The thin profunda femoral artery perforator flap for tongue reconstruction.

BACKGROUND: With the ongoing global epidemic of obesity in the Western countries, thigh flaps such as the profunda artery perforator (PAP) free flap, have been less favorable for glossectomy reconstruction due to large bulk of adipose tissue associated with traditional subfascial harvest. In this article, we present a series of 10 patients who underwent reconstruction with suprafascial PAP free flaps following oncologic tongue resection. METHODS: Our series included six men and four women with an average age of 53.9 years old (range, 28-71 years). All patients underwent preoperative computed tomographic angiography (CTA) for selection of the most suitable perforator and preoperative design of its customized thickness. Flap elevation was performed at the superficial fascia layer while modifying the plane of dissection according to the specific bulk needs in each case. RESULTS: Flaps survived in nine patients; one flap failed due to vasospasm. Mean pedicle length was 7.4 cm (range, 6-8 cm). Skin paddle dimensions varied between 8 × 6 and 15 × 9 cm. Flaps thicknesses ranged from 0.4 to 3 cm. Functional outcome was evaluated at 6 months follow up: good speech and deglutition functional outcomes relative to extent of resection were observed. CONCLUSIONS: The dissection above the superficial fascia layer represents an important refinement to the traditional fasciocutaneous PAP flap. Flap thickness can be tailored to avoid excess of bulk in the medial thigh observed in larger BMI populations.

Incidence of retrobulbar hemorrhage in the emergency department.

Retrobulbar hemorrhage is a rare but potentially devastating complication of midface trauma. Management of this entity requires prompt diagnosis and medical and surgical interventions. The incidence of retrobulbar hemorrhage has been cited to be lower than 1%; however, despite a low rate of occurrence, lack of immediate care can lead to major morbidity for the patient. This report presents a retrospective evaluation of the incidence and management of post-traumatic retrobulbar bleed in the emergency department by an oral and maxillofacial surgery service at a tertiary care trauma center.