor patients' quality of life and function of donor site.

OBJECTIVE: Free fibular flaps (FFFs) have been widely used in mandibular reconstruction. It is still unclear whether retaining flexor hallucis longus (FHL) is needed for flaps. This study introduces a comparison in quality of life and donor-site function between those who have and haven't harvested FHL with FFF. METHODS: Patients with FFFs were single-blind-randomly assigned into the FHL group or nFHL group. Patients were followed up preoperatively and 1, 3 and 6 months postoperatively via subjective evaluations (SF-36/AOFAS) and objective evaluation s(muscle strength and range of motion). Patients' hospitalization and intraoperative information, donor site morbidity were recorded. RESULTS: Each group had 15 patients. The flap harvesting time in FHL group was shorter significantly than nFHL group (125.9 ± 24.8 min vs 146.7 ± 29.9 min, P = 0.048). There were no significant differences in hospitalization information such as operation time, hospitalization days and cost. Donor site morbidities at 1, 3 and 6 months postoperatively showed no significant differences except for the presence of claw toes (nFHL group > FHL group, 40% vs 0, P = 0.017; 53.3% vs 6.7%, P = 0.014; 60.0% vs 13.3%, P = 0.021). There were no significant differences in SF-36 and AOFAS scores. There were no significant differences in muscle strength and range of motion. CONCLUSION: Excision of the FHL lowered the flap harvesting time. It did not increase donor site morbidity. The impacts on patients' quality of life and foot function were the same. The surgeons can use the FHL without considering the influence on patients if not retaining the FHL.

Competing endogenous RNA analysis reveals the regulatory potency of circRNA_036186 in HNSCC.

This study aimed to characterize circular RNA (circRNA) expression profiles and biological functions in head and neck squamous cell carcinoma (HNSCC). Differentially expressed circRNAs were screened using an Arraystar Human CircRNA Array and verified by reverse transcription-quantitative polymerase chain reaction. Multiple bioinformatics methods and a hypergeometric test were employed to predict the interactions between RNAs and the functional circRNA­microRNA (miRNA)-mRNA axes in HNSCC. As a result, 287 circRNAs and 1,053 mRNAs were determined to be differentially expressed in HNSCC compared with the adjacent tissue. In addition, the expression levels of circRNA_036186 and tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein, ζ polypeptide (14­3­3ζ) were identified to be significantly different. A competing endogenous RNA (ceRNA) network was constructed, consisting of 5 circRNAs, 385 miRNAs and 96 mRNAs. Furthermore, we predicted that miR­193b­3p exerts a significant effect on 14­3­3ζ, and was significantly associated with the Hippo signaling pathway in HNSCC. On the whole, these findings suggest that circRNA_036186 likely regulates 14­3­3ζ expression by functioning as a ceRNA in the development and progression of HNSCC.

The application of fibular free flap with flexor hallucis longus in maxilla or mandible extensive defect: a comparison study with conventional flap.

BACKGROUND: The repair and reconstruction of maxillary and mandibular extensive defects have put huge challenges to surgeons. The fibular free flap (FFF) is one of the standard treatment choices for reconstruction. The conventional FFF has deficiencies, such as forming poor oral mucosa, limited flap tissue, and perforator vessel variation. To improve the use of FFF, we add the flexor hallucis longus (FHL) in the flap (FHL-FFF). In this paper, we described the advantage and indication of FHL-FFF and conducted a retrospective study to compare FHL-FFF and FFF without FHL. METHODS: Fifty-four patients who underwent FFF were enrolled and divided into two groups: nFHL group (using FFF without FHL, 38 patients) and FHL group (using FHL-FFF, 16 patients). The perioperative clinical data of patients was collected and analyzed. RESULTS: The flaps all survived in two groups. We mainly used FHL to fill dead space, and the donor-site morbidity was slight. In FHL group, flap harvesting time was shorter (118.63 ± 11.76 vs 125.74 ± 11.33 min, P = 0.042), the size of flap's skin paddle was smaller (16.5 (0-96) vs 21.0(10-104) cm2, P = 0.027) than nFHL group. There were no significant differences (P > 0.05) in hospital days, hospitalization expense, rate of perioperative complications, etc. between the two groups. Compared with FFF without FHL, FHL-FFF will neither affect the use of flap nor bring more problems. CONCLUSION: The FHL-FFF simplifies the flap harvesting operation. The FHL can form good mucosa and make FFF rely less on skin paddle. It can be used for adding flap tissue and dealing with perforator vessel variation in reconstruction of maxillary and mandibular extensive defects.