Faculty Bibliography

The trapezius osteomyocutaneous island flap has evolved in postablative head and neck reconstruction as a versatile and hardy local flap which can provide intraoral lining, well-vascularized bone, and muscle bulk for the reconstruction of a complex defect. This investigative study examines the anatomy of 20 osteomyocutaneous flaps in 10 fresh cadavers and in 8 clinical patients. In our series, 80 percent (type I) of the major vascular pedicle arose from the thyrocervical trunk. In 20 percent (type II), the major pedicle arose separately from the subclavian artery. The regions perfused by the vascular trunk were further examined with microopaque and Prussian blue injections through the transverse cervical artery. Consistent areas of cutaneous staining as well as bony staining were noted over the shoulder, arm, and back and into the scapula itself. Experience with eight clinical applications of this osteomyocutaneous flap resulted in successful healing with an excellent aesthetic and functional result. Long-term follow-up was maintained on the patients for up to 36 months. Panorex radiographs and biopsies of the grafted bone were obtained on several patients. These disclosed evidence of bony remodeling and viable bone tissue. Tetracycline labeling also revealed evidence of active bony turnover

Donor-site morbidity in 300 consecutive free flaps was reviewed to identify their etiologies and potentially prevent their recurrence in future cases. An overall morbidity rate of 20 percent was seen in this series. Secondary surgical procedures specific for donor-site problems were required in 7.7 percent of patients. Major complications occurred in 2.3 percent of the donor sites. From this review it is apparent that major donor-site morbidity is uncommon and most donor-site problems could probably have been avoided. Our recommendations are as follows: closure of the donor site to avoid excessive tension must be carefully planned preoperatively, donor-site anatomy and flap elevation techniques must be precisely understood, surgical retractors must be carefully placed to avoid injury to nearby structures, the donor site should be closed immediately following pedicle division, thus minimizing wound exposures, and complete surgical hemostasis is mandatory

Numerous methods exist for monitoring the patency of cutaneous free flaps. Monitoring the patency of microvascular anastomosis in buried free flaps are limited. The present case report is of a 39-year-old female with Rhomberg's disease who underwent an abdominus rectus muscle free flap to correct the contour deformity of the right face. Dynamic CT scan was performed on the sixth postoperative day. Plots of the rate of change of density of the free flap were compared to an adjacent muscle of the face. Dynamic CT scanning provides a high degree of resolution of the free flap, the ability to examine the entire free flap, and the ability to determine the patency of buried free flap

In the 2 cases reported the rectus abdominis muscle was used as a sling to construct the pelvic floor. In patient 1, a large squamous cell carcinoma of the perineum was treated with an abdominal perineal resection. Reconstruction was accomplished internally using a rectus abdominis muscle sling and externally with a gluteus maximus musculocutaneous flap. In the second case, the rectus abdominis muscle was used as a supportive sling to reinforce a perineal hernial repair and prevent recurrence.