Nsw speech path talk flapvs grafts
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Nsw speech path talk flapvs grafts

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Nsw speech path talk flapvs grafts Nsw speech path talk flapvs grafts Presentation Transcript

  • Flaps and Grafts
  • “….the application ofanatomical knowledge to restore form and function…”
  • Graft VS FlapWhat is the difference? View slide
  • What is a Flap?• 16th century Dutch word “flappe” – ….something that hangs broad and loose , fastened only by one side..” View slide
  • What is a Flap?• A flap is a unit of tissue that may be transferred from a donor to a recipient site while maintaining its blood supply. – Flaps can be characterized by their component parts • cutaneous, musculocutaneous, osseocutaneous – Their relationship to the defect • local, regional, or distant – Nature of the blood supply • random versus axial – The movement placed on the flap • advancement, pivot, transposition, free, pedicled
  • • Rung 1: Healing by secondary intention• Rung 2: Primary closure• Rung 3: Delayed primary closure• Rung 4: Split thickness graft• Rung 5: FTSG• Rung 6: tissue expansion• Rung 7: Random flap• Rung 8: Axial flap• Rung 9: Free Flap

  • Reconstructive Elevator• Get off at the right level
  • Composition of a flap• Skin – Muscle – Bone – Omentum – Composite
  • Composition of a flap – Skin• Muscle – Bone – Omentum – Composite
  • Composition of a flap – Skin – Muscle• Bone – Omentum – Composite
  • Composition of a flap – Skin – Muscle – Bone• Omentum – Composite
  • Composition of a flap – Skin – Muscle – Bone• Omentum / viscera – Composite
  • Composition of a flap – Skin +/- fascia – Muscle (+/- innervation) – Bone – Omentum / viscera• Composite
  • Which flap when?
  • Goals of reconstruction• Separating the physiological cavities – Eg brain, orbit, mouth, neck• Protecting the neck vessels• Obtaining a healed wound• Restore function• Restore swallowing• No leaks• Aesthetics
  • • Flaps reduce complications by: – Obliterating dead space – Recruiting healthy well-vascularized tissue into the region, which has commonly been irradiated and contaminated – Tension free closure – Interposing flap skin between irradiated wound edges
  • Pharyngeal defects• Partial defects – Pectoralis major flap with muscle and skin – Radial forearm free flap• Circumferential defects – Tubed radial forearm flap or ALT flap – Jejunum
  • Goals of reconstruction:• A single stage, reliable reconstruction• Prompt discharge from hospital• Return of swallowing and speech function• No salivary fistulas
  • Literature Review• Nelligan (J PlastReconstrAesthet Surg. 2008) reported a fistula rate of: – 13% for all fasciocutaneous flaps • ALT flap 16.4% • radial forearm free flap 14.4%. – Jejunum 9.4%• Charing Cross Study (Moradi et al) – fistula rate: 2/43 (4.7%) – stricture rate: 6/43 (14%)
  • Murray D, Novak C, Neligan P. Fasciocutaneous free flaps in pharyngolarngo- oesophageal reconstruction: A critical review of literature. J PlastReconstrAesthet Surg. 2008
  • Voice Restoration (Charing Cross series)• 22 of 42 received a primary (TEP)• 14 of 42 received a secondary TEP• 36/42 (85%) received either a primary or secondary TEP• Voice was reported as: – Good in 17 of 39 – Fair in 11 of 39. – 28 of 39 (72%) used their tracheoesophageal puncture as their primary mode of communication
  • When to eat?• No scientific evidence on the timing of oral intake• Err on the side of caution if previous radiotherapy• Day 10
  • Mandible reconstruction• Osteoradionecrosis (ORN) is a condition of non-vital bone in a site of radiation injury• Characterised by: – hypovascularity – hypocellularity – hypoxia• ORN occurs when, in the process of otherwise normal turnover of bone, the degradative function exceeds new bone production• Can be either spontaneous or the result of an insult
  • Facial reanimation• Goal of treatment – Rest symmetry – Facial function – Voluntary function – Spontaneous movement – Absence of synkinesis
  • Facial reanimation• Static vs dynamic• Static: Divide face into 1/3rds – Upper: – Middle: – Lower:
  • Dynamic: free gracilis
  • Static: slings
  • Tongue reconstruction• Depending on extent of defect and the status of the floor of mouth• Generally use: – Radial forearm free flap – Ulnar forearm free flap – ALT
  • Radial forearm free flap
  • Ulnar forearm free flap
  • Ulnar forearm free flap
  • Ulnar forearm free flap